Motivational enhancement to augment contingency management for SARS-CoV-2 testing and vaccination utilization among syringe exchange clients

项目总结 注射毒品的人极易感染SARS-CoV-2和 由SARS-CoV-2引起的疾病，冠状病毒疾病2019年(新冠肺炎)。PWID的基本经验 医疗条件和不稳定的住房使他们患新冠肺炎的风险增加。 残疾人也面临障碍，例如医疗保健系统的污名化和歧视的历史 以及接触错误信息，减少获得保健服务的机会，如SARS-CoV-2检测和 接种疫苗。拟议的项目建立在我们的第一阶段快速诊断项目(#67；PI： Stormshak)成功地将SARS-CoV-2检测嵌入到整个注射器交换计划(SEP)中 俄勒冈州，与艾滋病毒联盟(HIVA)合作。测试计划的成功与 应急管理(CM)干预，将测试利用率从4%提高到24%(d= 1.36)，尽管全国范围内的测试利用率正在下降。拟议项目的第一个目标是测试 在当前增加新冠肺炎疫苗的背景下，CM在测试结果上的持续有效性 可访问性。检测仍然是预防SARS-CoV-2在继续感染的PWID患者中传播的关键 处于高暴露风险，对那些疫苗犹豫不决的人来说。我们还将利用我们与 HIVA将在HIVA的SEP建立一个新冠肺炎疫苗项目。第二个目标是进行随机化的 对照试验(RCT)，以检查是否有短暂的动机增强(ME)干预(即Connect2Test) 加强CM对SARS-CoV-2检测和疫苗接种的影响。我们的第一阶段研究证明 CM提高了SARS-CoV-2检测的利用率。众所周知，CM还可以提高对以下疾病的免疫率 其他传染性疾病，如乙肝。此外，与研究表明ME一致 增强CM对健康行为结果的影响，我们预计Connect2Test将增强CM的 对戒毒者检测和接种疫苗的影响。此外，因为ME引发并加强了对 长期的行为改变，而CM会提示立即和短期的行为改变，而我们预计 CM+ME，而不是单独的CM，将对SARS-CoV-2检测产生长期影响，证据是 随着时间的推移，参与重复测试。拟议项目的第三个目标是评估CM和 Connect2测试实施，包括单独使用CM与使用CM Plus的成本效益分析 Connect2Test，以提高测试、疫苗接种和干预方法的长期可持续性 减缓SARS-CoV-2的传播。

PROJECT SUMMARY People who inject drugs (PWIDs) are highly vulnerable to contracting SARS-CoV-2 and to the effects of the disease caused by SARS-CoV-2, coronavirus disease 2019 (COVID-19). PWIDs experience underlying medical conditions and unstable housing that put them at increased risk for COVID-19 morbidity and mortality. PWIDs also experience barriers such as a history of stigmatization and discrimination by health care systems and exposure to misinformation that reduces access to health care services, such as SARS-CoV-2 testing and vaccination. The proposed project builds on our Phase I Rapid Acceleration of Diagnostics project (#67; PI: Stormshak) that successfully embedded SARS-CoV-2 testing into syringe exchange programs (SEPs) across the state of Oregon, in collaboration with HIV Alliance (HIVA). The testing program’s success is linked to a contingency management (CM) intervention that increased the rates of testing utilization from 4% to 24% (d = 1.36), even as nationwide testing utilization was decreasing. The first aim of the proposed project is to test the sustained effectiveness of CM on testing outcomes, given the current context of increasing COVID-19 vaccine accessibility. Testing remains critical to prevent the transmission of SARS-CoV-2 among PWIDs who continue to be at high exposure risk, and for whom vaccine hesitancy is high. We will also leverage our partnership with HIVA to establish a COVID-19 vaccine program at HIVA’s SEPs. The second aim is to conduct a randomized control trial (RCT) to examine whether a brief motivational enhancement (ME) intervention (i.e., Connect2Test) augments the effects of CM on SARS-CoV-2 testing and vaccination uptake. Our Phase I study demonstrates that CM improves SARS-CoV-2 testing utilization. CM is also known to increase immunization rates against other infectious diseases, such as Hepatitis B. Additionally, consistent with research showing that ME enhances the effects of CM on health behavior outcomes, we anticipate that Connect2Test will augment CM’s effects on testing and vaccination among PWIDs. Moreover, because ME elicits and strengthens motivation for long-term behavior change, whereas CM prompts immediate and short-term behavior change, we anticipate that CM + ME, versus CM alone, will have long-term effects on SARS-CoV-2 testing, evidenced by participation in repeated testing over time. The third aim of the proposed project is to assess CM and Connect2Test implementation, including a cost-effectiveness analysis of CM alone versus CM plus Connect2Test, to improve long-term sustainability of testing, vaccination, and intervention approaches to mitigate the spread of SARS-CoV-2.