Proposed is a continuing evaluation of the Baltimore Needle Exchange Program (NEP), to examine its impact on HIV seroincidence, levels of syringe sharing, health care utilization and referrals to drug treatment. Continued studies of the long-term impact of NEP, and specific components that optimize its effectiveness, are crucial for public health planning and informing policy. An important new aspect of our evaluation focuses on the effectiveness of NEP as a bridge to drug treatment. Based on our experience only one third of NEP attenders requesting referrals actually enter treatment, and 68 percent return to NEP to exchange needles within a year. We recently showed that IDUs who remain in treatment for at least one year are 5 times less likely to return to NEP taking into account levels of ongoing drug use. These data provide a powerful rationale for using a second-tiered intervention at NEP to reinforce the referral process and improve treatment outcomes.
The specific aims of this project are: 1) To continue to compare rates of drug-related risk behaviors, HIV seroincidence and health care utilization patterns among participants and non-participants of the Baltimore NEP, and to evaluate innovative components such as i) van vs. pharmacy-based venues, ii) daytime vs. evening NEP services; 2) To determine whether a strengths-based case management (SBCM) intervention significantly improves rates of entry, re-entry and retention in drug treatment among NEP attenders referred to opioid-agonist drug treatment, 3) To determine the cost-effectiveness of a SBCM intervention aimed at improving outcomes achieved through referring NEP participants to opioid-agonist drug treatment programs. To meet Aim 1, comparisons of NEP attenders vs. non-attenders will be conducted using survival analysis and Poisson regression. Descriptive analyses will be used to compare IDUs accessing various types of NEP services.
For Aim 2, we will conduct a randomized trial of SBCM vs. standard referrals (i.e., 200 subjects per arm). Follow-up will continue 18 months post-randomization. Logistic regression will be used to identify predictors of entry vs. non-entry, treating subject allocation as a covariate. Survival analysis will be used to compare retention across groups.
For Aim 3, we will assess the costs of drug treatment with and without the intervention, and will determine whether the additional cost of SBCM is justified by the economic returns from lower rates of drug use, morbidity, economically motivated crime, and higher levels of employment. In meeting the above specific aims, the proposed study will have an important impact on policies surrounding NEP in the United States and elsewhere.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Study Section
Special Emphasis Panel (ZRG1-AARR-7 (01))
Program Officer
Hartsock, Peter
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Johns Hopkins University
Public Health & Prev Medicine
Schools of Public Health
United States
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Brouwer, Kimberly C; Lozada, Remedios; Weeks, John R et al. (2012) Intraurban mobility and its potential impact on the spread of blood-borne infections among drug injectors in Tijuana, Mexico. Subst Use Misuse 47:244-53
Syvertsen, Jennifer; Pollini, Robin A; Lozada, Remedios et al. (2010) Managing la malilla: Exploring drug treatment experiences among injection drug users in Tijuana, Mexico, and their implications for drug law reform. Int J Drug Policy 21:459-65
Philbin, Morgan M; Mantsios, Andrea; Lozada, Remedios et al. (2009) Exploring stakeholder perceptions of acceptability and feasibility of needle exchange programmes, syringe vending machines and safer injection facilities in Tijuana, Mexico. Int J Drug Policy 20:329-35
Ramos, Rebeca; Ferreira-Pinto, João B; Brouwer, Kimberly C et al. (2009) A tale of two cities: Social and environmental influences shaping risk factors and protective behaviors in two Mexico-US border cities. Health Place 15:999-1005
Brouwer, K C; Lozada, R; Cornelius, W A et al. (2009) Deportation along the U.S.-Mexico border: its relation to drug use patterns and accessing care. J Immigr Minor Health 11:1-6
Poon, Art F Y; Brouwer, Kimberly C; Strathdee, Steffanie A et al. (2009) Parsing social network survey data from hidden populations using stochastic context-free grammars. PLoS One 4:e6777
Havens, Jennifer R; Latkin, Carl A; Pu, Minya et al. (2009) Predictors of opiate agonist treatment retention among injection drug users referred from a needle exchange program. J Subst Abuse Treat 36:306-12
Case, Patricia; Patricia, Case; Ramos, Rebeca et al. (2008) At the borders, on the edge: use of injected methamphetamine in Tijuana and Ciudad Juarez, Mexico. J Immigr Minor Health 10:23-33
Miller, Cari L; Firestone, Michelle; Ramos, Rebeca et al. (2008) Injecting drug users'experiences of policing practices in two Mexican-U.S. border cities: public health perspectives. Int J Drug Policy 19:324-31
Bishai, D; Sindelar, J; Ricketts, E P et al. (2008) Willingness to pay for drug rehabilitation: implications for cost recovery. J Health Econ 27:959-72

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