HIV Risk and treatment among opiate injectors

Background: This paper reports on a study comparing two interventions for opiate-using injection drug users (IDUs). The two interventions are strengths-based case management (CM) vs. strengths-based case management plus a facilitated therapeutic alliance (CM/FTA). In the FTA, case managers facilitate a relationship between treatment counselors and clients. Outcomes include methadone treatment engagement and retention, and reduction of HIV risk. Methods: Three hundred and twenty-six IDUs were recruited through street outreach from 2007 - 2010. Subjects were randomly assigned to receive either CM (n=161) or CM/FTA (n=165) intervention. One hundred and ninety-eight participants were followed at 6 months. Participants were 65% white, 72% male and averaged 42 years old. Results: Compared to CM, CM/FTA had a large effect on treatment retention for at least 90 days (71% vs. 49%, p=0.06) among those who entered treatment. Conversely, treatment entry and the reduction in drug injections did not differ between interventions. CM/FTA also had a larger reduction in sharing needles/paraphernalia in the last 30 days (-49 vs. -8, p=0.07). Those who entered treatment had a larger reduction in number of injections than those who did not (-92 vs. -32, p<0.0001) while reduction of risk behaviors was modest (-32 vs. -21, p=0.65). Those who stayed in treatment had a larger reduction in injection and risk behaviors than those who dropped out (-110 vs. -68, p=0.051; -58 vs. 4, p=0.06). Conclusions: Evidence was found for the effectiveness of adding the FTA to SBCM for treatment retention and reduction of HIV risk behaviors.