Building on Needle Exchange to Optimize HIV Prevention/Treatment

7.项目摘要 直接适用于注射毒品者（PWID）的生物医学干预措施已经蓬勃发展， （艾滋病毒治疗作为预防、接触前预防、办公室药物辅助 用丁丙诺啡治疗（MAT）和用直接作用剂治疗丙型肝炎病毒（HCV））。 然而，相对于潜在的好处，这些干预措施在PWID中的渗透率较低。注射器 服务计划（SSP）是PWID的一项基本风险降低服务，代表了 为这一人群提供公共卫生服务。巴尔的摩市卫生局（BCHD）和调查人员在 约翰霍普金斯大学正在开发一个专门的综合护理货车（ICV），以补充城市的 移动的服务项目，目标是优化艾滋病毒阳性客户的艾滋病毒护理级联， 对PWID的生物医学干预。一名执业护士，个案工作者和同行导航员将参与艾滋病毒- 积极的客户（已知的和新诊断的），并与当地艾滋病毒诊所密切合作，以促进进展 持久的病毒抑制。为了支持ICV在艾滋病护理便利化方面的作用，我们提出了一个创新的 应用疾病预防控制中心赞助的“数据护理”倡议--一个多来源的卫生服务数据库， 协助卫生部门真实的跟踪艾滋病毒护理级联。此外，ICV将提供快速的艾滋病毒 检测、PrEP筛查和启动、基于丁丙诺啡的MAT、HCV检测和转诊治疗，以及 伤口护理使用随机分组试验设计，我们建议确定ICV干预是否 在艾滋病毒阳性的PWID中推进艾滋病毒护理级联，改善PrEP连续性， MAT和HCV治疗的摄取（目的1）。此外，我们亦会研究ICV的实施情况， 在PWID、地方/州公共卫生利益相关者之间使用混合方法进行干预， 医疗提供者检查干预的可行性、可接受性、覆盖范围、忠诚度和可持续性 (Aim 2）。最后，我们将确定ICV干预的增量成本效益（目标3）。我们有 组建了一个多学科团队，在PWID干预和成本方面具有方法学专业知识， 有效性评估以及与BCHD合作伙伴的长期合作。我们的团队是 热衷于提出一种结构性干预措施的混合有效性-实施试验， 对SSP客户及其注射网络成员进行低门槛、循证的生物医学干预。

7. PROJECT SUMMARY Biomedical interventions that have direct applicability to people who inject drugs (PWID) have flourished over the past 15 years (HIV treatment as prevention, pre-exposure prophylaxis, office-based medication-assisted treatment (MAT) with buprenorphine, and hepatitis C virus (HCV) treatment with direct acting agents). However, penetration of these interventions among PWID is low relative to the potential benefits. Syringe service programs (SSP) are an essential risk reduction service for PWID, and represent the outermost reach of public health services for this population. The Baltimore City Health Department (BCHD) and investigators at Johns Hopkins University are developing a dedicated integrated care van (ICV) to complement the city's mobile SSP, with the goals of optimizing the HIV care cascade in HIV-positive clients and extending needed biomedical interventions to PWID. A nurse practitioner, case worker, and peer navigators will engage HIV- positive clients (known and newly diagnosed) and collaborate closely with local HIV clinics to promote progress toward durable viral suppression. To support the ICV's role in HIV care facilitation, we propose an innovative application of the CDC-sponsored “Data to Care” initiative - a multi-source health service database designed to assist health departments track the HIV care cascade in real time. Additionally, the ICV will provide rapid HIV testing, PrEP screening and initiation, buprenorphine-based MAT, HCV testing and referrals to treatment, and wound care. Using a cluster-randomized trial design, we propose to determine whether the ICV intervention advances the HIV care cascade among HIV-positive PWID, improves the PrEP continuum, and increases uptake of MAT and HCV treatment (Aim 1). Additionally, we will examine the implementation of the ICV intervention using a mixed methods approach among PWID, local/state public health stakeholders, and medical providers to examine the intervention's feasibility, acceptability, coverage, fidelity, and sustainability (Aim 2). Finally, we will determine the incremental cost-effectiveness of the ICV intervention (Aim 3). We have assembled a multi-disciplinary team with methodological expertise in PWID interventions and cost- effectiveness evaluations, and longstanding collaboration with our partners at the BCHD. Our team is enthusiastic to propose a hybrid effectiveness-implementation trial of a structural intervention designed to bring low-threshold, evidence-based biomedical interventions to SSP clients and their injecting network members.