Community-Based Intervention at Needle Exchange Sites

针交换场所的社区干预

基本信息

批准号：
8215889
负责人：
MICHAEL S KIDORF
金额：
$ 68.09万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
1999
资助国家：
美国
起止时间：
1999-04-01 至 2015-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8215889
关键词：
Adherence Admission activity Area Baltimore Behavior Behavior Therapy Behavioral Caring Clinical assessments Communicable Diseases Communities Counseling Data Dose Drops Drug abuse Early treatment Effectiveness Enrollment Equipment Exposure to Funding HIV Harm Reduction Health Health Personnel Incentives Individual Injecting drug user Injection of therapeutic agent Intervention Left Maintenance Measures Methadone Methods Modeling Motivation National Institute of Drug Abuse Needle Sharing Needle-Exchange Programs Opioid Outcome Outcome Measure Outpatients Participant Patient Self-Report Patients Pharmaceutical Preparations Pharmacotherapy Policy Maker Population Psychiatric therapeutic procedure Psychological reinforcement Randomized Readiness Reporting Resources Risk Behaviors Sampling Schedule Services Severities Shelter facility Site Source Structure Subgroup Syringes Testing Treatment Cost Treatment Effectiveness Treatment outcome United States National Institutes of Health Urinalysis Work alternative treatment base comparison group design disorder risk evidence base high risk high risk behavior improved indexing interest methadone maintenance motivational intervention novel primary outcome programs psychologic psychosocial public health relevance routine care satisfaction substance abuse treatment treatment duration treatment program voucher

项目摘要

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: Treatment-seeking opioid users referred from community syringe exchange programs (SEPs) have more severe drug problems and achieve worse treatment outcomes (i.e., higher rates of drug use and attrition) than individuals referred from other sources. The proposed 5-year competing continuation application evaluates two novel stepped-based induction strategies (compared to usual stepped-care) to improve retention and other outcomes in syringe exchangers entering methadone treatment.

描述（由申请人提供）：基于社区的注射器交换计划（SEP）的参与者参与了超过其他药物使用者中报告的注射药物使用率（Wood等，2007）。我们小组的先前工作表明，结合动机和行为干预措施的组合方法与美沙酮治疗率的提高以及药物使用率降低和其他高风险行为有关（Kidorf＆Brooner，2006年）。与其他来源相比，SEP中的转诊至关重要，美沙酮治疗的结果较差，包括较高的药物使用和损耗率（Kidorf＆Brooner，2006年）。拟议的5年竞争连续申请通过评估基于阶梯式的归纳策略来改善进入美沙酮治疗的注射器交换机的其他结果，扩大了我们以前的工作。阿片类药物依赖性巴尔的摩针交换（BNEP）参与者（n = 520）对美沙酮治疗表示兴趣，将完成临床评估电池，并随机分配给三个3个月的治疗诱导策略之一。第一个是低阈值诱导（LTSC），该阈值是通过临时美沙酮维持（Schwartz等，2006）广泛建模的，旨在逐渐逐渐过渡到SEP参与者到维持治疗的日常结构，同时最大程度地暴露于美沙酮药物治疗。第二个是基于凭证的干预措施，该干预措施使用货币激励措施来增强美沙酮剂量和基于阶梯式咨询的时间表。最终条件（RSC）将使参与者接触常规的阶梯护理。在所有条件下，参与者将在参与的最后三个月内获得常规的阶梯护理。所有参与者将稳定在美沙酮（90 mg）上，并每周持续6个月。将在各种条件下使用结构化的再入院干预措施，以重新引入参与者在吸毒的背景下离开治疗（Brooner＆Kidorf，2002年）。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指标。中介模型将评估治疗准备和满意度变化作为结果的预测因素的影响。这些发现将为这一重要的注射阿片类药物亚组优化美沙酮治疗有效性的基于证据的策略提供信息。公共卫生相关性：从社区注射器交换计划（SEP）中提到的寻求治疗的阿片类药物使用者比其他来源提到的个人更严重的药物问题，并实现更严重的药物问题（即吸毒和流失率更高）。拟议的5年竞争连续申请评估了两种新型基于步进的诱导策略（与通常的阶梯护理相比），以改善进入美沙酮治疗的注射器交换器中的保留率和其他结果。