HIV incidence among people who inject drugs (PWIDs) in Ukraine: results from a clustered randomised trial.
HIV incidence among people who inject drugs (PWIDs) in Ukraine: results from a clustered randomised trial.
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DOI：
10.1016/s2352-3018(16)30040-6
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发表时间：
2016-10
期刊：
影响因子：
16.1
通讯作者：
Latkin, Carl A.
中科院分区：
文献类型：
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作者：
Booth, Robert E.;Davis, Jonathan M.;Dvoryak, Sergey;Brewster, John T.;Lisovska, Oksana;Strathdee, Steffanie A.;Latkin, Carl A.
在这项研究中，我们试图评估社交网络干预在影响吸毒者艾滋病毒发病率方面是否优于艾滋病毒检测和咨询。尽管这不是主要研究目标，但它与减少药物和性风险行为有关，而这是主要目标。从乌克兰敖德萨、顿涅茨克和尼古拉耶夫的街道招募吸毒者进行集群随机临床试验 (RCT)。 “索引”或同伴领导者及其两名网络成员被随机分配到测试和咨询组（N = 589）或测试和咨询加社交网络干预组（N = 611）。网络干预的参与者接受了 5 次培训，以培训其网络成员降低风险。那些被分配测试和咨询的人在咨询后没有接受进一步的干预。采用意图治疗分析，主要结果是使用 Cox 回归并结合伽玛脆弱项来解释聚类的 HIV 血清转化。没有使用分层或最小化。该试验已在 ClinicalTrial.gov 注册，NCT01159704。 2010年7月12日至2012年11月23日期间，招募了2,304名吸毒者，其中1,200名艾滋病毒呈阴性，并被纳入本研究。在基线时，各组之间没有显着差异。在 1,200 名 HIV 阴性参与者中，有 1,085 名（90.4%）在 12 个月时被保留。发病率密度显示，干预组参与者每 100 人年 (py) 发生 18.45 起事件（95% CI 14.87 – 22.03，553.0 py 中有 102 起事件），对照组参与者每 100 人年 (py) 发生率 31.78（95% CI 26.83–36.74，497.1 py 中有 158 起事件）。这对应于干预组的风险降低，HR= 0.53 (95% CI 0.38, 0.76, p = 0.0003)。没有与研究相关的不良事件。这些数据为将同伴教育纳入吸毒者综合艾滋病毒预防计划提供了强有力的支持，并表明了开发和测试同伴主导的干预措施对于改善 PrEP 和 ART 的获取和依从性的价值。这项研究由国家药物滥用研究所 (RO1 DA026739) 资助。
In this study, we sought to assess whether a social network intervention was superior to HIV testing and counseling in impacting HIV incidence among PWID. Although this was not a primary study aim, it is associated with reducing drug and sex risk behaviors, which were primary aims. PWID were recruited from street settings in Odessa, Donetsk, and Nikolayev, Ukraine for a clustered randomized clinical trial (RCT). “Index” or peer leaders, along with two of their network members, were randomly assigned to testing and counseling block (N=589) or testing and counseling plus a social network intervention block (N=611). Participants in the network intervention received 5-sessions to train their network members in risk reduction. Those assigned testing and counseling received no further intervention following counseling. Employing an intent to treat analyses, the primary outcome was HIV sero-conversion using Cox regression and incorporating a gamma frailty term to account for clustering. No stratification or minimization was utilized. The trail was registered with ClinicalTrial.gov, NCT01159704. Between July 12, 2010 and November 23, 2012, 2,304 PWID were recruited, 1,200 of whom were HIV negative and included in the present study. At baseline, there were no significant differences between groups. Of the 1,200 HIV negative participants, 1,085 (90.4%) were retained at 12 months. Incidence density revealed 18.45 (95% CI 14.87 – 22.03, 102 events in 553.0 py) per 100 person years (py) for those in the intervention group and 31.78 (95% CI 26.83–36.74, 158 events in 497.1 py) per 100 py among control arm participants. This corresponded to a reduced hazard in the intervention group, HR= 0.53 (95% CI 0.38, 0.76, p =0.0003). There were no study-related adverse events. These data provide strong support for integrating peer education into comprehensive HIV prevention programs for PWID and suggest the value in developing and testing peer-led interventions for improving access and adherence to PrEP and ART. This study was funded by the National Institute on Drug Abuse (RO1 DA026739).