Baker A, Heather N, Wodak A, Dixon J, Holt P
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
AIDS. 1993 Feb;7(2):247-56. doi: 10.1097/00002030-199302000-00014.
To evaluate the effectiveness of relapse prevention (RP) and brief intervention (BI) in reducing HIV risk-taking behaviours among injecting drug users (IDU) enrolled in methadone programmes. The hypotheses tested were: (1) that a six-session RP programme would be more effective in reducing HIV risk-taking behaviours than a one-session BI and a non-intervention control condition (C); and (2) that BI would be more effective in reducing HIV risk-taking behaviours than C.
Clients of methadone programmes were randomly assigned to either RP, BI, or C. Follow-up occurred 6 months after pre-intervention assessment and was conducted by independent research assistants who were not aware of subjects' group allocations.
Confidential assessment interviews and interventions generally took place at the methadone unit treating the subject.
Ninety-five IDU enrolled in methadone programmes. Study entry criteria were: injection of any drug in the 6 months before the day of pre-intervention assessment; literacy in English; agreement to HIV-antibody testing for research purposes; and no known diagnosis of a serious mental illness. Eighty subjects were contacted successfully for a 6-month follow-up.
The RP intervention was a six-session programme. Each 60-90 min session was conducted individually. The BI was a one-session motivational interview lasting 60-90 min, accompanied by a self-help booklet.
All subjects were administered the Drug Use Scale and HIV Risk-Taking Behaviour Scale of the Opiate Treatment Index and consented to the collection of a capillary blood sample for HIV-antibody testing at pre-intervention assessment and follow-up. At follow-up, the Highest HIV Risk-Taking Behaviour Scale, collateral reports from subjects' sexual partners pertaining to the previous month and urinalysis results for the month before follow-up were collected.
Compliance with interventions was good. Correspondence of self-reports with urinalysis and collateral reports was satisfactory. There were no significant differences between groups in risk-taking behaviours during the month before follow-up. However, there was evidence of a lower rate of needle-risk behaviour (sharing and cleaning) during the heaviest risk-taking month since pre-intervention assessment in the group given RP. There were no indications that BI was of greater benefit than the usual methadone treatment and neither intervention appeared to reduce sexual risk behaviour.
The results are cautiously interpreted as showing that individual RP programmes decrease the level of needle-risk behaviour during relapse episodes, but further research is required to replicate this finding.
评估预防复发（RP）和简短干预（BI）在减少参加美沙酮治疗项目的注射吸毒者（IDU）的艾滋病毒风险行为方面的效果。所检验的假设为：（1）一个为期六节的RP项目在减少艾滋病毒风险行为方面比一节的BI项目和无干预对照条件（C）更有效；（2）BI在减少艾滋病毒风险行为方面比C更有效。
美沙酮治疗项目的客户被随机分配到RP、BI或C组。在干预前评估6个月后进行随访，由不知道受试者分组情况的独立研究助理进行。
保密评估访谈和干预一般在治疗受试者的美沙酮治疗单元进行。
95名参加美沙酮治疗项目的IDU。研究纳入标准为：在干预前评估当天前6个月内注射过任何药物；具备英语读写能力；同意为研究目的进行艾滋病毒抗体检测；且无已知的严重精神疾病诊断。80名受试者成功接受了6个月的随访。
RP干预是一个为期六节的项目。每节时长60 - 90分钟，单独进行。BI是一次时长60 - 90分钟的动机访谈，并配有一本自助手册。
在干预前评估和随访时，所有受试者均接受了阿片类药物治疗指数的药物使用量表和艾滋病毒风险行为量表评估，并同意采集毛细血管血样进行艾滋病毒抗体检测。在随访时，收集最高艾滋病毒风险行为量表、受试者性伴侣关于前一个月的旁证报告以及随访前一个月的尿液分析结果。
对干预措施的依从性良好。自我报告与尿液分析及旁证报告的一致性令人满意。随访前一个月，各组在风险行为方面无显著差异。然而，有证据表明，在接受RP干预的组中，自干预前评估以来风险行为最严重的月份里，针头风险行为（共用和清洁）的发生率较低。没有迹象表明BI比常规美沙酮治疗更有益，且两种干预措施似乎都未降低性风险行为。
结果谨慎解读为表明个体RP项目可降低复发期间的针头风险行为水平，但需要进一步研究来重复这一发现。
