HIV and HCV Risk Reduction Interventions in Drug Detoxification and Treatment Settings

1. HIV and HCV Risk Reduction Interventions in Drug Detoxification and Treatment Settings Study #: NIDA-CTN-0017 Lead Investigator: Robert E. Booth, Ph.D.

2. 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) Participating CTPs

3. Key Players Rocky Mountain: Suzell Klein, Marilyn Macdonald, Mark Royer, Laetitia Thompson, Catherine Dempsey, Susan Mikulich-Gilbertson, 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

4. Special Thanks To: • Jacques Normand, Ph.D. – Director of AIDS Research • Jim Robinson & Connie Klein – NKI • Larry Brown, M.D. – CTP Laison

5. 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

6. 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

7. 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

8. 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)

9. Secondary Outcome Variables • Treatment Entry • Treatment Retention • Treatment Compliance • Abstinence or 100% Condom Use

10. Components of the C & E InterventionSession 1: • Brief introduction about what will be covered this session • Presentation of 9 cue cards addressing drug & sex risks for HIV/HCV infection • Demonstration and rehearsal of correct condom-use and needle cleaning techniques (if new needle is unavailable) • Information about syringe exchange programs, pharmacies, and local ordinances related to sale of syringes • Consent to draw blood for HIV/HCV testing • Blood draw (if consent provided) • Second session scheduled within two weeks

11. Components of the C & E InterventionSession 2: • Brief introduction about what will be covered this session • Test results provided (if tested) • 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 • Demonstration and rehearsal of correct condom-use and needle cleaning techniques (if new needle is unavailable) • Information about syringe exchange programs, pharmacies, and local ordinances related to sale of syringes

12. 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)

13. Design • Random assignment to one of three conditions, Counseling & Education, Therapeutic Alliance or, treatment as usual

14. 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-of-treatment injection drug users.” Journal of Psychoactive Drugs, 30, 269-277 N = 3679

15. 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-of-treatment injection drug users.” Journal of Psychoactive Drugs, 30, 269-277 N = 3679

16. Evidence Supporting Role Induction • Patients receiving alcohol-focused 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 • Craigie and Ross (1980)

17. 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)

18. Sample Characteristics (N = 646) Age: 34.50 (SD = 9.52) Gender: Males 74.4% Females 24.8% Race: White 70% African American 8% Native American 3% Other 4% Multi-Race 10% Missing 6% Ethnicity: Hispanic 9% Non-Hispanic 86% Missing 5% :

19. Drug Use

20. Injected Drug Use Past 30 Days

21. Non-Injected Drug Use Past 30 Days

22. Injected-Related Risk Behaviors Past 30 Days

23. Number of Sex Partners Past 30 Days

24. Follow-up Rates as of May 31, 2006

25. 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”!