Program Profile: Community-Friendly Health Recovery Program (CHRP)

This is an HIV risk-reduction intervention targeting opioid-dependent individuals in drug treatment, with the objective of reducing drug- and sex-related HIV risks. The program is rated Promising. Individuals in the CHRP intervention showed statistically significant improvement on drug and sex risk-reduction skills over time; however, there was no effect on their knowledge of safer drug use, social motivation, and self-efficacy.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals/Target Population

The Community-Friendly Health Recovery Program (CHRP) is an HIV risk-reduction intervention targeting opioid-dependent individuals in drug treatment. The program specifically targets injection drug users, who are at high risk of contracting HIV. The goal is to provide the CHRP to high-risk drug users while they are seeking treatment, to reduce drug- and sex-related HIV risks.

Program Components

The CHRP uses a manual-guided approach, which comprises four, 50–minute group sessions that focus on sex- and drug-related HIV risks among opioid-dependent adults in treatment. Program sessions are delivered using cognitive-remediation strategies (such as presenting material visually, verbally, and experientially), which are designed to accommodate the mild-to-moderate cognitive difficulties that may be common among opioid-dependent individuals.

Group topics of CHRP include the following:

• Health care participation, including understanding HIV and the immune system, strategies for improving health, and developing a partnership with healthcare providers.
• Reducing the harm of injection drug use, including identifying drug-related HIV risks, learning about proper needle cleaning, and managing cravings during needle cleaning.
• Harm reduction with latex (i.e., condoms), including identifying sex-related HIV risks, and learning about latex products and their correct use.
• Negotiating harm reduction with partners, including negotiating the use of latex, communicating about sex-related HIV risks, and eroticizing safe sexual practices.

Program Theory

The CHRP is based on the information-motivation-behavioral skills model of health behavior change. The model specifies that HIV risk and HIV risk reduction are determined by prevention information, motivation, and behavioral skills. HIV prevention information (i.e., knowledge about HIV prevention) and prevention motivation (including personal and social motivations) are prerequisites to determining if an individual will initiate and maintain HIV risk-reduction behavior. HIV- prevention behavioral skills are also a prerequisite that can determine if a well-informed and well-motivated individual will use HIV risk-reduction behavior (Copenhaver, Lee, and Baldwin 2013).

Study

Copenhaver, Lee, and Baldwin (2013) conducted a randomized controlled trial to examine the effectiveness of the Community-Friendly Health Recovery Program (CHRP) intervention. All participants were provided with a description of the study (verbal and written) and were asked to sign an informed consent form prior to participation. To be eligible for the study, patients had to be at least 18 years of age; opioid-dependent and seeking methadone maintenance treatment; have reported drug- or sex-related HIV risk behavior in the past 6 months; able to read and understand questionnaires; available for the duration of the study; and not actively suicidal, homicidal, or psychotic.

The study participants were 304 HIV-negative opioid-dependent individuals in a community-based, methadone maintenance program. Participants were double blindly randomized to one of two groups: the CHRP intervention group (n=149) or the active control group (n=155). Approximately 48 percent of the study participants were male, and the median age was 33. About three quarters of the study participants (74.7 percent) were white (the other race/ethnicities were not reported). There were no significant differences at baseline between the intervention and control groups on demographics.  

The intervention group received the CHRP, while the active control condition served as a time- and contact-matched support and orientation group for individuals entering the methadone maintenance program. They received information regarding methadone program services and policies, as well as general health care information related to opioid-dependent patients entering methadone therapy. All study participants continued to receive methadone maintenance treatment regardless of group assignment.  

Data was collected from participants using an audio computer-assisted structured interview (ACASI) at the pre- and post-intervention periods, and at the 3-, 6-, and 12-month follow-up periods. An event-level, sex- and drug-related HIV risk behavior assessment was used to gather information on drug and sex risk-reduction skills and knowledge. Drug-risk behavior included items related to how participants used drugs, whether they used new or cleaned syringes (and if so, how they cleaned syringes), and whether they shared syringes. Sex-related behavior was assessed using items that asked whether participants used male or female condoms, and if not, whether it was due to abstinence from sexual activity. Participants were also asked about their drug- and sex-related HIV risk-reduction knowledge, personal and social motivation to reduce HIV risk behavior, and self-efficacy about reducing HIV risk behavior. A mixed-effects model was used to investigate the effects of the intervention on the outcomes.

The Community-Friendly Health Recovery Program (CHRP) is an adapted and shortened version of the Holistic Health Recovery Program (HHRP). The program was adapted specifically for use within a clinical setting (i.e., methadone maintenance program), where high-risk drug users would seek treatment services. The sessions were provided by two trained Bachelor’s level facilitators. The sessions were guided by an CHRP manual (Copenhaver, Lee, and Baldwin 2013). 

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Copenhaver, Michael M., and I-Ching Lee. 2006. “Optimizing a Community-Friendly HIV Risk Reduction Intervention for Injection Drug Users in Treatment: A Structural Equation Modeling Approach.” Journal of Urban Health: Bulletin of the New York Academy of Medicine 83(6):1132–42.

Copenhaver, Michael M., and I-Ching Lee. 2007. “Examining the Decay of HIV Risk Reduction Outcomes Following a Community-Friendly Intervention Targeting Injection Drug Users in Treatment.” Journal of Psychoactive Drugs 39(3):223–29.

Copenhaver, Michael M., I-Ching Lee, and Arthur Margolin. 2007. “Successfully Integrating an HIV Risk Reduction Intervention into a Community-Based Substance Abuse Treatment Program.” The American Journal of Drugs and Alcohol Abuse 33:109–20.