Impacts of structural and system-level interventions on HIV/STI and overdose epidemics among SWs

项目概要/摘要 这种相互竞争的更新的目标是评估两种“自然发生的”干预措施的影响- 社区赋权和警务做法的变化-艾滋病毒/性传播感染、吸毒过量、 在加拿大城市的街头和室内性工作者（SW）中参与成瘾服务 设置.目前，缺乏关于综合干预措施的研究，以解决与艾滋病毒/艾滋病相关的共同发生的危害。 艾滋病毒/性传播感染和用药过量流行病，特别是性工作者，他们面临着不成比例的艾滋病毒和性传播感染 在获得循证戒毒服务方面的负担和严重差距。虽然结构和系统层面 CE等干预措施和警务实践的变化具有很大的潜力，可以减轻相关危害 由于艾滋病毒/性传播感染和药物过量流行病相互重叠，关于如何实施 这些干预措施的实施对艾滋病毒/性传播感染和吸毒过量的发生率以及对戒毒服务的参与产生了影响， 性工作者从2018年开始，在不列颠哥伦比亚省的大温哥华启动了一项新颖的CE干预措施 包括：同伴导航;同伴提供的纳洛酮和护理点（POC）艾滋病毒/性传播感染筛查;以及 系统级医疗保健提供者敏感性培训。针对针对性工作者和性工作者的暴力行为高发率， 在宣传工作中，两个大温哥华警务管辖区目前正在实施新的指导方针， 不骚扰和逮捕SW。“自然发生的”结构和系统一级的干预提供了 这是一个及时的机会来评估其单独和综合影响。通过R 01，我们的团队招募了 自2010年以来，在温哥华大都会对800多名街头和非街头女性SW进行了跟踪调查，其中 艾滋病毒/性传播感染和非致命性吸毒过量发病率仍然高得惊人。我们打算利用 通过解决以下问题，有机会评估“自然发生的”社区教育和地方治安干预措施 在温哥华的SW中进行前瞻性研究的目的：（1）检查组合CE的影响 艾滋病毒/性传播感染和吸毒成瘾发病率的干预措施，以及参与吸毒成瘾预防和服务的情况;（2）评估 基于同伴的艾滋病毒/性传播感染护理点艾滋病毒/性传播感染筛查的可行性、可接受性和实施情况 （3）衡量新的警察执法做法对吸毒的影响 成瘾服务和艾滋病毒/性传播感染和药物过量的发生率，包括CE前后的潜在差异 实施;（4）评估暴露于结构和系统级CE和警务的综合影响 艾滋病毒/性传播感染和吸毒成瘾发病率的干预措施。为达致这些目标，我们会继续跟进及补充 800名HIV血清阴性女性SW的AESHA队列，这是唯一正在进行的纵向SW队列， 北美数据收集将包括半年一次的问卷调查、艾滋病毒/性传播感染血清学和行政管理。 与外部警务和死亡率数据库的联系。在艾滋病毒/性传播感染、阿片类药物使用和吸毒过量的综合征中 在北美的SW和PWUD中，这项研究将为联合干预提供信息， 边缘化人群中艾滋病毒/性传播感染和吸毒过量的发病率。

PROJECT SUMMARY/ABSTRACT The goal of this competing renewal is to evaluate impacts of two `naturally occurring' interventions - community empowerment (CE) and changes in policing practices - on incidence of HIV/STIs, overdose (OD), and engagement with addiction services among street and indoor sex workers (SWs) in an urban Canadian setting. Currently, there is a lack of research on integrated interventions to address co-occurring harms related to HIV/STI and overdose epidemics, particularly among sex workers, who face disproportionate HIV and STI burdens and severe gaps in access to evidence-based addiction services. While structural and system-level interventions such as CE and changes in policing practices have strong potential to mitigate harms associated with overlapping HIV/STI and overdose epidemics, there remains a scarcity of data on how the implementation of such interventions impacts HIV/STI and overdose incidence and engagement with addiction services among sex workers. Beginning in 2018, a novel CE intervention was launched in Metro Vancouver, British Columbia comprised of: peer navigation; peer-delivered naloxone and point-of-care (POC) HIV/STI screening; and system-level healthcare provider sensitivity training. In response to high rates of violence against SWs and SW advocacy efforts, two Metro Vancouver policing jurisdictions are currently implementing new guidelines for non-harassment and arrest of SWs. Both `naturally occurring' structural and system-level interventions provide a timely opportunity to evaluate their individual and combined effects. Through an R01, our team has recruited and followed a cohort of >800 street and off-street women SWs in Metro Vancouver since 2010, among whom incidence of HIV/STIs and non-fatal OD remain alarmingly high. We propose to take advantage of the rare opportunity to evaluate `naturally-occurring' CE and local policing interventions by addressing the following aims prospectively amongst SWs in Metro Vancouver: (1) Examine the effects of a combination CE intervention on HIV/STI and OD incidence and engagement with OD prevention and services; (2) Evaluate the feasibility, acceptability, and implementation of peer-based HIV/STI point-of-care (POC) screening on HIV/STI incidence and linkage to addiction treatment; (3) Measure impacts of new police enforcement practices on use of addiction services and incidence of HIV/STIs and overdose, including potential differences pre/post CE implementation; (4) Evaluate combined effects of exposure to structural and system-level CE and policing interventions on HIV/STI and OD incidence. To achieve these aims, we will continue to follow and replenish the AESHA cohort of 800 HIV-seronegative women SWs, which is the only ongoing longitudinal SW cohort in North America. Data collection will include semi-annual questionnaires, HIV/STI serology, and administrative linkages to external policing and mortality databases. Amidst syndemics of HIV/STIs, opioid use, and OD among SWs and PWUD in North America, this study will inform combination interventions to reduce the incidence of HIV/STIs and OD amongst marginalized populations.