Objectives of the research study :

The primary aim of the proposed project is to investigate the efficacy of oral substitution of Buprenorphine for opiate dependent injecting drug users. Additionally, the study will investigate the benefit of a variety of other intervention components, such as HIV voluntary counseling and testing, needle exchange, health education, and nutritional support.

With Johns Hopkins, Sharan have jointly established a highly productive research team, enhanced the research skills of project staff, on HIV prevention and drug use studies, established trust and rapport with the IDU community, and completed rigorous preliminary research under difficult field conditions. The project will further these efforts and provide vital information on the scope and nature of buprenorphine injecting, and the effectiveness and cost-effectiveness of feasible interventions designed to reduce injecting drug use and associated HIV risk in India, other developing countries, and globally.

Our specific aims for this study are:

1. To describe the socio-demographic, psychological, behavioral, biologic, and clinical characteristics of IDUs enrolled in an outpatient risk reduction and drug treatment intervention program in New Delhi, India.
2. To evaluate the effectiveness of three sequential HIV-1 behavioral intervention program components (a: risk reduction & health stabilization through health education, NEP, wound management, nutritional support and condoms; b: biologic testing for HIV-1 VCT and STI diagnosis and treatment; and c: drug treatment with oral Buprenorphine substitution), and the association of these interventions with temporal trends in psychological, behavioral, social, biologic, and clinical outcomes.
3. To determine the impact of knowledge of HIV-1 serostatus on injecting risk behaviors, and differences in risk reduction by HIV-1 infection status.
4. To calculate the marginal cost-effectiveness of each of the three intervention components listed in aim 2 in terms of the cost per HIV-1 infection averted, and number of Disability Adjusted Life Years saved.
5. To enumerate and characterize injecting drug users who graduate from the intervention program and enter a detoxification & rehabilitation program, and assess how the level of intervention utilization affects uptake of the detoxification & rehabilitation program.