Pilot Test of an Intervention to Change Syringes Used by Injecting Drug Users

说明（由申请人提供）：塔吉克斯坦和其他中亚共和国正在经历注射吸毒导致的艾滋病毒流行。拟议的为期3年的R34项目将试点测试一项结构性干预措施的可行性，以将塔吉克斯坦的针头和注射器计划（NSP）客户从高死区转向低死区针头和注射器。来自实验室实验、生物行为调查、生态学研究和数学模型的间接证据表明，这种干预可以大大减少注射吸毒者（PWID）之间的艾滋病毒传播。在数学模型中，这种干预措施将首先防止与注射有关的艾滋病毒流行病在艾滋病毒感染者中发生，并防止已经发生的与反向注射有关的流行病。然而，没有人知道这种干预是否可行，或者它是否真的会降低艾滋病发病率。拟议的项目将采用与NSP（结构性干预）相结合的预防方法，分发低死区针头和注射器（生物医学设备/干预）。我们为促进低死区空间针头和注射器的采用和推广所作的努力将以创新扩散理论为指导。这项研究的结果将决定设计和实施一项昂贵的随机对照试验（RCT），将艾滋病发病率作为测试这种干预措施的结果是否有意义。拟议的试点测试将在位于塔吉克斯坦库廖布和霍罗格的两个国家安全中心进行。这些国家安全机构只分发高死亡空间针头和注射器。库廖布的艾滋病毒感染率为24%，霍罗格为14%。本研究的具体目的如下：目的1。试点测试结构干预的可行性，将塔吉克斯坦的NSP客户从高死区切换到低死区针头和注射器。目标2。通过将试点试验的结果纳入我们的注射器类型对PWID中HIV传播影响的预测数学模型，评估这种干预措施的潜在影响。如果我们发现干预是可行的，并且模型表明它将产生实质性影响，我们将设计一个完整的随机对照试验，以艾滋病毒发病率作为结果来测试干预措施。

DESCRIPTION (provided by applicant): Tajikistan and the other Central Asian Republics are experiencing HIV epidemics that are driven by injecting drug use. The proposed 3-year R34 project will pilot test the feasibility of a structural intervention to switch needle and syringe program (NSP) clients in Tajikistan from high dead space to low dead space needles and syringes. Circumstantial evidence from laboratory experiments, biobehavioral surveys, ecological studies, and mathematical models suggests that such an intervention could substantially reduce HIV transmission among people who inject drugs (PWID). In mathematical models, such an intervention would prevent injection- related HIV epidemics among PWID from occurring in the first place and reverse injection-related epidemics that have occurred. However, no one knows whether such an intervention is feasible or whether it would actually reduce HIV incidence. The proposed project will use a combination prevention approach that works with NSP (structural intervention) to distribute low dead space needles and syringes (biomedical device/intervention). Our efforts to promote the adoption and diffusion of low dead space needles and syringes will be informed by Diffusion of Innovations Theory. Findings from the study will determine whether it makes sense to design and implement an expensive randomized controlled trial (RCT) with HIV incidence as an outcome to test such an intervention. The proposed pilot test will be conducted at two NSP that are located in Kulyob and Khorog, Tajikistan. These NSP distribute only high dead space needles and syringes. HIV prevalence among PWID is 24% in Kulyob and 14% in Khorog. The specific aims of the proposed study are as follows: Aim 1. To pilot test the feasibility of a structural intervention to switch NSP client in Tajikistan from high dead space to low dead space needles and syringes. Aim 2. To evaluate the potential impact of such an intervention by incorporating findings from the pilot test into ou predictive mathematical model of the effects of syringe type on HIV transmission among PWID. If we find that the intervention is feasible and the model suggests that it would have substantial impact, we will design a full RCT to test the intervention using HIV incidence as an outcome.