INCREASING DRUG USERS' ADHERENCE TO HIV THERAPEUTICS

提高吸毒者对艾滋病毒治疗的依从性

• 批准号: 6078603
• 负责人: ROBERT S BROADHEAD
• 金额: $ 61.15万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-12-25 至 2003-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6078603
• 关键词: AIDS education /prevention; AIDS therapy; HIV infections; behavior therapy; behavioral /social science research tag; clinical research; combination therapy; community health services; drug abuse; drug abuse therapy; dyadic interaction; high risk behavior /lifestyle; human subject; human therapy evaluation; intravenous drug abuse; managed care; outcomes research; patient care management; peer group; protease inhibitor; questionnaires; sex behavior; social support network; substance abuse related behavior; therapy compliance

HIV+ active and recovering drug users suffer from both poor utilization of, and low adherence to, primary care for HIV disease. Services that combine drug treatment and on-site primary care reduce these problems significantly because they create a support structure in which program staffs are able to monitor patients' health status, and give patients cues, reminders and reinforcement for keeping up with their treatments. However, only 10% to 15% of drug users are in drug treatment at any given time, and the vast majority of drug treatment programs do not provide primary care on-site. Thus only a small minority of drug users receive this demonstrably effective form of care. Hence, some alternative support structure is urgently needed for the large majority of HIV+ drug users who need help in obtaining and adhering to primary care services. This need is especially critical now that more effective antiretroviral therapy has become available with the advent of the protease inhibitors and potent combination regimens. Strict adherence to these regimens is essential, both for effectiveness and to prevent the emergence of HIV resistance. Studies of drug users' utilization of therapy - outside of structured settings like methadone treatment programs -- suggest that as a group they are less likely to benefit from these new therapies and more likely than other populations to spread multidrug-resistant HIV to others through unprotected sex and/or the sharing of syringes. This project's aim is to evaluate an innovative approach, termed a Peer-Driven Intervention, that harnesses peer support among drug users to promote admission into primary care, adherence to HIV therapeutics and reduction of HIV-related behaviors. The feasibility of the approach has been demonstrated by a multi-year, MDA-funded HIV-prevention project for injection drug users (RO1 DA08014), directed by the PI of this proposal. The proposed project also grows out of a pilot study that demonstrates the viability of the approach as a means for increasing adherence to medical care among HIV+ drug users. We propose to recruit and randomly assign 300 HIV+ active and recovering drug users to two treatment conditions, a Peer- Driven Intervention and a Usual-Care Intervention, and compare their enrollment and retention in primary care services, adherence to HIV therapeutics, entry and retention in drug treatment, reduction of HIV risk behaviors, and increase in medical knowledge. The study site, New Haven, Connecticut, is especially well suited for this community-based study. It is a geographically compact city with a highly integrated health care system that has been heavily impacted by HIV. The project brings together a strong interdisciplinary team with extensive experience in studies of drug users, AIDS, drug treatment, and innovative health and prevention services.

HIV 阳性吸毒者和正在康复的吸毒者对 HIV 疾病初级保健的利用率和依从性都较低。将药物治疗和现场初级保健相结合的服务可显着减少这些问题，因为它们创建了一个支持结构，使项目工作人员能够监测患者的健康状况，并为患者提供提示、提醒和强化，以跟上治疗的进度。然而，只有 10% 至 15% 的吸毒者在任何特定时间都接受戒毒治疗，而且绝大多数戒毒治疗项目不提供现场初级保健。因此，只有一小部分吸毒者接受这种明显有效的护理形式。因此，对于大多数需要帮助获得和坚持初级保健服务的艾滋病毒阳性吸毒者来说，迫切需要一些替代性的支持结构。随着蛋白酶抑制剂和有效联合治疗方案的出现，已经有了更有效的抗逆转录病毒疗法，这种需求尤其重要。严格遵守这些治疗方案对于提高有效性和防止艾滋病毒耐药性的出现至关重要。对吸毒者使用治疗的研究（在美沙酮治疗计划等结构化环境之外）表明，作为一个群体，他们不太可能从这些新疗法中受益，并且比其他人群更有可能通过未受保护的方式将多重耐药艾滋病毒传播给其他人性行为和/或共用注射器。 该项目的目的是评估一种称为同伴驱动干预的创新方法，该方法利用吸毒者之间的同伴支持来促进进入初级保健、坚持艾滋病毒治疗并减少艾滋病毒相关行为。 该方法的可行性已由 MDA 资助的针对注射吸毒者的多年期 HIV 预防项目 (RO1 DA08014) 得到证明，该项目由本提案的 PI 指导。拟议的项目还源于一项试点研究，该研究证明了该方法作为提高艾滋病毒阳性吸毒者对医疗护理依从性的一种手段的可行性。我们建议招募并随机分配 300 名 HIV+ 活跃和正在康复的吸毒者接受两种治疗条件，即同伴驱动干预和常规护理干预，并比较他们在初级保健服务中的注册和保留、对 HIV 治疗的依从性、进入和保留药物治疗、减少艾滋病毒危险行为以及增加医学知识。 研究地点位于康涅狄格州纽黑文，特​​别适合这项基于社区的研究。这是一个地理紧凑的城市，拥有高度一体化的医疗保健系统，但受到艾滋病毒的严重影响。该项目汇集了一支强大的跨学科团队，在吸毒者、艾滋病、药物治疗以及创新健康和预防服务研究方面拥有丰富的经验。