Heroin Cessation and Hiv Risk: A Case-Control Study

海洛因戒断和艾滋病毒风险：病例对照研究

基本信息

批准号：
7285755
负责人：
DAVID VLAHOV
金额：
$ 62.4万
依托单位：
NEW YORK ACADEMY OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-09-20 至 2012-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7285755
关键词：
AIDS prevention Abstinence Acquired Immunodeficiency Syndrome Age Age-Years Awareness Case-Control Studies Censuses Characteristics Child Chronic Cities Cocaine Communities Condition Consent Control Groups Counseling Criminal Justice Cues Data Disadvantaged Drug Metabolic Detoxication Drug abuse Drug usage Epidemiology Ethnic Origin Ethnography Event Factor Analysis Family Frequencies Goals HIV HIV Infections Heroin Heroin Users Human immunodeficiency virus test Imprisonment Incidence Individual Injection of therapeutic agent Intervention Interview Jamaica Libido Life Literature Location Logistic Regressions Long Island Maps Marital Status Medical Methadone Methods Minority Groups Modeling Narcotics Natural History Neighborhoods New York City Opiates Opioid Outcome Overdose Participant Patient Self-Report Pattern Persons Pharmaceutical Preparations Policies Population Purpose Race Recording of previous events Recovery Recruitment Activity Relapse Replacement Therapy Reporting Research Research Personnel Respondent Risk Risk Behaviors Risk Factors Risk Reduction Route Sampling Services Sexual Partners Social support Specific qualifier value Structure System Techniques Testing Therapeutic Time Unsafe Sex Urine Visit Work base case control demographics density experience high risk sexual behavior land use outreach prognostic programs segregation sex success

项目摘要

DESCRIPTION (provided by applicant): The purpose of this case-control study is to characterize the prognostic indicators, including HIV infection, for the positive outcome of sustained heroin cessation among persons with a prior history of chronic heroin use within economically disadvantaged, predominantly racial/ethnic minority neighborhoods in New York City (NYC). With drug use as a major risk factor for HIV and a chronic relapsing condition, identifying factors that promote sustained cessation can be key to enhancing HIV prevention and treatment efforts. Also unknown is what happens with sexual risk after short and long term cessation; an important but understudied consideration. Previous studies that have described patterns of cessation have been limited for several reasons. First, while much work has been done on relapse and cessation, the literature is sparse on long- term effective cessation. Second, most studies have sampled from treatment settings which misses persons who cease use without treatment. Third, previous research has not investigated the possible impact of determinants at multiple levels, including initial circumstances of cessation (e.g., influence of incarceration, family, etc.), potential influences of individual-level factors (e.g., social support, network characteristics) and one's neighborhood context (e.g., availability of drugs, density of AIDS cases). Post treatment relapse is more common in disadvantaged communities where persons return to settings with cues for drug use, however a proportion sustains cessation; characterizing neighborhood factors that contribute to this remains understudied. To identify factors associated with sustained cessation, we will recruit 1800 heroin using individuals utilizing venue- and respondent-driven sampling in 36 NYC neighborhoods. Eligible individuals will be those aged >27 years with a history of heroin use at least five years before interview. Eligible and consenting participants will undergo structured interviews include a year by year recall for the prior 6 years as has been used successfully in earlier studies. For analyses, cases will be defined as former heroin users, i.e., non-use at interview (N=744). Two control groups are specified: (1) heroin users who used continuously through past six years, (N=527) and (2) relapsed heroin users who were abstinent sometime in the past 5 years but who subsequently relapsed to drug use (N=527). Cases (sustained cessation) and controls will be frequency matched on age and age at heroin initiation (¿2 years) during analysis. Determinants of sustained cessation will be assessed using conditional logistic regression and hierarchical modeling. Data from this study can be used to identify modifiable factors that can be subjected to individual, group or policy intervention to promote sustained cessation from opiate use. Additionally, we will consider heroin cessation as an "exposure" by examining the relation between cessation and high-risk sexual behavior.

描述（由申请人提供）：本病例对照研究的目的是描述预后指标（包括 HIV 感染）对于经济弱势群体（主要是种族）中具有长期海洛因吸食史的人群持续戒除海洛因的积极结果。由于吸毒是艾滋病毒和慢性复发性疾病的主要危险因素，因此确定促进戒烟的因素可能是加强艾滋病毒预防和治疗工作的关键。短期和长期戒烟后的性风险；一个重要但尚未充分研究的考虑因素，之前描述戒烟模式的研究由于多种原因而受到限制。其次，大多数研究都是从治疗环境中抽取的，漏掉了未经治疗就停止使用的人。第三，以前的研究没有调查多个层面的决定因素的可能影响，包括最初的戒烟情况（例如，监禁、家庭等的影响）、个人因素（例如社会支持、网络特征）和社区环境（例如药物的可用性、艾滋病病例的密度）的潜在影响在治疗后复发的情况更为常见。弱势社区的人们返回有吸毒线索的环境，但仍有一部分人持续戒毒；为了确定与持续戒毒相关的因素，我们将招募人员。纽约市 36 个社区中的 1800 名海洛因吸食者将接受为期 1 年的结构化访谈，其中年龄 >27 岁且有至少 5 年海洛因吸食史。按照早期研究中成功使用的年份回忆，病例将被定义为前海洛因使用者，即访谈时未使用海洛因（N = 744）。 (1) 过去六年连续吸毒的海洛因吸食者 (N=527) 和 (2) 过去 5 年内曾戒毒但随后又重新吸食海洛因的病例 (N=527)。戒烟）和对照将根据年龄和吸食海洛因时的年龄进行频率匹配（¿分析期间，将使用条件逻辑回归和分层模型来评估持续戒烟的决定因素，可用于确定可以进行个人、团体或政策干预以促进持续戒除阿片类药物的可修改因素。此外，我们将通过检查戒烟与高风险性行为之间的关系，将海洛因戒断视为一种“暴露”。