Gilchrist Gail, Swan Davina, Shaw April, Keding Ada, Towers Sarah, Craine Noel, Munro Alison, Hughes Elizabeth, Parrott Steve, Strang John, Taylor Avril, Watson Judith
Institute of Psychiatry, Psychology and Neuroscience, King's College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, England, UK.
School of Media, Culture & Society, University of the West of Scotland, Paisley Campus, High Street, Paisley, PA1 2BE, Scotland, UK.
Harm Reduct J. 2017 Mar 21;14(1):14. doi: 10.1186/s12954-017-0142-5.
While opiate substitution therapy and injecting equipment provision (IEP) have reduced blood-borne viruses (BBV) among people who inject drugs (PWID), some PWID continue to share injecting equipment and acquire BBV. Psychosocial interventions that address risk behaviours could reduce BBV transmission among PWID.
A pragmatic, two-armed randomised controlled, open feasibility study of PWID attending drug treatment or IEP in four UK regions. Ninety-nine PWID were randomly allocated to receive a three-session manualised psychosocial group intervention and BBV transmission information booklet plus treatment as usual (TAU) (n = 52) or information booklet plus TAU (n = 47). The intervention was developed from evidence-based literature, qualitative interviews with PWID, key stakeholder consultations, and expert opinion. Recruitment rates, retention in treatment, follow-up completion rates and health economic data completion measured feasibility.
Fifty-six percent (99/176) of eligible PWID were recruited. More participants attended at least one intervention session in London (10/16; 63%) and North Wales (7/13; 54%) than in Glasgow (3/12; 25%) and York (0/11). Participants who attended no sessions (n = 32) compared to those attending at least one (n = 20) session were more likely to be homeless (56 vs 25%, p = 0.044), injected drugs for a greater number of days (median 25 vs 6.5, p = 0.019) and used a greater number of needles from an IEP in the last month (median 31 vs 20, p = 0.056). No adverse events were reported. 45.5% (45/99) were followed up 1 month post-intervention. Feedback forms confirmed that the intervention was acceptable to both intervention facilitators and participants who attended it. Follow-up attendance was associated with fewer days of injecting in the last month (median 14 vs 27, p = 0.030) and fewer injections of cocaine (13 vs 30%, p = 0.063). Analysis of the questionnaires identified several service use questionnaire categories that could be excluded from the assessment battery in a full-randomised controlled trial.
Findings should be interpreted with caution due to small sample sizes. A future definitive RCT of the psychosocial intervention is not feasible. The complex needs of some PWID may have limited their engagement in the intervention. More flexible delivery methods may have greater reach.
ISRCTN66453696.
虽然阿片类药物替代疗法和提供注射设备（IEP）已降低了注射吸毒者（PWID）中的血源性病毒（BBV）感染率，但仍有一些PWID继续共用注射设备并感染BBV。针对危险行为的社会心理干预措施可减少PWID中的BBV传播。
在英国四个地区对接受药物治疗或IEP的PWID进行一项务实的双臂随机对照开放性可行性研究。99名PWID被随机分配接受为期三阶段的标准化社会心理小组干预和BBV传播信息手册加常规治疗（TAU）（n = 52），或信息手册加TAU（n = 47）。该干预措施基于循证文献、对PWID的定性访谈、关键利益相关者咨询以及专家意见制定。通过招募率、治疗留存率、随访完成率和卫生经济数据完成情况来衡量可行性。
招募了符合条件的PWID的56%（99/176）。在伦敦（10/16；63%）和北威尔士（7/13；54%）参加至少一次干预阶段的参与者比在格拉斯哥（3/12；25%）和约克（0/11）的更多。与参加至少一次（n = 20）阶段的参与者相比，未参加任何阶段的参与者（n = 32）更有可能无家可归（56%对25%，p = 0.044），注射毒品的天数更多（中位数25天对6.5天，p = 0.019），且在上个月从IEP使用的针头数量更多（中位数31个对20个，p = 0.056）。未报告不良事件。干预后1个月对45.5%（45/99）进行了随访。反馈表证实该干预措施对干预促进者和参加干预的参与者来说都是可以接受的。随访参与与上个月注射天数减少（中位数14天对27天，p = 0.030）和可卡因注射次数减少（13%对30%，p = 0.063）相关。对问卷的分析确定了几个在全面随机对照试验中可从评估组中排除的服务使用问卷类别。
由于样本量小，研究结果应谨慎解读。未来对该社会心理干预进行确定性随机对照试验不可行。一些PWID的复杂需求可能限制了他们参与干预。更灵活的实施方式可能覆盖范围更广。
ISRCTN66453696。
