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.

摘要 中亚(CA)是世界上增长最快的艾滋病毒流行地区之一，自2010年以来增长了30%。到2017年， 关键人群及其性伴占新感染艾滋病毒的95%，其中9%为女性。 性服务工作者(FSW)，注射吸毒者(PWID)中39%，性服务对象/性伴侣中28% 工人/其他关键人群。在哈萨克斯坦，一个主要的CA地区经济体，新的增长了106% 2010年至2017年的艾滋病毒感染情况。也注射毒品(FSWID)的FSW感染艾滋病毒的风险显著增加 感染，但不太可能进行艾滋病毒检测和接受护理。艾滋病毒检测是进入艾滋病毒的关键切入点 护理和抗逆转录病毒治疗，对于艾滋病毒阴性的人，提供PrEP/PEP。在哈萨克斯坦，FSWID艾滋病毒检测的障碍， 包括耻辱、不便和医疗保健提供者对女性女性的偏见和/或吸毒。 虽然HST是世界卫生组织推荐的，但关于FSW和PWID的研究非常有限。评论： 增加检测的干预措施表明，HST可以增加一致性或频繁的检测，但这种联系 使用HST可以降低护理率。重要的是，在CA还没有进行过任何研究，据我们所知， 在FSWID中，鉴于他们感染艾滋病毒的风险较高，艾滋病毒检测接受率较低，以及 双重耻辱的经历。这项研究的主要目标是评估可接受性、可行性、初步 以同伴为基础的艾滋病毒自我检测干预的有效性和成本，以增加一致的艾滋病毒检测和与 在哈萨克斯坦使用R34机制对交换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，以确定对HST的反应 从有效的HST和与FSW的护理干预的联系中获得的组件。在第二阶段，我们将参与设计 思维方法和干预适应，以优化现有组件的保真度和适配性并开发 反映我们理论方法的新组件；我们将进行组件测试(N=20)和预试 成分(N=20)。在第三阶段，我们将90名未感染艾滋病毒的FSWID随机分配到适应的实验 条件(4个疗程)或时间和注意力控制的标准艾滋病毒检测咨询条件，并遵循以下条件 18个月，对持续的艾滋病毒检测、HST和与护理/预防的联系产生影响。将进行随机对照试验 与非营利性FSW倡导组织Amelia和领导全国艾滋病毒的KSCDID合作 治疗/预防战略。结果将填补关于最佳HST的知识库中的主要空白 在加州FSWID中的实施，通过分析创新干预措施，明确重点是 使用物质的人群减少耻辱和同伴支持。结果将与HST和 其他CA国家以及120个艾滋病毒流行国家的联动规划，在这些国家， 和PWID扮演着重要的角色，包括美国。