Brief Intervention to Reduce STDs in ER Drug Users

减少急诊吸毒者性传播疾病的简短干预措施

• 批准号: 6797640
• 负责人: Edward Bernstein Bernstein
• 金额: $ 49.34万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-04-01 至 2009-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6797640
• 关键词: AIDS education /prevention; HIV infections; behavioral /social science research tag; chlamydial disease; clinical research; cocaine; communicable disease control; communicable disease diagnosis; counseling; drug abuse; drug detection; emergency care; gonorrhea; heroin; high risk behavior /lifestyle; hospitals; human subject; human therapy evaluation; interview; longitudinal human study; medically underserved population; motivation; opiate alkaloid; patient oriented research; safe sex /sex abstinence; sex behavior; sexually transmitted diseases; substance abuse related behavior

DESCRIPTION (provided by applicant): Barriers to health care utilization limit drug users' interaction with the primary health care system, resulting in episodic health care received through Emergency Departments (ED) and Urgent Care Centers (UCC). Since 1994, the BMC ED and UCC have provided substance abuse screening as standard of care. This program employs the Brief Negotiated Interview (BNI) to assess readiness to change and offer intervention alternatives and referrals to substance abusing patients. Drug users' high rates of STDs, HIV, and Hepatitis C (HCV) and utilization of EDs and UCCs as usual sources of health care support the introduction of sexual behavior intervention in the ED and UCC setting. The proposed study will apply existing BNI theory and research to a new behavioral context. The proposed project is a collaborative effort to adapt the BNI to encourage safe sex behaviors to prevent gonorrhea, chlamydia, and HIV among male and female ED and UCC patients age 18-44 years who use heroin and/or crack/cocaine and are not in treatment. We will enroll and 1:1 randomize 3,340 patients to intervention (safe sex BNI) or control (standard counseling) over a 2.5-year period, with 6- month and 12-month follow-up. Enrollment will begin Month 9 of Year 1 and Follow-Up will be completed Month 3 of Year 5. The goal of the proposed project is to determine the effectiveness of safe sex BNI counseling to prevent STDs and HIV by comparing cumulative STD incidence and frequency of safe sex behavior between intervention and standard counseling (control) groups over a one year follow-up period. STD and HIV will be diagnosed by specific laboratory assay at baseline, 6-month, and 12-month follow-up. Sexual and drug using behavior will be by participant self-report at baseline, 6-month, and 12-month follow-up, with biochemical testing of hair samples for opiates and cocaine at enrollment and 12-month follow-up. Sexual behavior risk will be measured in terms of proportion of vaginal and anal sex acts protected by condom use and condom use at last sexual act, by sexual partner type. Stage of change will be assessed by the Readiness Ruler. Differences in cumulative incidence between intervention and control groups will be evaluated using Poisson regression with random effects modeling if needed. Differences in safe sex behavior between intervention and control groups will be evaluated using logistic regression. After assessing intervention effect in the base model, we will assess intervention effect controlling for age, gender, race, and baseline readiness to change and sexual and drug using behavior. We will conduct exploratory analyses for the potential interaction and mediating effects between intervention status and abstinence from drug use on incidence of STDs and self-reported behaviors. An effective, brief intervention for safe sex behaviors to reduce STDs and HIV among drug users in ED and UCC settings may provide a sustainable intervention opportunity for drug users who are otherwise difficult to access.

描述（由申请人提供）：医疗保健利用的障碍限制吸毒者与初级卫生保健系统的互动，从而通过急诊部门（ED）和紧急护理中心（UCC）获得了情节医疗保健。自1994年以来，BMC ED和UCC提供了作为护理标准的药物滥用筛查。该计划采用简短谈判的访谈（BNI）来评估愿意改变并提供干预替代方案，并将其转介给滥用患者的物质。药物使用者的性病，艾滋病毒和丙型肝炎（HCV）的高率以及像往常的医疗保健来源的EDS和UCC的利用率支持在ED和UCC环境中引入性行为干预。拟议的研究将将现有的BNI理论和研究应用于新的行为环境。拟议的项目是一项合作的努力，旨在调整BNI，以鼓励安全的性行为，以防止男性和女性ED和UCC患者在使用海洛因和/或裂纹/可卡因且不在治疗中的男性和女性ED和UCC患者中，以预防淋病，衣原体和HIV。我们将在2。5年的时间内将3,340名患者随机入学，并将3,340名患者随机分组（安全性BNI）或对照（标准咨询），并进行6个月和12个月的随访。入学人数将从第1年的第9个月开始，然后进行随访第5个月。拟议项目的目标是确定安全性BNI咨询的有效性，以通过比较一年的随访期，通过比较累积性病的发生率和安全性行为和标准咨询（对照）组之间的安全性行为的频率来防止性病和HIV。在基线，6个月和12个月的随访时，将通过特定的实验室测定法诊断性病和艾滋病毒。使用行为的性和毒品将由参与者的自我报告，基线，6个月和12个月的随访，并在入学率和12个月的随访中对头发样本进行生化测试。性行为风险将以性伴侣类型在最后的性行为中受到避孕套使用和使用避孕套的保护的阴道和肛交的比例来衡量。变革阶段将由准备统治者评估。如果需要，将使用Poisson回归评估干预组和对照组之间的累积发生率差异。干预组和对照组之间的安全性行为的差异将使用逻辑回归评估。在评估基本模型中的干预效果之后，我们将评估控制年龄，性别，种族和基线的干预效果，并使用行为准备改变以及性和毒品。我们将进行探索性分析，以实施干预状况与戒毒对性病发生率和自我报告行为的潜在相互作用和中介作用。在ED和UCC环境中，有效的，简短的干预措施，以减少药物使用者中的性病和HIV，为原本难以获得的吸毒者提供可持续的干预机会。