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

描述(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%的成年人口携带病毒，某些地区吸毒者的流行率估计为33%。注射吸毒者占乌克兰新增艾滋病毒病例的36%。最近，国际、政府和非政府机构之间的合作努力扩大了乌克兰获得替代疗法和针头/注射器交换计划的机会。然而，对于这些针对注射吸毒者的计划来说，系统和立法障碍依然存在。此外，尽管提供无菌注射设备很重要，而且已被证明可以减少注射吸毒者中新的艾滋病毒感染，但仅有这些方案并不能解决吸毒者中的性艾滋病毒风险。因此，目前在乌克兰注射吸毒者中预防艾滋病毒的努力需要扩大到包括基于证据的战略，这些战略寻求改变危险行为，不需要广泛的政策变化或政治支持，并且解决吸毒者面临的多重艾滋病毒风险。鼓励服务提供商提供循证干预措施(EBI)的努力侧重于忠实于“核心要素”的实施，即被认为对其有效性负责的每项干预措施的组成部分。虽然150多项独特的干预措施已被确定为循证干预措施，其中包括9项针对吸毒者的干预措施，但在实践中，它们纳入了有效干预措施的共同因素：认知、情感和行为技能培养；针对特定行为的量身定做的内容；以及解决导致行为改变的环境障碍。这项为期4年的RO1研究试图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循证艾滋病毒预防策略的使用。本研究结合定性和定量的方法，探索一种艾滋病毒预防、科学传播和干预发展的模式，该模式1)促进有效的行为风险减少干预措施的共同因素的传播(而不是干预特定的核心要素)；2)使服务提供者能够制定反映其特定组织背景的艾滋病毒预防干预措施。将向位于艾滋病毒和毒品使用率最高的乌克兰地区的7-9个非政府组织传授有效干预的共同因素，以此作为制定干预措施的基础。在培训之后，我们将使用定性方法，包括与非政府组织工作人员的访谈，记录每个机构制定和实施干预措施的过程。然后，使用观察、定性访谈、实施核对表和风险评估，我们将记录干预实施情况，以评估公共因素的纳入；计划交付的各个方面，包括覆盖范围和范围；以及有效性。初步的定性分析将考察每个非政府组织在干预发展、交付和有效性方面的差异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的背景下纳入共同因素和干预有效性的异同。

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.