HIV and Drug Use in Georgian Women

描述（由申请人提供）：东欧是妇女中注射吸毒和艾滋病毒感染的新兴中心。在东欧，格鲁吉亚共和国是仍然能够避免艾滋病毒流行病的最后几个国家之一。该提案是对RFA-DA-10-008艾滋病毒/艾滋病和药物使用国际研究合作的回应，它是在美国和东欧格鲁吉亚共和国和俄罗斯研究人员之间成功合作的基础上提出的。最近来自格鲁吉亚邻国俄罗斯的数据报告说，59%的注射吸毒妇女艾滋病毒血清反应呈阳性;这是格鲁吉亚面临的一个威胁。了解在俄罗斯推动这一流行病的风险因素可能有助于防止格鲁吉亚发生这样的灾难。因此，该建议直接回应了东欧区域区域框架的具体问题，即“如何将药物滥用治疗干预措施与既定的艾滋病毒预防办法相结合，以优化其综合效力？“注射吸毒的格鲁吉亚妇女艾滋病毒感染率为2%，丙型肝炎感染率为25%。格鲁吉亚妇女艾滋病毒感染率低，这为进行干预和避免艾滋病毒流行的可能性提供了重要的机会。在格鲁吉亚，妇女从属于男子的地位使妇女容易感染艾滋病毒/丙型肝炎病毒。拟议的研究将通过满足四个连续目标来进行。目标1。探索药物使用（例如，类型和模式），HIV和HCV注射和性风险行为，共病状况（例如，人际暴力，共病精神障碍），以及治疗障碍和经历（例如，性别歧视）。目标2.确定从n=34治疗提供者的做法和对注射吸毒妇女在目前的格鲁吉亚药物治疗系统的看法。目标3。我们将调整和预先测试基于强化的治疗（RBT）的药物滥用治疗方法，该方法整合了基于证据的妇女合作艾滋病毒预防和注射吸毒者格鲁吉亚妇女的病例管理方法。这一目标包括n=16名注射吸毒妇女和n=16名提供者在不同的重点小组，然后是n=20名注射吸毒妇女完成预测试。目标4。在一项小规模随机试验（n=128）中，确定我们的Georgian RBT模型相对于病例管理模型的可行性和初步疗效，即其对治疗后和治疗后3个月随访时无保护性行为和共用注射器频率的各自影响。拟议项目对公共卫生的影响是深远的。从规模上看，我们的格鲁吉亚RBT治疗模式不仅有望减少艾滋病毒流行的可能性，减缓格鲁吉亚丙型肝炎病毒传播率的增加，而且还将对以妇女为重点的药物滥用干预模式的发展产生重大影响，以便在其他国家进行治疗和传播。公共卫生相关性：这是美国、格鲁吉亚共和国和俄罗斯合作者进一步确定吸毒模式和风险文化背景的一个有利时机，以便调整和测试针对女性注射吸毒者的综合治疗模式，以避免艾滋病毒流行和格鲁吉亚共和国丙型肝炎病毒的进一步增加。

DESCRIPTION (provided by applicant): Eastern Europe is an emerging epicenter of injection drug use and HIV infection, among women. Within Eastern Europe, the Republic of Georgia is one of the last countries where an HIV epidemic can still be averted. This proposal responds to RFA-DA-10-008 International Research Collaborations on HIV/AIDS and Drug Use by building on the successful collaboration among US and Eastern European investigators from the Republic of Georgia and Russia. Recent data from Georgia's neighbor, Russia, reported 59% of IDU women HIV seropositive; this is a threat that looms over Georgia. Understanding the risk factors that operate in Russia that drive this epidemic may help forestall such a catastrophe in Georgia. As such, this proposal directly responds to the Eastern European Region RFA-specific question of "How can drug abuse treatment interventions be integrated with established HIV prevention approaches to optimize their combined effectiveness?" Injection drug using (IDU) Georgian women show prevalence rates of 2% for HIV and 25% for hepatitis C (HCV). The low prevalence of HIV in Georgian women provides an important window of opportunity to intervene and avoid the possibility of an HIV epidemic. In Georgia, women's expected subordination to men makes women vulnerable to HIV/HCV infection. The proposed study will proceed by meeting four sequential aims. Aim 1. Explore drug use (e.g., types and patterns), HIV and HCV injection and sexual risk behaviors, comorbid conditions (e.g., interpersonal violence, comorbid psychiatric disorders), and treatment barriers and experiences (e.g., gender discrimination) among n=54 IDU Georgian women. Aim 2. Identify from n=34 treatment providers their practices and perceptions regarding IDU women in the current Georgian drug-treatment system. Aim 3. We will adapt and pretest both a drug abuse treatment approach of Reinforcement-Based Treatment (RBT) that integrates the evidence based Women's Co-Op HIV prevention and a case management approach for IDU Georgian women. This aim includes n=16 IDU women and n=16 providers in separate focus groups followed by n=20 IDU women completing pretesting. Aim 4. In a small- scale randomized trial (n=128), determine the feasibility and initial efficacy of our Georgian RBT model relative to a case management model in terms of their respective impacts on the frequency of unprotected sexual acts and syringe sharing at post-treatment and 3-month post-treatment follow-up. The public health impact of the proposed project is far-reaching. Taken to scale, our Georgian RBT treatment model holds the promise not only to lessen the possibility of an HIV epidemic and slow the increase in the HCV transmission rate in Georgia, but also to strongly influence the development of women-focused drug abuse intervention models for treatment tailoring and dissemination in other nations. PUBLIC HEALTH RELEVANCE: This is an opportune time for United States, Republic of Georgia, and Russian collaborators to further identify the patterns of drug use and cultural contexts of risks in order to adapt and test a comprehensive treatment model for women injection drug users to avert an HIV epidemic and further increases in HCV in the Republic of Georgia.