HIV and Drug Use in Georgian Women

格鲁吉亚妇女的艾滋病毒和吸毒情况

• 批准号: 8494029
• 负责人: Hendree E Jones
• 金额: $ 37.99万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8494029
• 关键词: AIDS prevention; AIDS/HIV problem; Adult; Aftercare; Behavioral; Case Management; Collaborations; Country; DA10; Data; Development; Discrimination; Drug Addiction; Drug Rehabilitation Centers; Drug abuse; Drug usage; Drug user; Eastern Europe; Effectiveness; Epidemic; European; Focus Groups; Frequencies; Gender; General Population; Goals; HIV; HIV Infections; HIV Seropositivity; HIV risk; Health; Health Personnel; Hepatitis C; Hepatitis C Transmission; Hepatitis C virus; Infection; Injecting drug user; Injection of therapeutic agent; International; Interpersonal Violence; Intervention; Knowledge; Low Prevalence; Mental disorders; Modeling; Needle Sharing; Pattern; Perception; Pharmaceutical Preparations; Pilot Projects; Prevalence; Prevention approach; Provider; Psychological reinforcement; Public Health; Relative (related person); Reporting; Research; Research Personnel; Risk; Risk Behaviors; Risk Factors; Russia; Sex Behavior; System; Testing; Time; United States; Western Asia Georgia; Woman; Work; base; evidence base; experience; follow-up; high risk behavior; injection drug use; interest; meetings; men; randomized trial; sex risk; substance abuse treatment; treatment program

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.

描述（由申请人提供）：东欧是妇女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可以避免艾滋病毒流行的最后几个国家之一。该提案以美国和来自格鲁吉亚共和国和俄罗斯的东欧研究人员之间的成功合作为基础，回应了RFA-DA-10-008关于艾滋病毒/艾滋病和药物使用的国际研究合作。格鲁吉亚邻国俄罗斯最近的数据显示，59%的注射过量妇女艾滋病毒血清检测呈阳性；这是格鲁吉亚面临的威胁。了解在俄罗斯造成这种流行病的风险因素可能有助于预防格鲁吉亚发生这种灾难。因此，这一建议直接回应了东欧区域区域管制局的具体问题，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结合起来，以优化其综合效果？”格鲁吉亚妇女注射吸毒（IDU）的艾滋病毒患病率为2%，丙型肝炎（HCV）患病率为25%。格鲁吉亚妇女的艾滋病毒感染率较低，这为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，人们认为妇女从属于男子，这使妇女容易感染艾滋病毒/丙型肝炎病毒。拟议的研究将依次满足四个目标。目的1。探索药物使用（例如，类型和模式），艾滋病毒和丙型肝炎病毒注射和性风险行为，共病条件（例如，人际暴力，共病精神障碍），以及治疗障碍和经验（例如，性别歧视）在n=54 IDU格鲁吉亚妇女。目标2。从n=34个治疗提供者中确定他们对目前格鲁吉亚药物治疗系统中IDU妇女的做法和看法。目标3。我们将调整和预测试基于强化治疗（RBT）的药物滥用治疗方法，该方法结合了基于证据的妇女合作艾滋病毒预防和格鲁吉亚注射过量妇女的病例管理方法。该目标包括n=16名IDU妇女和n=16名不同焦点小组的提供者，随后n=20名IDU妇女完成预测试。目标4。在一项小型随机试验中（n=128），确定格鲁吉亚RBT模式相对于病例管理模式的可行性和初步疗效，在治疗后和治疗后3个月随访时，它们各自对无保护的性行为频率和注射器共用的影响。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格鲁吉亚艾滋病毒流行的可能性，减缓丙型肝炎病毒传播率的增长，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推广。公共卫生相关性：现在是美国、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的文化背景的适当时机，以便适应和测试针对妇女注射吸毒者的综合治疗模式，以避免格鲁吉亚共和国艾滋病毒流行和丙型肝炎病毒进一步增加。