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

一种促进注射吸毒者循证艾滋病毒预防的自下而上的新方法

• 批准号: 8486410
• 负责人: Jill Owczarzak
• 金额: $ 0.84万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-06-15 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8486410
• 关键词: AIDS prevention; Accountability; Accounting; Address; Adult; Affective; Behavior; Behavior Therapy; Behavioral; Characteristics; Cities; Cognitive; Country; Data; Drug usage; Drug user; Eastern Europe; Educational process of instructing; Effectiveness; Effectiveness of Interventions; Elements; Epidemic; Equipment; Evidence based intervention; Face; Guidelines; HIV; HIV Infections; HIV risk; Information Dissemination; Injecting drug user; Injection of therapeutic agent; International; Intervention; Interview; Life; Methods; Modeling; Monitor; Needle-Exchange Programs; Needles; Nongovernmental Organizations; Participant; Policies; Population; Populations at Risk; Prevalence; Prevention; Prevention strategy; Preventive Intervention; Problem Solving; Process; Program Development; Program Evaluation; Provider; Public Health; Publishing; Qualitative Methods; Research Infrastructure; Resource Allocation; Resources; Risk; Risk Assessment; Risk Behaviors; Risk Reduction; Role; Science; Services; Shapes; Solutions; Sterility; Sustainable Development; Target Populations; Training; Ukraine; Variant; Virus; Work; base; behavior change; effective intervention; evidence base; experience; improved; injection drug use; innovation; meetings; novel; outreach; primary outcome; programs; response; skills; theories; therapy development

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.

描述（由申请人提供）：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%的成年人携带病毒，某些地区的吸毒者中估计有33%的流行率。注射吸毒者占乌克兰艾滋病毒新病例的36%。最近，国际、政府和非政府机构之间开展了合作努力，以扩大乌克兰替代疗法和针头/注射器交换方案的可及性。然而，这些针对注射吸毒者的方案仍然存在系统和立法障碍。此外，虽然提供无菌注射设备很重要，而且已证明可以减少注射吸毒者中新的艾滋病毒感染，但单靠这类方案并不能解决吸毒者中的艾滋病毒性风险。因此，需要扩大目前在乌克兰注射吸毒者中开展的艾滋病毒预防工作，以包括循证战略，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，并解决吸毒者面临的多种艾滋病毒风险。 鼓励服务提供者提供循证干预措施的努力侧重于忠实于“核心要素”的实施，或被认为对每项干预措施的有效性负责的具体组成部分。虽然有150多项独特的干预措施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，这些干预措施纳入了有效干预措施的共同因素：认知、情感和行为技能建设;量身定制的特定行为内容;以及解决行为改变的环境障碍。 这项为期4年的RO 1研究旨在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战略的使用。本研究结合定性和定量方法，探索艾滋病毒预防科学传播和干预措施发展的模型，该模型1）促进有效行为风险降低干预措施的共同因素（而不是特定于干预措施的核心要素）的传播;和2）使服务提供商能够制定反映其特定组织背景的艾滋病毒预防干预措施。7-9非政府组织，位于乌克兰艾滋病毒和毒品使用率最高的地区，并被选为代表关键组织背景标准（例如，机构规模、目标人群、艾滋病毒预防经验），将教授有效干预措施的共同因素，作为制定干预措施的基础。培训结束后，我们将使用定性方法，包括与非政府组织工作人员的访谈，记录每个机构的干预措施制定和实施过程。然后，使用观察，定性访谈，实施检查表和风险评估，我们将记录干预措施的实施，以评估包括共同因素;方案交付的各个方面，包括范围和范围;和有效性。主要的定性分析将审查干预措施的发展，交付和有效性之间的关系在每个非政府组织和定性数据的服务提供者的特点。我们还将比较和对比机构的共同因素和干预有效性方面的相似性和差异性的背景下，干预实施。