HIV Risk Reduction Intervention Trial for Young Incarcerated IDUs

Background/Purpose: HIV infection continues to disproportionately affect African Americans, incarcerated individuals, and injection drug users (IDUs) (CDC, 2009). This National Institute on Drug Abuse (NIDA) - funded longitudinal study examined the relative efficacy of three HIV risk reduction interventions targeting direct and indirect syringe sharing practices. Findings from this behavioral trial can inform the design of evidenced-based interventions targeting these vulnerable populations. Methods: 228 young (16-30 years), HIV negative, African American, IDUs serving the last six months of their sentence in the local jail were randomized to one of three HIV risk reduction intervention arms (2:2:1 ratio): 1) CT- counseling and testing which served as the standard of care employing CDC-approved HIV pre/post test counseling; 2) PSP- pharmacy syringe purchase which taught social/behavioral skills to purchase syringes from pharmacies; and 3) CCBI- 4-session client centered behavioral intervention using motivational interviewing to encourage safe injecting. HIV, Hepatitis B (HBV) and Hepatitis C (HCV) laboratory data (Abbott Laboratories) and baseline interview data gathered using audio computer assistance (ACASI) were compared with parallel data gathered 6 months post incarceration. Interview data included demographics, substance use history and high risk injecting practices (sharing syringes, cookers, cotton, rinse water, and backloading). Interviews and standardized interventions were completed by corrections social workers at baseline and follow-up. Results: At baseline, mean age was 24 years; 97% male; 68.7% HCV infected; 4.3% HBV infected and 3.8% co-infected. Of 228 participants initially interviewed, 156 completed 6 month follow-up (7 died, 28 re-incarcerated, 37 not located). Risk reduction data for 156 participants are reported. At 6 month follow-up, among 63 participants randomized to the CT arm, 28 no longer injected and 17 had not shared syringes in the prior 6 months (71.4%); of 61 randomized to the PSP arm, 25 no longer injected and 20 had not shared syringes in the prior 6 months (73.8%) and of 32 randomized to the CCBI arm, 13 no longer injected and 6 had not shared syringes in the prior 6 months (59.4%). Similar patterns were observed for reduction in sharing cookers, cotton, rinse water and backloading (CT: 41 (63.1%); 40 (61.5%); 43 (66.1%); 39 (60%) PSP: 38 (62.3%); 38 (62.3%); 37 (60.7%); 38 (62.3%) CCBI: 22 (68.8%); 20 (62.5%); 23 (71.8%); 14 (43.8%) respectively. Conclusions/Implications: While harm reduction and not abstinence from injecting was the focus of this intervention study, it is important to note that at follow-up 66 (42%) of participants no longer injected. Interestingly, there were no statistically significant differences in abstinence rates across arms (CT-45.2%; PSP-41% & CCBI- 40.6%). While there was a slight risk reduction advantage for the CT arm, there were no statistically significant differences in risk reduction across groups. Because the CT intervention was the least costly in terms of time and money, it appears that this intervention would be the most cost effective and easiest to employ. Finally, this intervention was initiated in jail and conducted by corrections social workers demonstrating that the correctional setting is both a feasible and effective site for HIV prevention/intervention services.