A couple-based antiretroviral therapy adherence intervention for people who inject drugs in Kazakhstan

项目摘要/摘要 该指导研究科学家发展奖(K01)的目的是为候选人提供 过渡到艾滋病毒预防和研究科学的研究独立性所需的培训和专业知识 干预。全球增长最快的艾滋病毒流行是由注射毒品推动的。中亚地区有 一些注射吸毒率最高的人，也是世界上增长最快的艾滋病毒流行之一。艾滋病毒-- 注射毒品的阳性患者(PWID)在坚持抗逆转录病毒疗法(ART)方面面临许多障碍，例如 对艺术、污名和物质使用的误解。此前在这一人群中的研究表明 以夫妇为基础的艾滋病毒干预在减少危险行为方面非常有效，但目前还没有 以夫妻为基础的PWID的艺术依从性干预。这项建议的研究目的是：1)确定核心 聪明夫妇干预的组成部分和其他现有的ART坚持干预策略和 评估其作为一种综合的、以夫妇为基础的艺术坚持干预措施的适当性和可行性 生活在哈萨克斯坦的HIV+PWID；2)适应和完善聪明的夫妇并确定强化干预措施 为HIV+PWID及其主要患者创建综合的、基于夫妇的ART依从性干预的策略 性伴侣使用目标1的结果；以及3a)在66个人中对由此产生的基于夫妇的干预进行试点测试 哈萨克斯坦异性恋PWID夫妇通过随机对照试验评估其安全性、可行性、 以及干预措施的可接受性，并获得对遵守结果的初步估计 干预组与护理标准的对比；以及3b)评估实施干燥剂的可行性和可接受性 在临床环境中，作为依从性干预的一部分进行血点检测。拟议的职业发展 计划旨在加强候选人目前在流行病学方面的培训，使她能够获得 艾滋病毒干预措施的设计和适应方面的研究技能，重点是遵守 2)获得二元体和密集纵向分析的方法专长； 三角测量行为、生物医学和技术数据的三角测量，尤指为了解释的目的 并对这些类型的数据进行分析以评估干预效果并测量ART依从性；3)获取 开展和分析定性深入访谈和重点小组方面的培训，特别是 设计和调整艾滋病毒干预措施，评估干预措施的可行性和可接受性；以及4) 为成功的独立研究生涯增加专业技能。这些培训目标将会实现 通过教学课程、专门的研讨会和研讨会、实践研究和 跨学科专家团队。从这次K01中获得的研究成果和方法技巧 对疾病研究具有广泛的适用性，在不同的研究环境中具有高度的可转移性。

PROJECT SUMMARY/ABSTRACT The purpose of this Mentored Research Scientist Development Award (K01) is to provide the candidate with the training and expertise needed to transition to research independence in the science of HIV prevention and intervention. The fastest growing HIV epidemics globally are driven by injection drug use. Central Asia has some of the highest rates of injection drug use and one of the fastest growing HIV epidemics in the world. HIV- positive people who inject drugs (PWID) face many barriers to antiretroviral therapy (ART) adherence, such as misperceptions about ART, stigma and substance use. Previous research among this population has shown that couple-based HIV interventions are highly efficacious at reducing risk behaviors, but there is currently no couple-based ART adherence intervention for PWID. The research aims of this proposal are to 1) identify core components of the SMART Couples intervention and other existing ART adherence intervention strategies and assess their appropriateness and feasibility as an integrated, couple-based ART adherence intervention for HIV+ PWID living in Kazakhstan; 2) adapt and refine SMART Couples and identify augmentative intervention strategies to create an integrated, couple-based ART adherence intervention for HIV+ PWID and their primary sex partners using results from Aim 1; and 3a) pilot test the resulting couple-based intervention among 66 heterosexual PWID couples in Kazakhstan through a randomized control trial to assess the safety, feasibility, and acceptability of the intervention and obtain preliminary estimates of adherence outcomes in the intervention arm versus standard of care; and 3b) assess the feasibility and acceptability of conducting dried blood spot testing as part of an adherence intervention in a clinical setting. The proposed career development plan has been designed to augment the candidate’s current training in epidemiology and enable her to 1) gain research skills in the design and adaptation of HIV interventions, with an emphasis on adherence among marginalized populations; 2) obtain methodological expertise in dyad and intensive longitudinal analysis and the triangulation of behavioral, biomedical, and technological data, particularly for the purposes of interpreting and analyzing these types of data to assess intervention efficacy and measure ART adherence; 3) acquire training in the conduct and analysis of qualitative in-depth interviews and focus groups, particularly for designing and adapting HIV interventions and assessing intervention feasibility and acceptability; and 4) increase professional skills for a successful independent research career. These training goals will be achieved through a combination of didactic courses, specialized workshops and seminars, hands-on research, and an interdisciplinary team of experts. The research findings and methodological skills to be gained from this K01 have wide applicability for disease research and high transferability across diverse research settings.