Prison Interventions and HIV Prevention Collaboration

东欧和中亚(EECA)的监禁率最高(前10名中有5名) 在世界范围内，注射毒品的人数惊人(PWID)，其中大部分患有阿片类药物使用障碍(OUD： 82%)和HIV(PWH：18%)。EECA的艾滋病毒疫情主要集中在PWID，他们占56% 艾滋病高发人群中新感染艾滋病毒的比例(7.3-53.4%)。监狱和缓刑环境 提供使用阿片类激动剂疗法(OAT)预防艾滋病毒的机会。新成立的(过去5年) 这些国家的缓刑制度为艾滋病毒预防提供了新的机遇和挑战，缓刑 没有确保人权获得艾滋病毒预防和治疗的国际授权。 这项建议建立在我们在几个欧洲经委会国家的现有执行科学网络的基础上。具体来说， 首先，MAT-LINK与训练有素的研究人员一起使用SBIRT(筛查、短暂干预和转诊治疗)来 试点测试一种扩大阿片类激动剂疗法的策略。第二，许多欧亚经济共同体国家最近引入了 缓刑，提供机会确保与缓刑中的跨机构人员接触，以更好地协调 公共卫生与公共安全。第三，在使用现有基础设施和人员的情况下进行实际实施 现在需要更多的地点来扩大整个监狱和缓刑的OAT。第四，我们开发了第一个 EECA中的Echo项目，以指导将OAT纳入初级保健和将精神护理纳入OAT环境。 我们成功地将EPIS(探索、准备、实施和维持)框架与 提高OAT规模的流程改进的NIATx模型。同样使用EPIS，我们使用Project ECHO集成 燕麦和艾滋病毒护理进入乌克兰的初级保健诊所，向非专科医生传授专门护理，我们 建议用来教授监狱医生。NIATx是一种循证的促进策略，并记录了 在采用和扩大循证实践(EBP)方面取得成功，如OAT。使用EPIS 框架和NIATx办法，我们建议：目标1：扩大燕麦片作为监狱和监狱前艾滋病毒预防工作的规模 在欧洲和非洲经济共同体进行审判拘留，并在释放后将其与社区治疗联系起来；以及 目标2：在欧洲经济和社会事务部新成立的缓刑制度中扩大燕麦片作为艾滋病毒预防的规模，并针对患有艾滋病毒的个人 并将其与燕麦片治疗联系起来，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，通过与我们在欧洲经委会的合作伙伴的合作来实现这些目标。 意义重大，因为需要减少在艾滋病毒、PWID和监禁的EECA中的艾滋病毒传播 主要集中在PWID和OAT覆盖率较低的地区。创新率高达 使用NIATx模型在监狱和缓刑中扩大OAT，以及协作学习工具，如 项目Echo以教授和维护技能。由于这两家公司之间的长期合作，可行性很高 许多合作者和来自CJS设置的买入。公共健康收益很高，因为解决了 健康和正义是许多最弱势群体存在的地方。

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.