Prison Interventions and HIV Prevention Collaboration

东欧和中亚（EECA）的监禁率最高（前10名中的5名） 全球范围内，注射毒品（PWID）的人数惊人，其中大多数患有阿片类药物使用障碍（OUD： 82%）和艾滋病毒（PWH：18%）。EECA的艾滋病毒流行主要集中在PWID，占56% 艾滋病毒感染者中艾滋病毒流行率较高的新艾滋病毒感染者（7.3-53.4%）。监狱和缓刑环境 为使用阿片类激动剂疗法（OAT）预防艾滋病毒提供了机会。新成立的（过去5年） 这些国家的缓刑制度为艾滋病预防带来了新的机遇和挑战， 没有国际授权确保人权获得艾滋病毒预防和治疗。 这项建议建立在我们在几个欧洲经委会国家现有的执行科学网络的基础上。具体地说， 首先，MAT-LINK使用SBIRT（筛查、短暂干预和转诊治疗），由训练有素的研究人员进行， 试点测试扩大阿片类激动剂治疗的策略。其次，许多EECA国家最近推出了 缓刑，提供机会，确保接触缓刑中的跨机构人员， 公共卫生与公共安全。第三，利用现有基础设施和人员配置， 现在需要更多的地点，以扩大在监狱和缓刑期间的OAT。第四，我们开发了第一个 在EECA开展ECHO项目，指导OAT纳入初级保健和精神病护理。 我们成功地使用了EPIS（探索，准备，实施和维持）框架， 扩大OAT规模的流程改进NIATx模型。同样使用EPIS，我们使用Project ECHO集成 OAT和艾滋病毒护理进入乌克兰的初级保健诊所，向非专科医生教授专业护理， 教监狱医生。NIATx是一种循证促进策略， 在采用和扩大循证实践（EBP）方面取得的成功，如OAT。使用EPIS 目标1：扩大OAT作为监狱和监狱前预防艾滋病毒的方法， 在EECA和OUD个人中进行审判拘留，并在释放后将他们与社区治疗联系起来; 目标2：扩大OAT作为EECA新成立的缓刑制度中的艾滋病毒预防措施， OUD并将其与OAT治疗联系起来，作为常规护理的一部分，以使公共安全和公共卫生保持一致。 我们将继续利用我们的网络，通过与EECA合作伙伴的合作来实现这些目标。 重要性很高，因为需要减少艾滋病毒在EECA的传播，艾滋病毒，PWID和监禁 主要集中在PWID和OAT覆盖率低的地方。创新是高 使用NIATx模型在监狱和缓刑中扩大OAT，沿着协作学习工具， ECHO项目旨在教授和保持技能。可行性很高，因为这些之间的长期合作 许多合作者和购买从CJS设置。公共卫生效益很高，因为解决了 健康和正义，那里有许多最脆弱的人。

Eastern Europe and Central Asia (EECA) have among the highest (5 of the top 10) incarceration rates worldwide, with staggering numbers of people who inject drugs (PWID), mostly with opioid use disorder (OUD: 82%) and HIV (PWH: 18%). The HIV epidemic in EECA is primarily concentrated in PWID, who account for 56% of new HIV infections with a high HIV prevalence among PWID (7.3-53.4%). The prisons and probation settings provide an opportunity for HIV prevention using opioid agonist therapies (OAT). The newly (past 5 years) formed probation system in these countries presents new opportunities and challenges for HIV prevention as probation does not have an international mandate to ensure human rights access to HIV prevention and treatment. This proposal builds on our existing implementation science network in several EECA countries. Specifically, first, MAT-LINK used SBIRT (screening, brief intervention, and referral to treatment) with trained researchers to pilot test a strategy to scale-up opioid agonist therapies. Second, many EECA countries have recently introduced probation, providing opportunities to ensure access to trans-institutionalized persons in probation to better align public health with public safety. Third, real-world implementation using existing infrastructure and staffing across more sites is now needed to expand OAT throughout prisons and probation. Fourth, we developed the first Project ECHO in EECA to guide OAT integration into primary care and psychiatric care into OAT settings. We have successfully used the EPIS (Explore, Prepare, Implement and Sustain) framework combined with the NIATx model of process improvement to scale-up OAT. Also using EPIS, we used Project ECHO to integrate OAT and HIV care into primary care clinics in Ukraine to teach specialized care to non-specialists, which we propose to use to teach prison doctors. NIATx is an evidence-informed facilitation strategy with documented successes in the adoption and scale-up of evidence-based practices (EBPs), like OAT. Using the EPIS framework and the NIATx approach we propose to: AIM 1: Scale-up OAT as HIV prevention in prisons and pre- trial detention in EECA and for individuals with OUD and link them to community treatment after release; and AIM 2: Scale-up OAT as HIV prevention in the newly formed probation system in EECA and for individuals with OUD and link them to OAT treatment as part of routine care to align public safety and public health. We will continue using our network to achieve these goals through collaboration with our partners in EECA. Significance is high due to the need to reduce HIV transmission in EECA where HIV, PWID and incarceration are syndemic, which is primarily concentrated in PWID and where OAT coverage is low. Innovation is high by using the NIATx model to scale-up OAT in prisons and probation, along with collaborative learning tools like Project ECHO to teach and maintain skills. Feasibility is high due to longstanding collaborations between these many collaborators and buy-in from CJS settings. Public health benefit is high due to addressing the interface of health and justice where many of the most vulnerable exist.