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

项目总结/摘要 这个指导研究科学家发展奖（K 01）的目的是为候选人提供 向艾滋病毒预防科学研究独立过渡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病是由注射吸毒造成的。中亚 注射毒品使用率最高的国家之一，以及世界上艾滋病毒流行病增长最快的国家之一。艾滋病毒- 注射毒品（PWID）阳性者在坚持抗逆转录病毒治疗（ART）方面面临许多障碍，例如 对抗逆转录病毒疗法、污名化和药物使用的误解。此前对这一人群的研究表明， 以夫妇为基础的艾滋病毒干预措施在减少危险行为方面非常有效，但目前还没有 基于夫妇的抗逆转录病毒疗法依从性干预PWID。本研究的目的是：1）确定核心 SMART夫妇干预的组成部分和其他现有的ART依从性干预策略， 评估其作为一种综合的、以夫妇为基础的ART依从性干预措施的适当性和可行性， 生活在哈萨克斯坦的艾滋病毒+ PWID; 2）调整和完善SMART夫妇并确定辅助干预措施 针对艾滋病毒+ PWID及其主要疾病制定综合的、以夫妇为基础的ART依从性干预策略 使用目标1的结果对性伴侣进行干预;以及3a）在66名 哈萨克斯坦的异性恋PWID夫妇通过随机对照试验，以评估安全性，可行性， 和干预的可接受性，并获得对依从性结果的初步估计， 干预组与标准护理;和3b）评估进行干燥的可行性和可接受性 血斑测试作为临床环境中依从性干预的一部分。拟议的职业发展 一项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1）获得 在设计和调整艾滋病毒干预措施方面的研究技能，重点是在 边缘化人口; 2）获得二元和密集纵向分析的方法学专门知识， 行为、生物医学和技术数据的三角测量，特别是为了解释 并分析这些类型的数据，以评估干预效果和衡量ART依从性; 3）获得 进行和分析定性深入访谈和焦点小组方面的培训，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） 提高专业技能，为成功的独立研究生涯。这些培训目标将实现 通过教学课程，专业讲习班和研讨会，实践研究，以及 跨学科专家团队。从本K 01中获得的研究结果和方法技能 在疾病研究中具有广泛的适用性，并且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.