Couples-Based HIV/STI Prevention for Injecting Drug Users in Kazakhstan

哈萨克斯坦注射吸毒者以夫妻为基础的艾滋病毒/性传播感染预防

• 批准号: 7494920
• 负责人: Nabila El-Bassel
• 金额: $ 67.61万
• 依托单位: COLUMBIA UNIV NEW YORK MORNINGSIDE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-15 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7494920
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Afghanistan; Age; Appendix; Asians; Behavior; Behavior Therapy; Behavioral; Biological; Centers for Disease Control and Prevention (U.S.); Central Asia; Child Sexual Abuse; China; Chlamydia; Coitus; Collaborations; Communication; Condition; Couples; Criminal Justice; Development; Drug Addiction; Drug abuse; Drug usage; Effectiveness of Interventions; Eligibility Determination; Epidemic; Expectancy; Gender; Gonorrhea; HIV; HIV Seropositivity; Health; Hepatitis C; Hepatitis C Incidence; Hepatitis C virus; Heterosexuals; Incidence; Infection; Infection prevention; Injecting drug user; Injection of therapeutic agent; Institutes; Interdisciplinary Study; International; International AIDS; Intervention; Kazakhstan; Knowledge; Length; Link; Maps; Measures; Mediating; Mediator of activation protein; Needle Sharing; Needle-Exchange Programs; Needles; Numbers; Outcome; Participant; Patient Self-Report; Pharmaceutical Preparations; Population; Population Study; Prevention Protocols; Prevention Research; Prevention approach; Prevention intervention; Preventive Intervention; Principal Investigator; Protocols documentation; Public Health; Race; Randomized; Randomized Controlled Trials; Rate; Recording of previous events; Recruitment Activity; Reporting; Research; Research Infrastructure; Research Institute; Research Personnel; Research Training; Risk; Risk Behaviors; Risk Reduction; Route; Russia; Schools; Self Efficacy; Sexual Partners; Sexually Transmitted Diseases; Site; Skin; Social Work; Social support; Study Section; Substance abuse problem; Syphilis; Syringes; Testing; Universities; Vagina; Venipunctures; World Health Organization; base; condoms; day; experience; follow-up; innovation; intimate partner violence; outreach; peer; pilot trial; prevention service; programs; psychological distress; satisfaction; sex; skills; social; stem; trafficking; treatment effect

DESCRIPTION (provided by applicant): The proposed study will rigorously test the efficacy of an innovative, couples-based HIV/STI risk reduction intervention (CHSR) to decrease new cases of HIV and Hepatitis C (HCV) and incidence of sexually transmitted infections (STIs), as well as to reduce unsafe injection practices and increase condom use among injecting drug users (IDUs) and their heterosexual, intimate partners in Shu, Kazakhstan. Central Asia has experienced one of the fastest growing HIV/AIDS epidemics due to a sharp increase in injection drug use. This investigative team from the Social Intervention Group at Columbia University and the Shu Policlinic Needle Exchange Program in Kazakhstan completed a pilot randomized controlled trial of the proposed CHSR among 40 IDUs and their primary, heterosexual partners (N=80) in Shu, Kazakhstan. Compared to participants assigned to the wellness promotion comparison condition (WP) (n=40), CHSR participants (n=40) reported significantly fewer unsafe injection behaviors and greater condom use from baseline to the 3-month follow-up. For the proposed study, the participants will be 400 IDUs and their heterosexual, intimate partners, who meet eligibility criteria (e.g., at least one partner reports unsafe injection and unprotected sexual intercourse in the past 30 days). Participants will be recruited from the Shu Policlinic needle exchange program and through street outreach in Shu. Shu is located along a major drug trafficking route and has an estimated 4,500 IDUs out of a population of 35,000. In the proposed study, 400 couples will be randomized to one of two interventions: a 5-session couples-based HIV/STI risk reduction intervention or a 5- session couples-based wellness promotion intervention, which will serve as a comparison condition. Participants will be assessed with repeated measures at baseline, 3-, 6- and 12-months post-intervention. The primary behavioral outcomes are self- reported proportion of injection acts in which needles or syringes are shared in the past 30 days and proportion of condom-protected acts of sexual intercourse in the past 30 days. The primary biological outcomes are the rate of new HIV cases and new HCV cases, as well as the incidence of Chlamydia, gonorrhea, and syphilis over the 12-month post-intervention period. The proposed study will advance the understanding of HIV/HCV/STI risk reduction among a population of IDUs and their heterosexual partners, and thereby help to stem the rising epidemic of HIV, HCV, and STIs in Kazakhstan and Central Asia. PUBLIC HEALTH RELEVANCE The proposed study addresses a significant public health threat of HIV, HCV and other STIs among a very high risk population of active IDUs and their sexual partners in Kazakhstan - a region that is experiencing one of the fastest rising HIV epidemics in the world. There is a race to develop and implement effective HIV preventive interventions for IDUs and their sexual partners to stem the spread of HIV, HCV and other STIs in Shu and other Central Asian towns along drug trafficking routes.

描述（由申请人提供）：拟议的研究将严格测试一种创新的、基于夫妻的艾滋病毒/性传播感染风险降低干预（CHSR）的有效性，以减少艾滋病毒和丙型肝炎（HCV）的新病例和性传播感染（STI）的发病率，并减少不安全的注射做法，增加注射吸毒者（IDUs）及其异性亲密伴侣的安全套使用。由于注射毒品的使用急剧增加，中亚是艾滋病毒/艾滋病流行增长最快的地区之一。来自哥伦比亚大学社会干预小组和哈萨克斯坦舒州政策针头交换项目的调查小组在哈萨克斯坦舒州的40名注射吸毒者及其主要异性伴侣（N=80）中完成了拟议的CHSR的随机对照试验。与被分配到健康促进比较条件（WP）的参与者（n=40）相比，从基线到3个月的随访，CHSR参与者（n=40）报告了更少的不安全注射行为和更多的安全套使用。在拟议的研究中，参与者将是400名注射吸毒者及其异性亲密伴侣，他们符合资格标准（例如，在过去30天内至少有一名伴侣报告不安全注射和无保护的性交）。参与者将从Shu Policlinic的针头交换计划中招募，并通过在Shu的街道外展。舒州位于一条主要的毒品走私路线上，在3.5万人口中，估计有4500名注射吸毒者。在拟议的研究中，400对夫妇将被随机分配到两种干预措施中的一种：一种是基于夫妇的5次艾滋病毒/性传播感染风险降低干预措施，另一种是基于夫妇的5次健康促进干预措施，这将作为比较条件。参与者将在干预后的基线、3个月、6个月和12个月进行重复评估。主要行为结果是自我报告的在过去30天内共用针头或注射器的注射行为比例，以及在过去30天内使用避孕套的性交行为比例。主要生物学结果是干预后12个月期间新发HIV病例和新发HCV病例的比率，以及衣原体、淋病和梅毒的发病率。拟议的研究将促进对在注射吸毒者及其异性伴侣中降低艾滋病毒/丙型肝炎病毒/性传播感染风险的认识，从而有助于遏制哈萨克斯坦和中亚地区艾滋病毒、丙型肝炎病毒和性传播感染的日益流行。