A randomized clinical trial of a manual-guided risk reduction intervention for HIV-positive injection drug users.

Abstract

This study randomized 90 HIV-seropositive, methadone-maintained injection drug users (IDUs) to an HIV Harm Reduction Program (HHRP+) or to an active control that included harm reduction components recommended by the National AIDS Demonstration Research Project. The treatment phase lasted 6 months, with follow-ups at 6 and 9 months after treatment entry. Patients in both treatments showed reductions in risk behaviors. However, patients assigned to HHRP+ were less likely to use illicit opiates and were more likely to adhere to antiretroviral medications during treatment; at follow-up, they had lower addiction severity scores and were less likely to have engaged in high risk behavior. Findings suggest that enhancing methadone maintenance with an intervention targeting HIV-seropositive IDUs increases both harm reduction and health promotion behaviors.

Translation of a comprehensive health behavior intervention for women living with HIV: the SMART/EST Women's Program

“…Translational research has addressed a variety of medical conditions (e.g., cardiovascular disease, diabetes, and HIV/AIDS) and has been applied to medical, behavioral, and biobehavioral interventions (e.g., the Diabetes Prevention Program) [2]. Translation of behavioral interventions for people living with HIV/AIDS (PLWHAs) that addresses multiple risk behaviors is especially appropriate, as PLWHAs have been identified as being at increased risk of comorbid health conditions, such as cardiovascular and pulmonary diseases, depression, diabetes, and addiction [3,4]. In addition, psychiatric disorders have also been associated with decrements in essential health behaviors for PLWHAs (e.g., antiretroviral medication adherence [5][6][7][8][9] and medical appointment attendance [10,11]) and with poorer overall mental health and quality of life [12,13].…”

Optimizing a Community-Friendly HIV Risk Reduction Intervention for Injection Drug Users in Treatment: A Structural Equation Modeling Approach

“…32 In addition, because of the community-based clinical context in which the present study was conducted, we were obliged to use a brief assessment battery 29 that covered a relatively short time frame 3 and did not capture long-term behavioral patterns. Related to this, we should emphasize that our objective was to optimize the CHRP intervention within community-based treatment programs where significant rates of continued drug-and sex-related HIV risk behavior have been well documented 3,4,26,33 and where intervention integration appears promising 26 ; our findings are not intended to generalize to Bout-of-treatment^IDUs who may tend to possess different characteristics (e.g., pre-contemplation stage of health behavior change 34 ) that may be more effectively addressed using a different intervention approach.…”

“…The intervention from which our study data were obtained was the Community-friendly Health Recovery Program (CHRP), 26 which is an adapted, substantially abbreviated, form of the comprehensive evidence-based Holistic Health Recovery Program (HHRP). 3,4,27 The CHRP intervention consisted of four weekly group meetings led by two bachelor's level facilitators, each of which lasted approximately 50-min. The significant effects associated with the intervention have been reported elsewhere 26 and, thus, were not the focus of this report.…”

“…1,2 Injection drug users (IDUs) remain a target population as they continue to represent a critical vector for the transmission of new HIV infections, 3,4 which occurs primarily through drug-and sexual-related risk behaviors that are highly preventable. As there is currently no vaccine to prevent new HIV infections, behavioral interventions are our primary intervention tools.…”

“…15 Of particular relevance to the present study, findings point to the importance of addressing both drug-and sexual-related HIV risk behaviors and doing so in a balanced manner. Although there is accumulating evidence that more effective risk reduction interventions for IDUs tend to incorporate an equivalent focus on drug-and sexual-related risks, 3,4 research to date has not been designed to specify the role played by particular components that comprise such interventions. Therefore, our objective in the present study was to implement a structural equation modeling (SEM) approach to specify the pathways leading from our intervention components to the risk reduction outcomes that we observed.…”