Efficacy of Drug-HIV counseling among IDU at Methadone clinics in Jakarta

雅加达美沙酮诊所注射吸毒者药物艾滋病毒咨询的效果

• 批准号: 7687184
• 负责人: DAVID S METZGER
• 金额: $ 36.86万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-15 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7687184
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Asia; Asians; Behavior; Behavior Therapy; Behavioral; China; Clinic; Cognitive; Collaborations; Cost-Benefit Analysis; Costs and Benefits; Counseling; Country; Data; Development; Doctor of Philosophy; Drug Addiction; Drug Costs; Drug abuse; Drug usage; Drug user; Economics; Enrollment; Environment; Epidemic; Equipment; Fellowship; HIV; HIV Infections; Heroin; Heroin Users; Hospitals; Individual; Indonesia; Informed Consent; Injecting drug user; Injection of therapeutic agent; Intervention; Laboratories; Malaysia; Manuals; Measures; Methadone; National Institute of Drug Abuse; Opiate Addiction; Opiates; Participant; Patients; Pennsylvania; Pharmaceutical Preparations; Population; Prevalence; Procedures; Randomized; Randomized Controlled Clinical Trials; Recruitment Activity; Relative (related person); Research; Research Personnel; Risk; Risk Assessment; Risk Behaviors; Risk Reduction; Structure; System; Testing; Time; Universities; Upper arm; Urinalysis; Work; cost; cost effective; design; drug efficacy; evidence base; experience; follow-up; group intervention; methadone clinic/center; methadone maintenance; programs; prospective; public health relevance; response; scale up; sex risk; standard care; tool; treatment as usual

DESCRIPTION (provided by applicant): According to UNAIDS, Indonesia is experiencing one of the most rapidly expanding HIV/AIDS epidemics in Asia. The epidemic in Indonesia has been fueled by injection drug use among heroin users and the national response includes the scale-up of methadone maintenance treatment. Drug counseling is considered to be an integral part of methadone treatment, but few studies have been designed to assess its benefits and costs. In settings such as Jakarta, data regarding the costs and benefits of drug counseling have critical public heath relevance. We propose to conduct a prospective randomized trial to evaluate the efficacy of integrated drug and HIV counseling among injecting drug users. This study will be conducted at six methadone clinics in Jakarta, Indonesia where the HIV prevalence among injecting drug users ranges between 50- 86%, with collaborators from the Drug Dependence Hospital in Jakarta, the University of Pennsylvania and Yale University. The specific aims of this four year study are to evaluate the impact of Behavioral Drug and Risk Counseling (BDRC)-a low intensity, cognitive behavioral approach that integrates drug counseling and risk reduction intervention. Those assigned to the BDRC arm will be compared to those who receive treatment as usual which includes an initial risk reduction intervention and counseling as needed. We hypothesize that the structured, low intensity BDRC approach will be more cost effective and result in higher rates of retention in treatment, lower rates of drug use and lower rates of HIV risk. To test these hypotheses, the research team in Jakarta will recruit 300 injecting drug users as they enter treatment at the Drug Dependence Hospital and its five satellite programs. Following informed consent procedures, research staff will randomize participants to either the BDRC intervention or to treatment as usual. All subjects will be fuly assessed at baseline and months 3, 6, 9, and 12. The proposed work will be build on collaborations that have been established with the Indonesian Investigator Adhi Nurhidayat,MD during his NIDA INVEST Fellowship at University of Pennsylvania when he spent time with David Metzger, PhD and George Woody, MD. It will also extend findings from a WHO study on substitution therapy of opiates and HIV/AIDS that was completed by Riza Sarasvita, MS,MHS (former NIDA Humphrey Fellow at Johns Hopkins University) and her colleagues at The Drug Dependence Hospital Jakarta-Indonesia. PUBLIC HEALTH RELEVANCE: The AIDS epidemic in Indonesia has been fueled by injection drug use among heroin users and the National response includes the scale-up of methadone maintenance treatment. Drug counseling is considered to be an integral part of methadone treatment, but few studies have been designed to assess its benefits and costs. In settings such as Jakarta, data regarding the costs and benefits of integrated drug and risk counseling have critical public heath relevance.

描述（由申请人提供）：根据UNAIDS，印度尼西亚正在经历亚洲最快扩大的HIV/AIDS流行病之一。印度尼西亚的流行病是由海洛因使用者的注射药物使用加剧的，国家反应包括对美沙酮维护治疗的扩展。药物咨询被认为是美沙酮治疗中不可或缺的一部分，但是很少有研究以评估其收益和成本。在雅加达等环境中，有关药物咨询的成本和收益的数据具有关键的公共荒地相关性。我们建议进行一项前瞻性随机试验，以评估注射吸毒者中综合药物和艾滋病毒咨询的功效。这项研究将在印度尼西亚雅加达的六家美沙酮诊所进行，在那里，注射吸毒者的艾滋病毒患病率在50％至86％之间，与雅加达毒品依赖医院，宾夕法尼亚大学和耶鲁大学的毒品依赖医院合作者。这项四年研究的具体目的是评估行为药物和风险咨询（BDRC）的影响 - 一种低强度，认知行为方法，将药物咨询和降低风险干预整合在一起。将分配给BDRC部门的人将与像往常一样接受治疗的人进行比较，其中包括根据需要进行初始的降低风险干预和咨询。我们假设结构化的低强度BDRC方法将更具成本效益，并导致较高的治疗率，较低的药物使用率和较低的HIV风险率。为了检验这些假设，雅加达的研究小组将在药物依赖医院及其五个卫星计划中招募300名注射吸毒者。遵循知情同意程序，研究人员将将参与者随机进行BDRC干预或照常治疗。所有受试者将在基线和第3、6、9和12月进行评估。拟议的工作将建立在与印尼调查员Adhi Nurhidayat，MD在NIDA Invest Invest Invest奖学金期间与宾夕法尼亚大学的NIDA Invest Invest奖学金建立的合作。它还将扩展来自WHO的关于阿片类药物替代治疗和艾滋病毒/艾滋病的研究结果，该研究由Riza Sarasvita，MS，MHS（前约翰·霍普金斯大学的前NIDA Humphrey研究员）和她在药物依赖医院雅加达 - 印度人的同事完成。公共卫生相关性：印度尼西亚的艾滋病流行受到海洛因使用者的注射药物使用的推动，国家反应包括对美沙酮维护治疗的扩大。药物咨询被认为是美沙酮治疗中不可或缺的一部分，但是很少有研究以评估其收益和成本。在雅加达等环境中，有关综合药物和风险咨询的成本和收益的数据具有至关重要的公共荒地相关性。