Impacts of structural and system-level interventions on HIV/STI and overdose epidemics among SWs
Impacts of structural and system-level interventions on HIV/STI and overdose epidemics among SWs
批准号:
9926658
负责人:
Shira Miriam Goldenberg
金额:
$53.87万
依托单位国家:
美国
项目类别:
财政年份:
2010
资助国家:
美国
项目状态:
未结题
起止时间:
2010-07-15 至 2025-03-31
关键词:
AddressAdvocacyAreaBedside TestingsBritish ColumbiaCommunitiesDataData CollectionDatabasesDrug usageDrug userEpidemicExposure toFaceGoalsGovernmentGuidelinesHIVHIV SeronegativityHIV/HCVHIV/STDHealth InsuranceHealth PersonnelHealthcareIncidenceIndividualInterventionMeasuresNaloxoneNorth AmericaOpiate AddictionOutcomeOverdosePharmaceutical PreparationsPolicePoliciesPopulationPrevalencePreventionQuestionnairesReportingResearchRiskRoleSerologic testsServicesSiteSocial Health ServicesStructureSystemTestingTimeUnited States National Institutes of HealthViolenceWomanWorkaddictionadministrative databasebasebehavioral/social sciencecohortcommunity interventioncomorbiditycomparison interventionempowermentevidence basefemale sex workerimprovedmortalitynovelopioid epidemicopioid misuseopioid useoverdose preventionpeerpoint of careprevention serviceprogramsprospectiverecruitresponsescreeningsensitivity trainingservice utilizationsextransmission process
中文摘要
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。
英文摘要
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.
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Impacts of structural and system-level interventions on HIV/STI and overdose epidemics among SWs
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批准号:10376758
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项目类别:
-
资助金额:$53.87万
-
财政年份:2010
-
负责人:Shira Miriam Goldenberg
-
依托单位:
Impacts of structural and system-level interventions on HIV/STI and overdose epidemics among SWs
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批准号:10597053
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项目类别:
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资助金额:$53.93万
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财政年份:2010
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负责人:Shira Miriam Goldenberg
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依托单位:
海外基金