Effect of a Nursing Outreach Intervention to Drug Users in Detroit, Michigan

Article excerpt

The aim of the National Institute on Drug Abuse Cooperative Agreement Project's Detroit site was to compare the effectiveness of two outreach interventions in decreasing the AIDS-related high-risk behaviors of active, injecting drug users and crack cocaine users not in treatment programs. A sample of 539 drug users, 70% males and 30% females, was selected from two high-risk neighborhoods. All subjects participated in two standard AIDS educational and counseling sessions. Half of the subjects then participated in an enhanced intervention-a nursing intervention called Personalized Nursing LIGHT Model. A regression model was used to compare the effects within the two study groups on:

(a) number of times injecting heroin,

(b) crack cocaine usage, and

(c) number of episodes of unprotected sex during the preceding 30 days. The differences between the enhanced group's actual post-test behavior and the behavior predicted by standard treatment alone may be attributable to the addition of the enhanced treatment. The results show the differences are in the expected direction during year two of the study when program conditions were at their maximum, staff were on board and trained, and clients participated actively.

Significant decreases were obtained for all three risky behaviors; for heroin, for crack, and for unprotected sex. A dosage measure, participation in addiction treatment ("Tuesday group"), was also significant. These results show that enhanced treatment adds to behavior improvement beyond the contribution of the standard intervention-when the treatment conditions are operating as planned.

Overview and Objectives Intravenous drug users (IDUs) constitute an increasingly high percentage of the identified HIV-positive population. Thus, new and innovative interventions are being tested within this population to halt the spread of the disease (Simpson et al. 1994; Booth and Watters 1994; Brettle 1991). These interventions are aimed at other drug users as well, including those addicted to crack cocaine. It has been shown that crack cocaine leads to high levels of risk behavior related to sexual practices among addicts (Donoghoe 1992). In the mid-1980s the scientific community realized the magnitude and potential threat of HIV/AIDS among drug users. At that time the National Institute on Drug Abuse (NIDA) initiated a number of research projects to test the effectiveness of community outreach intervention models in clinical trials. The program to reach out-of-treatment drug users (Brown and Beschner 1993) was designed and initiated in 1990. The multicity randomized clinical trial project known as the NIDA Cooperative Agreement Project was begun in six United States cities. It currently includes 23 cities and is housed in NIDA's Community Outreach Branch.

Prior to the NIDA-funded project, little information was known or published about the habits and practices of drug users not in treatment programs. A large proportion of the available information was based on targeted quota samples conducted in areas where addicts had contact with a formal organization; a hospital, law enforcement agency, or drug treatment center (Braunstein 1993). These studies, although reflective of the setting they were examining, gave little idea of what was happening "behind the scenes," i.e., in the neighborhoods and communities where intravenous (IV) drugs and crack cocaine were being used. For instance, a person actively seeking treatment for a drug problem has different characteristics from an individual not seeking treatment. To gain a better understanding of out-of-treatment drug use patterns, including possible effective intervention strategies, comparisons were advocated. The NIDA Cooperative Agreement Project encouraged the grantees, in their respective cities, to compare the effectiveness of a cooperatively developed and agreed upon standard model of care with community-based enhanced intervention outreach models used in conjunction with the standard care. …