Download HIV Prevention Efforts Targeting Injection Drug Users

HIV and HCV Risk Reduction
Interventions in Drug Detoxification
and Treatment Settings
Study #: NIDA-CTN-0017
Lead Investigator: Robert E. Booth, Ph.D.
Participating CTPs
•
Rocky Mountain:
Denver Health and Hospital Authority
Island Grove Regional Treatment (Greeley)
•
Northern New England:
Stanley Street Treatment and Resources
• Rhode Island
• Fall River
•
Washington:
Recovery Centers of King County
• Seattle Detox Facility
• Kent Detox facility
•
Oregon:
Willamette Family Treatment
(Eugene)
•
Great Lakes:
James Gilmore Jr. Treatment Center
(Kalamazoo)
Key Players
Rocky Mountain:
Suzell Klein, Marilyn Macdonald, Mark Royer, Laetitia Thompson, Catherine Dempsey, Susan MikulichGilbertson, Paula Riggs, Bill Wendt, Heather Ferguson, B.J. Dean, Ed Casper, Mark Write, Susan
Summer, Michelle Deland, Katherine Bryant, Carolina Belloso, Bob Booth
Oregon:
Bret Fuller, Barbara Campbell, Lynn Kunkel, Lucy Zammarelli, Davina Jones, Karen Oliver, Carol Crowe,
Eva Williams, Dennis McCarty
Washington:
Patricia Knox, Anthony Floyd, Don Calsyn, Lindsey Jenkins, Jessica DiCenzo, Tiffany Woelfel, Donna
Hertel, Lisa Chui, Ardi Bury, Gail Mackey, Donald McGhee, Dennis Donovan
Great Lakes:
Mike Liepman, Nancy Wallace, Sara Carvel, Amanda Moore, Pat Burch, Cheryl Parente-Roggow, Pat
Clark, Adam Martin, Jim Brundirks, Sally Reames, Mike Pioch, Janis Greiner, Bob Schuster
Northern New England:
Nancy Paull, Michelle Rapoza, John Bois, Jonathan Paull, Scott Provost, Roger Weiss
NIDA:
Arnaldo, Quinones, Paul Wakim, Mary Ellen Michael, Betty Tai
Special Thanks To:
• Jacques Normand, Ph.D. – Director of AIDS
Research
• Jim Robinson & Connie Klein – NKI
• Larry Brown, M.D. – CTP Laison
Target Population
• Adult (18 years or older) injection drug
users recruited during residential
detoxification treatment
– at risk for infection with HIV and HCV
(operationally defined as engaging in unsafe
needle and/or sex behaviors)
– or if infected, at risk for transmitting HIV
and/or HCV
Eligibility Criteria
•
•
•
•
•
•
•
•
Comprehends and provides informed consent
A reading of 0.000 on breathalyzer test
Self-reports injecting drugs in past 30 days
Shows visible signs of recent injection
Plans to be in the area for the next 6 months
Agrees to urine test at the time of each interview
Eligible for further treatment
Has not previously been in the study
General Objectives
• Primary Aim: To reduce drug-related HIV
and HCV risk behaviors
• Secondary Aims:
– Increase treatment entry
– Increase treatment retention
– Decrease sexual risk behaviors
Primary Outcome Variable
– Frequency of risky injection behaviors (sharing
needles, cotton/cooker/water, solution) in the past
30 days (measured by the Risk Behaviors Survey,
adopted from NIDA’s Risk Behavior Assessment
measure for the Cooperative Agreement and
collected through an Audio Computer Assisted
Self-Inventory or ACASI)
Secondary Outcome Variables
– Treatment Entry
– Treatment Retention
– Treatment Compliance
– Abstinence or 100% Condom Use
Components of the C & E Intervention
Session 1:
1. Brief introduction about what will be covered this session
2. Presentation of 9 cue cards addressing drug & sex risks for
HIV/HCV infection
3. Demonstration and rehearsal of correct condom-use and
needle cleaning techniques (if new needle is unavailable)
4. Information about syringe exchange programs, pharmacies,
and local ordinances related to sale of syringes
5. Consent to draw blood for HIV/HCV testing
6. Blood draw (if consent provided)
7. Second session scheduled within two weeks
Components of the C & E Intervention
Session 2:
1. Brief introduction about what will be covered this session
2. Test results provided (if tested)
3. Presentation of 6 of the original cards addressing drug and
sex risks for HIV/HCV infection and 3 additional cards
depending on HIV/HCV serostatus
4. Demonstration and rehearsal of correct condom-use and
needle cleaning techniques (if new needle is unavailable)
5. Information about syringe exchange programs, pharmacies,
and local ordinances related to sale of syringes
Therapeutic Alliance Intervention
• Therapeutic Alliance
– Delivered at the Detox Facility
– Performed by the outpatient counselor who will see
the client upon discharge from detox
– Enhances the relationship between the counselor and
client by:
• Putting a face on outpatient treatment
• Establishing a treatment appointment prior to discharge
• Teaching the client about therapy (role induction)
Design
• Random assignment to
one of three conditions,
Counseling & Education,
Therapeutic Alliance or,
treatment as usual
TAU
C&E
TA
Evidence Supporting C & E
• Decrease in the Proportion
Sharing Needles/Syringes from
Baseline to Follow-up for Both
Standard and Enhanced
Interventions
Booth et. al (1998):
“Effectiveness of HIV/AIDS
interventions on drug use and
needle risk behaviors for out-oftreatment injection drug users.”
Journal of Psychoactive Drugs,
30, 269-277
Baseline
Follow-Up
35%
30%
25%
29%
28%
20%
15%
10%
5%
0%
11%
12%
N = 3679
Standard
Enhanced
Evidence Supporting C & E,
continued…
• Decrease in the Proportion
Sharing Cotton/Cooker/Water
from Baseline to Follow-up for
Both Standard and Enhanced
Interventions
Booth et. al (1998):
“Effectiveness of HIV/AIDS
interventions on drug use and
needle risk behaviors for out-oftreatment injection drug users.”
Journal of Psychoactive Drugs,
30, 269-277
Baseline
Follow-Up
60%
50%
56%
54%
40%
30%
20%
29%
28%
10%
0%
N = 3679
Standard
Enhanced
Evidence Supporting Role Induction
• Patients receiving alcoholfocused role induction were
significantly more likely to
leave detoxification with a
treatment referral and to make
an initial post detox treatment
contact than patients receiving
alcohol education only
70%
60%
64%
50%
50%
40%
30%
20%
10%
• Craigie and Ross (1980)
Role Induction
Alcohol Education
18%
18%
0%
Tx referral
Tx Contact
Evidence Supporting Role Induction
• Clients in the two RI
groups were
significantly more
likely to return for at
least one treatment
session than the
attention and no
intervention controls.
Stark and Kane
(1985)
Psychotherapy RI
Drug Treatment RI
Attentional Control
No Intervention
100%
92%
80%
60%
40%
72%
61%
51%
20%
0%
Return Rate
Sample Characteristics (N = 646)
Age:
34.50 (SD = 9.52)
Gender:
Males
Females
74.4%
24.8%
White
African American
Native American
Other
Multi-Race
Missing
70%
8%
3%
4%
10%
6%
Hispanic
Non-Hispanic
Missing
9%
86%
5%
Race:
Ethnicity:
Drug Use
Drug Type
Ever Used
Used Past 30 days
Cocaine
95.2%
60.5%
Heroin
90.4%
81.6%
Speedball
72.6%
44.3%
Other opiates
73.5%
39.5%
Amphetamines
64.6%
33.9%
Injected Drug Use Past 30 Days
Drug Type
Injected
Days Injected Times
Injected
Cocaine
45.5%
9.2
59.3
Heroin
79.9%
21.4
106.8
Speedball
38.2%
8.7
40.1
Other Opiates
16.7%
7.3
29.5
Amphetamine
26.5%
8.8
24.3
Non-Injected Drug Use Past 30 Days
Drug Type
Used
Days Used
Times Used
Cocaine
48.8%
9.9
72.1
Heroin
15.9%
9.4
52.8
Speedball
17.0%
6.6
32.2
Other Opiates
31.6%
6.5
27.6
Amphetamine
19.7%
5.8
25.2
Injected-Related Risk Behaviors
Past 30 Days
Used Used Needles/Syringes 38.7% (Mean times 2.6)
Did Not Bleach (N/S)
47.1%
Shared cotton/cooker/rinse
water
47.0% (Mean times 5.0)
Shared Drug Solution
54.8% (Mean times 6.5)
Number of Sex Partners Past 30 Days
Number of Sex
Partners
0
Males (N=479)
Females (N=161
44.5%
21.1%
1
35.7%
39.1%
2 or more
19.8%
39.8%
Average
2.32
3.35
Follow-up Rates as of May 31, 2006
Window
2 Week
2 Month
4 Month
6 Month
HardWindow
71%
63%
60%
64%
SoftWindow
73%
65%
62%
67%
Conclusions
• Overall recruitment quotas were met
• The profile of the participants recruited reflect extremely high HIV
and HCV-related risk behaviors
• The current follow-up rate at 6-months is 64% - 67%
• At present, 10 publications are planned
• The little engine “could”!