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

项目摘要 注射毒品的人（PWID）非常容易感染SARS-CoV-2， 由SARS-CoV-2、2019冠状病毒病（COVID-19）引起的疾病。PWID经验基础 医疗条件和不稳定的住房使他们面临更高的COVID-19发病率和死亡率风险。 残疾人还遇到障碍，如卫生保健系统的污名化和歧视历史 暴露于错误信息，减少获得医疗保健服务，如SARS-CoV-2检测， 预防针拟议项目建立在我们的第一阶段快速加速诊断项目（#67; PI： Stormshak）成功地将SARS-CoV-2测试嵌入到了全球各地的注射器交换计划（SEP）中。 俄勒冈州，与艾滋病联盟（HIVA）合作。测试计划的成功与一个 应急管理（CM）干预，将测试利用率从4%提高到24%（d = 1.36），即使全国范围内的测试利用率下降。拟议项目的第一个目标是测试 在当前COVID-19疫苗增加的背景下，CM对检测结果的持续有效性 可访问性。检测对于防止继续感染SARS-CoV-2的PWID之间的传播仍然至关重要 处于高暴露风险中，并且对疫苗犹豫不决的人很高。我们还将利用我们的伙伴关系， HIVA将在HIVA的SEPs建立COVID-19疫苗计划。第二个目标是进行一项随机 对照试验（RCT），以检查是否短暂的动机增强（ME）干预（即，Connect2Test） 增强CM对SARS-CoV-2检测和疫苗接种的影响。我们的第一阶段研究表明， CM提高了SARS-CoV-2检测的利用率。CM也被称为增加免疫接种率， 其他传染病，如B型肝炎。此外，与研究表明，我 增强CM对健康行为结果的影响，我们预计Connect 2 Test将增强CM的 对艾滋病病毒感染者的检测和疫苗接种的影响。此外，由于我激发并加强了 长期的行为改变，而CM提示即时和短期的行为改变，我们预计 CM + ME与单独CM相比，将对SARS-CoV-2检测产生长期影响， 随着时间的推移参与重复测试。拟议项目的第三个目的是评估CM， Connect 2 Test实施，包括单独CM与CM+的成本效益分析 Connect 2 Test，提高检测、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.