Peer-based HIV Self-testing among High Risk Women Who Inject or Use Drugs in Kazakhstan, Central Asia

哈萨克斯坦、中亚地区注射或吸毒高危女性中基于同伴的艾滋病毒自我检测

• 批准号: 10458069
• 负责人: Nabila El-Bassel
• 金额: $ 14.42万
• 依托单位: CITY COLLEGE OF NEW YORK
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10458069
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Advocacy; Africa; Amelia; Attention; Awareness; Behavioral; Caring; Central Asia; Cessation of life; Client; Communicable Diseases; Communities; Counseling; Country; Data; Dermatology; Development; Drug usage; Drug user; Early Diagnosis; Epidemic; Focus Groups; Goals; HIV; HIV Infections; HIV Seronegativity; HIV/STD; Health Personnel; High Risk Woman; Human immunodeficiency virus test; Incidence; Individual; Infection; Injecting drug user; Intention; Intervention; Interview; Kazakhstan; Knowledge; Link; Persons; Pharmaceutical Preparations; Phase; Play; Population; Population Intervention; Prevalence; Prevention; Prevention strategy; Privatization; Public Health; Randomized; Research; Research Infrastructure; Risk; Risk Reduction; Role; Services; Sexual Partners; Site; Technology; Testing; Text; Thinking; Time; Training; Treatment Efficacy; United States; Validation; Viral; Vulnerable Populations; Woman; Work; advocacy organizations; antiretroviral therapy; arm; base; behavior change; case finding; coping; cost; design; empowerment; evidence base; experience; experimental arm; female sex worker; follow-up; improved; injection drug use; innovation; internalized stigma; knowledge base; novel; peer; peer support; pre-exposure prophylaxis; preference; primary outcome; response; secondary outcome; self testing; sex; social stigma; substance use; success; theories; tool; uptake

ABSTRACT Central Asia (CA) has one of the world’s fastest growing HIV epidemics, increasing 30% since 2010. By 2017, key populations and their sex partners made up 95% of new HIV infections, including 9% among female sex workers (FSW), 39% among people who inject drugs (PWID), and 28% among clients/sex partners of sex workers/other key populations. In Kazakhstan, a major CA regional economy, there was a 106% increase in new HIV infections from 2010 to 2017. FSW who also inject drugs (FSWID) are at significantly increased risk of HIV infection, but are less likely to engage in HIV testing and receive care. HIV testing is the key point of entry to HIV care and ART, and, for HIV-negative individuals, to PrEP/PEP. In Kazakhstan, barriers to HIV testing for FSWID, include stigma, inconvenience, and health care provider bias against women who are FSW and/or drug users. Although HST is recommended by the WHO, very limited research on FSW and PWID exists. Reviews of interventions to increase testing suggest that HST can increase consistent or frequent testing, but that linkage to care rates can be lower with HST. Importantly, no studies have been conducted in CA or, to our knowledge, among FSWID, a vital population to target given their elevated risk for HIV, low uptake of HIV testing, and experiences of dual stigma. The primary goal of this study is to assess acceptability, feasibility, preliminary efficacy and cost of a peer-based HIV self-testing intervention to increase consistent HIV testing and linkage to care or prevention among women who exchange sex and inject drugs in Kazakhstan using the R34 mechanism. In Phase 1, we will conduct in-depth interviews and focus groups with 40 FSWID to identify responses to HST components from efficacious HST and linkage to care interventions with FSW. In Phase 2, we will engage design thinking approaches and intervention adaptation to optimize fidelity and fit of existing components and develop novel components reflecting our theoretical approaches; we will component test (N=20) and pre-pilot components (N=20). In Phase 3, we will randomize 90 HIV-uninfected FSWID to either the adapted experimental condition (4 sessions) or a time- and attention-controlled standard HIV test-counseling condition and follow for 18 months for impacts on consistent HIV testing, HST and linkage to care/prevention. The RCT will be conducted in partnership with Amelia, a non-profit, FSW advocacy organization, and KSCDID, which leads national HIV treatment/prevention strategy. Results will fill key gaps in the knowledge base around optimal HST implementation among FSWID in CA, through analysis of an innovative intervention with an explicit focus on stigma reduction and peer support with substance using populations. Results will have relevance for HST and linkage programming in other CA countries, as well as the 120 countries that have HIV epidemics where FSW and PWID play important roles, including the United States.

抽象的 中亚 (CA) 是世界上艾滋病毒流行增长最快的地区之一，自 2010 年以来增长了 30%。到 2017 年， 重点人群及其性伴侣占新增艾滋病毒感染者的 95%，其中女性占 9% 工作者 (FSW)、注射吸毒者 (PWID) 中的 39%、以及嫖客/性伴侣中的 28% 工人/其他重点人群。哈萨克斯坦是中亚地区的主要经济体，新增就业增长了 106%。 2010 年至 2017 年 HIV 感染情况。同时注射吸毒的 FSW (FSWID) 感染 HIV 的风险显着增加 感染，但不太可能进行艾滋病毒检测和接受护理。 HIV检测是HIV感染的关键切入点 护理和 ART，对于 HIV 阴性个体，还包括 PrEP/PEP。在哈萨克斯坦，FSWID 的 HIV 检测存在障碍， 包括对 FSW 和/或吸毒妇女的耻辱、不便和医疗保健提供者的偏见。 尽管 WHO 推荐 HST，但对 FSW 和 PWID 的研究非常有限。评论 增加检测的干预措施表明 HST 可以增加一致或频繁的检测，但这种联系 HST 的护理率可能会更低。重要的是，尚未在加利福尼亚州进行过任何研究，或者据我们所知， FSWID 是一个重要的目标人群，因为他们感染艾滋病毒的风险较高，艾滋病毒检测率较低，并且 双重耻辱的经历。本研究的主要目标是评估可接受性、可行性、初步 基于同伴的艾滋病毒自我检测干预措施的功效和成本，以提高艾滋病毒检测的一致性和与 使用 R34 机制对哈萨克斯坦发生性行为和注射毒品的妇女进行护理或预防。 在第一阶段，我们将与 40 名 FSWID 进行深入访谈和焦点小组讨论，以确定对 HST 的回应 有效的 HST 的组成部分以及与 FSW 护理干预措施的联系。在第二阶段，我们将进行设计 思维方法和干预适应，以优化现有组件的保真度和适合度并开发 反映我们理论方法的新颖成分；我们将进行组件测试（N=20）和预试点 组件（N = 20）。在第 3 阶段，我们将 90 名未感染 HIV 的 FSWID 随机分配到适应的实验组中 条件（4 次）或时间和注意力控制的标准 HIV 检测咨询条件，并遵循 18 个月，了解对持续 HIV 检测、HST 以及与护理/预防的联系的影响。将进行 RCT 与非营利性 FSW 倡导组织 Amelia 以及领导国家艾滋病毒的 KSCDID 合作 治疗/预防策略。结果将填补最佳 HST 知识库中的关键空白 通过分析创新干预措施，明确关注以下方面，在加利福尼亚州 FSWID 中实施 减少药物滥用人群的耻辱和同伴支持。结果将与 HST 相关，并且 与其他 CA 国家以及 120 个艾滋病毒流行国家的联系规划 注射吸毒者和注射吸毒者发挥着重要作用，其中包括美国。