Prison Interventions and HIV Prevention Collaboration

监狱干预和艾滋病毒预防合作

• 批准号: 8305773
• 负责人: FREDERICK LEWIS ALTICE
• 金额: $ 40.01万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8305773
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Area; Behavior; Behavior Therapy; Chronic; Collaborations; Communicable Diseases; Communities; Comorbidity; Country; Criminal Justice; Data; Detection; Drug Addiction; Drug usage; Drug user; Epidemic; Evaluation; Evidence based intervention; Future; Grant; HIV; Harm Reduction; Health; Hepatitis B Virus; Hepatitis C virus; High Prevalence; Holistic Health; Housing; Imprisonment; Incidence; Individual; Infection; Injection of therapeutic agent; Intervention; Intervention Studies; Kazakhstan; Knowledge; Link; Mental disorders; Modeling; Morbidity - disease rate; Needs Assessment; North America; Opioid Rotation; Outcome; Phase; Play; Policy Research; Prevalence; Prisoner; Prisons; Recording of previous events; Recovery; Research; Research Activity; Research Infrastructure; Research Personnel; Research Priority; Risk; Risk Behaviors; Risk-Taking; Role; Sentinel; Sexual Partners; Sexual Transmission; Site; Substance Use Disorder; Substance abuse problem; Surveys; System; Testing; Tuberculosis; USSR; Ukraine; Viral hepatitis; Work; base; burden of illness; community setting; evaluation/testing; evidence base; experience; health care delivery; high risk; implementation research; innovation; meetings; mortality; programs; success; therapy development; transmission process

DESCRIPTION (provided by applicant): Injection drug use (IDU) has greatly contributed to an explosive and volatile HIV epidemic in states of the former Soviet Union (FSU) - especially in Ukraine. This region, for reasons similar in North America, incarceration of drug users is among the highest in the world. As a result, there is a concentration of HIV/AIDS and other infectious diseases (HBV, HCV, TB, STIs) within the criminal justice system (CJS). In many FSU countries, high-risk sexual and injection behaviors within prisons have resulted in significant intra-prison HIV transmission. The CJS is therefore a sentinel place not only to detect and treat HIV among drug users and their sexual partners, but to adapt and implement evidence-based interventions that are effective in decreasing HIV-related morbidity and mortality. In this application, we propose to create an innovative and new collaborative research program in Ukraine called PRIDE (Prison-related Research, Intervention Development and Evaluation), which addresses research and implementation issues in the FSU region associated with HIV, substance abuse and the CJS. PRIDE creates an infrastructure for research that involves both researchers and the CJS partners and includes collaborators from Ukraine, Kazakhstan and Georgia. The synergy between researchers and CJS partners allows an open dialogue and opportunity to incorporate implementation research using the Plan-Do-Study-Act (PDSA) that is likely to yield the most effective outcomes. Phase I provides a menu of surveillance activities that can be selected for research activities within the Ukraine CJS. Differing methodological strategies are available to answer different questions, including burden of infectious diseases and co-morbidity among prisoners, HIV risk behaviors and HIV transmission within prison, pre-release needs of prisoners with HIV, drug dependence and/or TB. Phase II reviews all surveillance and needs assessment activities and to select from a number of evidence-based interventions that should be adapted and pilot-tested among prisoners. Though not known a priori, the menu of options includes alternatives to incarceration, behavioral interventions such as the Holistic Health Recovery Program (HHRP), opioid substitution therapy (OST) administered either during incarceration or as a pre- or post-release intervention, prison-release interventions adapted from nationally-recognized models created by Yale investigators or others worthy of exploration and agreed upon through PRIDE. Phase III involves adaptation and pilot testing of selected interventions. Results from these pilots are to be used for further research, including application for new grants. The likelihood of success for PRIDE is based upon: 1) over 20 years of innovative research at the interface of substance abuse, HIV/AIDS and the CJS; 2) an extensive research history between Yale and Ukraine; and 3) conducting research in Ukraine where the burden of disease is great and its central role in FSU activities is considerable. PUBLIC HEALTH RELEVANCE: Criminal justice systems (CJS) are sentinels sites for the detection and treatment of HIV among IDUs and require effective transition to the community. This application seeks to innovatively promote and facilitate research in countries of the former Soviet Union through partnerships between researchers and the CJS and the conduct of evidence-based research to impede the HIV epidemic among IDUs in Ukraine.

描述（由申请人提供）：注射吸毒（IDU）在很大程度上导致了前苏联（FSU）国家（特别是乌克兰）爆炸性和不稳定的艾滋病毒流行。由于与北美类似的原因，该区域的吸毒者监禁率是世界上最高的。因此，在刑事司法系统内，艾滋病毒/艾滋病和其他传染病（乙型肝炎病毒、丙型肝炎病毒、结核病、性传播感染）集中存在。在许多前苏联国家，监狱内的高危性行为和注射行为导致了监狱内艾滋病毒的大量传播。因此，CJS不仅是在吸毒者及其性伴侣中检测和治疗艾滋病毒的哨点，而且是适应和实施有效降低艾滋病毒相关发病率和死亡率的循证干预措施的哨点。在此申请中，我们建议在乌克兰创建一个名为PRIDE（监狱相关研究，干预发展和评估）的创新和新的合作研究项目，该项目解决了FSU地区与艾滋病毒，药物滥用和CJS相关的研究和实施问题。PRIDE为研究人员和CJS合作伙伴建立了一个基础设施，包括来自乌克兰、哈萨克斯坦和格鲁吉亚的合作者。研究人员和CJS合作伙伴之间的协同作用允许进行公开对话，并有机会利用计划-执行-研究-法案（PDSA）纳入实施研究，这可能产生最有效的结果。第一阶段提供了一份监测活动菜单，可在乌克兰CJS内选择用于研究活动。不同的方法战略可用于回答不同的问题，包括囚犯的传染病负担和合并症、艾滋病毒风险行为和监狱内艾滋病毒传播、感染艾滋病毒的囚犯的释放前需求、药物依赖和/或结核病。第二阶段审查所有监测和需求评估活动，并从一些基于证据的干预措施中进行选择，这些干预措施应在囚犯中进行调整和试点测试。虽然不是先验的，但选项菜单包括监禁的替代方案，行为干预，如整体健康恢复计划（HHRP），阿片替代疗法（OST），在监禁期间或作为释放前或释放后的干预，监狱释放干预改编自耶鲁大学研究者创造的全国认可的模式或其他值得探索的模式，并通过PRIDE达成一致。第三阶段涉及选定干预措施的适应和试点测试。这些试点的结果将用于进一步的研究，包括申请新的赠款。PRIDE成功的可能性基于：1)在药物滥用，艾滋病毒/艾滋病和CJS的界面上进行了20多年的创新研究；2)耶鲁大学和乌克兰之间广泛的研究历史；3)在乌克兰开展研究，因为乌克兰的疾病负担很大，而且在FSU活动中发挥着相当大的中心作用。公共卫生相关性：刑事司法系统（CJS）是在注射吸毒者中检测和治疗艾滋病毒的哨点，需要有效地向社区过渡。这一申请旨在创新地促进和便利前苏联国家的研究，方法是通过研究人员与CJS之间的伙伴关系以及开展循证研究，以阻止乌克兰境内注射吸毒者中艾滋病毒的流行。