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

描述（由申请人提供）：塔吉克斯坦和其他中亚共和国正在经历由注射毒品驱动的艾滋病毒流行。拟议的3年R34项目将试点测试结构性干预的可行性，以将塔吉克斯坦的针头和注射器项目（NSP）客户从高死腔针头和注射器转换为低死腔针头和注射器。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，这种干预措施可以大大减少艾滋病毒在注射毒品者（PWID）中的传播。在数学模型中，这样的干预将首先防止PWID中与注射相关的HIV流行病的发生，并逆转已经发生的与注射相关的流行病。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毒的发病率。拟议的项目将采用一种综合预防方法，与NSP（结构性干预）一起分发低死腔针头和注射器（生物医学设备/干预）。我们的努力，以促进采用和低死腔针头和注射器的扩散将通知创新理论的扩散。这项研究的结果将决定是否有意义设计和实施一项昂贵的随机对照试验（RCT），以艾滋病毒发病率作为结果来测试这种干预措施。拟议的试点测试将在位于塔吉克斯坦Kulyob和Khorog的两个NSP进行。这些NSP只分发高死腔针头和注射器。Kulyob和Khorog的艾滋病毒感染率分别为24%和14%。拟议研究的具体目标如下：目标1。对塔吉克斯坦的NSP患者从高死腔针头和注射器转换为低死腔针头和注射器的结构性干预的可行性进行试点测试。 目标二。通过将试点试验的结果纳入预测性数学模型，评估这种干预措施的潜在影响，该模型预测了注射器类型对艾滋病毒在PWID中传播的影响。如果我们发现干预是可行的，并且模型表明它会产生实质性的影响，我们将设计一个完整的RCT，以艾滋病发病率作为结果来测试干预。

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.