Community-Based Intervention at Needle Exchange Sites

针交换场所的社区干预

• 批准号: 7616944
• 负责人: MICHAEL S KIDORF
• 金额: $ 32.07万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-04-01 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7616944
• 关键词: Admission activity; Baltimore; Behavior; Behavior Therapy; Behavioral; Blood; Caring; Clinical; Clinical Research; Clinical Services; Clinical assessments; Communicable Diseases; Communities; Condition; Counseling; Daily; Data; Development; Disease; Disease regression; Dose; Drops; Drug abuse; Drug usage; Effectiveness; Enrollment; Equipment; Experimental Designs; Exposure to; Funding; Goals; HIV; Harm Reduction; Health; Health Benefit; Incentives; Individual; Injecting drug user; Injection of therapeutic agent; Intervention; Left; Link; Maintenance; Marshal; Measures; Medical; Methadone; Modeling; Needle Sharing; Needle-Exchange Programs; Numbers; Opiate Addiction; Opioid; Outcome; Outcome Measure; Outpatients; Participant; Pathway interactions; Patient Self-Report; Patients; Pattern; Pharmaceutical Preparations; Pharmacotherapy; Phase; Population; Psychiatric therapeutic procedure; Public Health; Randomized; Rate; Readiness; Reporting; Resources; Risk; Risk Behaviors; Role; Schedule; Services; Severities; Shelter facility; Site; Social Welfare; Source; Standards of Weights and Measures; Statistical Models; Sterility; Structure; Subgroup; Substance abuse problem; Syringes; Testing; Therapeutic; Time; Treatment Effectiveness; Treatment Protocols; Treatment outcome; Urinalysis; Work; abstracting; base; day; design; disorder risk; expectation; follow-up; high risk behavior; improved; interest; novel; psychosocial; response; satisfaction; treatment program; voucher

Project Summary/Abstract Participants in community-based syringe exchange programs (SEPs) engage in rates of injection drug use that exceed those reported in other populations of substance users (Wood et al., 2007). Prior work by our group has shown that a combination approach incorporating motivational and behavioral interventions is associated with increased rates of methadone treatment enrollment and reduced rates of drug use and other high risk behaviors (Kidorf & Brooner, 2006). Neverthleless, referrals from the SEP achieved worse outcomes in methadone treatment compared to those referred from other sources, including higher rates of drug use and attrition (Kidorf & Brooner, 2006). The proposed 5-year competing continuation application extends our previous work by evaluating stepped-based induction strategies to improve retention and other outcomes of syringe exchangers entering methadone treatment. Opioid-dependent Baltimore Needle Exchange (BNEP) participants (n = 520) that express interest in methadone treatment will complete a clinical assessment battery and be randomly assigned to one of three 3-month treatment induction strategies. The first is a low threshold induction (LTSC) that is broadly modeled on interim methadone maintenance (Schwartz et al., 2006) and designed to more gradually transition SEP participants to the daily structure of maintenance treatment while maximizing exposure to methadone pharmacotherapy. The second is a voucher-based intervention that uses monetary incentives to reinforce treatment engagement to schedules of methadone dosing and stepped-based counseling. The final condition (RSC) will expose participants to routine stepped-care. Participants in all conditions will receive routine stepped care during the final 3-months of participation. All participants will be stabilized on methadone (90 mg) and followed weekly for 6-months. A structured readmission intervention will be used across conditions in efforts to re-engage participants leaving treatment in the context of drug use (Brooner & Kidorf, 2002). Retention, drug use (urinalysis and self-report), and other risk behaviors are the primary outcome measures. Mediational models will evaluate the impact of changes in treatment readiness and satisfaction as predictors of outcome. These findings will inform the field on evidenced-based strategies to optimize methadone treatment effectiveness for this important subgroup of injection opioid users.

项目摘要/摘要 参与社区基于社区的注射器交换计划（SEP）的参与者参与注射药物使用率 超过其他物质使用者种群中报告的（Wood等，2007）。我们小组的事先工作 表明结合动机和行为干预措施的组合方法与 美沙酮治疗入学率提高和毒品使用率降低和其他高风险行为 （Kidorf＆Brooner，2006年）。毫无疑问，来自SEP的转介在美沙酮中取得了较差的结果 与其他来源提到的治疗相比，包括毒品使用和损耗率较高（Kidorf） ＆Brooner，2006）。拟议的5年竞争继续申请将我们以前的工作扩展到 评估基于步进的归纳策略，以改善注射器交换机的保留率和其他结果 进入美沙酮治疗。阿片类药物依赖性巴尔的摩针交换（BNEP）参与者（n = 520） 对美沙酮治疗的表达兴趣将完成临床评估电池，并随机进行 分配给三个三个月的治疗诱导策略之一。第一个是低阈值诱导（LTSC） 这是广泛建模的，以临时美沙酮维护（Schwartz等，2006），并设计为更多 逐渐将SEP参与者过渡到维护处理的日常结构，同时最大化暴露 致美沙酮药物疗法。第二个是基于凭证的干预措施，该干预使用货币激励措施 加强对美沙酮剂量时间表和基于阶梯式咨询的时间表的治疗参与。决赛 病情（RSC）将使参与者接触常规的阶梯护理。在所有情况下的参与者都会收到 在参与的最后三个月期间，常规的升级护理。所有参与者将在美沙酮上稳定 （90毫克），每周持续6个月。结构化的再入院干预将在 在毒品使用情况下，重新接触参与者的努力的条件（Brooner＆Kidorf， 2002）。保留，药物使用（尿液分析和自我报告）以及其他风险行为是主要结果 措施。中介模型将评估治疗准备和满意度变化的影响 预测因素。这些发现将为基于证据的策略提供优化的领域。 美沙酮治疗的效力是注射阿片类药物使用者的重要亚组。