A Novel, Bottom Up Approach to Promote Evidence Based HIV Prevention for IDUs

描述（由申请人提供）：乌克兰是东欧艾滋病毒流行最严重的国家之一，估计有1.6%的成年人口携带该病毒，在某些地区，吸毒者中估计有33%的流行率。注射吸毒者（IDUs）占乌克兰新发艾滋病毒病例的36%。最近，国际、政府和非政府机构通力合作，扩大了乌克兰替代疗法和针头/注射器交换项目的可及性。然而，这些针对idu的规划仍然存在体制和立法障碍。此外，尽管提供无菌注射设备很重要，并且已被证明可以减少注射吸毒者中的新艾滋病毒感染，但仅靠此类方案并不能解决吸毒者中的性艾滋病毒风险。因此，乌克兰注射吸毒者中目前的艾滋病毒预防工作需要扩大，以包括寻求改变风险行为的循证战略，不需要广泛的政策变化或政治支持，并解决吸毒者面临的多重艾滋病毒风险。鼓励服务提供者提供以证据为基础的干预措施（ebi）的努力集中在忠实于“核心要素”的实施上，即对每一项被认为对其有效性负责的干预措施的具体组成部分。虽然已经确定了150多种基于证据的独特干预措施，包括9种针对吸毒者的干预措施，但在实践中，它们包含了有效干预措施的共同因素：认知、情感和行为技能建设；量身定制的、针对行为的内容；解决影响行为改变的环境障碍。这项为期4年的RO1研究旨在了解如何在与吸毒者合作的乌克兰非政府组织中最好地促进这些基于证据的艾滋病毒预防战略的使用。本研究将定性与定量相结合，探索一种促进有效行为风险降低干预措施共同因素（而非特定干预核心要素）传播的艾滋病预防科学传播与干预发展模式；2)使服务提供者能够制定反映其具体组织情况的艾滋病毒预防干预措施。7-9个非政府组织位于乌克兰艾滋病毒和药物使用率最高的地区，并被选中代表关键的组织环境标准（如机构规模、目标人口、预防艾滋病毒的经验），将学习有效干预措施的共同因素，作为制定干预措施的基础。培训结束后，我们将使用定性方法，包括与非政府组织工作人员的访谈，记录每个机构的干预发展和实施过程。然后，通过观察、定性访谈、实施检查表和风险评估，我们将记录干预措施的实施情况，以评估纳入的共同因素；项目交付的各个方面，包括范围和范围；和有效性。主要的定性分析将检查每个非政府组织在干预发展、交付和有效性方面的变化与有关服务提供者特征的定性数据之间的关系。我们还将比较和对比机构在干预实施背景下的共同因素和干预效果的相似性和差异性。

DESCRIPTION (provided by applicant): Ukraine has one of the most severe HIV epidemics in Eastern Europe, with an estimated 1.6% of the adult population living with the virus, and an estimated 33% prevalence among drug users in certain regions. Injection drug users (IDUs) account for 36% of new HIV cases in Ukraine. Recent collaborative efforts between international, governmental, and nongovernmental agencies have been made to expand access to substitution therapies and needle/syringe exchange programs in Ukraine. However, systematic and legislative barriers remain for these IDU-specific programs. In addition, while provision of sterile injection equipment is important, and has been shown to reduce new HIV infections among IDUs, such programs alone do not address sexual HIV risk among drug users. Therefore, current HIV prevention efforts among Ukrainian IDUs need to be expanded to include evidence-based strategies that seek to change risk behavior, do not require broad policy changes or political support, and that address the multiple HIV risks drug users face. Efforts to encourage service providers to deliver evidence-based interventions (EBIs) have focused on implementation with fidelity to "core elements," or integral components specific to each intervention thought to be responsible for its effectiveness. While over 150 unique interventions have been identified as evidence- based, including 9 that target drug users, in practice they incorporate common factors of effective interventions: cognitive, affective, and behavioral skill-building; tailored, behavior-specific content; and addressing environmental barriers to behavior change. This 4-year, RO1 study seeks to understand how to best promote the use of these evidence-based HIV prevention strategies among Ukrainian NGOs working with drug users. This study combines qualitative and quantitative methods to explore a model of HIV prevention science dissemination and intervention development that 1) promotes the dissemination of common factors of effective behavioral risk reduction interventions (rather than intervention-specific core elements); and 2) enables service providers to develop HIV prevention interventions that reflect their specific organizational contexts. 7-9 NGOs, located in regions of Ukraine with the highest HIV and drug use rates and selected to represent key organizational context criteria (e.g., agency size, target population, experience with HIV prevention), will be taught common factors of effective interventions as the basis for intervention development. Following training, we will use qualitative methods, including interviews with NGO staff, to document the process of intervention development and implementation at each agency. Then, using observations, qualitative interviews, implementation checklists, and risk assessments, we will document intervention implementation to assess inclusion of common factors; aspects of program delivery, including reach and scope; and effectiveness. Primary qualitative analyses will examine the relationship between variations in intervention development, delivery, and effectiveness at each NGO and qualitative data regarding service provider characteristics. We will also compare and contrast agencies' inclusion of common factors and intervention effectiveness with respect to similarities and differences in the context of intervention implementation.