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

结构性和系统级干预措施对社会工作者中艾滋病毒/性传播感染和药物过量流行的影响

• 批准号: 9926658
• 负责人: Shira Miriam Goldenberg
• 金额: $ 53.87万
• 依托单位: UNIVERSITY OF BRITISH COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9926658
• 关键词: Address; Advocacy; Area; Bedside Testings; British Columbia; Communities; Data; Data Collection; Databases; Drug usage; Drug user; Epidemic; Exposure to; Face; Goals; Government; Guidelines; HIV; HIV Seronegativity; HIV/HCV; HIV/STD; Health Insurance; Health Personnel; Healthcare; Incidence; Individual; Intervention; Measures; Naloxone; North America; Opiate Addiction; Outcome; Overdose; Pharmaceutical Preparations; Police; Policies; Population; Prevalence; Prevention; Questionnaires; Reporting; Research; Risk; Role; Serologic tests; Services; Site; Social Health Services; Structure; System; Testing; Time; United States National Institutes of Health; Violence; Woman; Work; addiction; administrative database; base; behavioral/social science; cohort; community intervention; comorbidity; comparison intervention; empowerment; evidence base; female sex worker; improved; mortality; novel; opioid epidemic; opioid misuse; opioid use; overdose prevention; peer; point of care; prevention service; programs; prospective; recruit; response; screening; sensitivity training; service utilization; sex; transmission process

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.

项目概要/摘要 这种竞争性更新的目标是评估两种“自然发生”干预措施的影响 - 社区赋权 (CE) 和警务实践的变化 - 关于艾滋病毒/性传播感染的发生率、服药过量 (OD)、 加拿大城市街头和室内性工作者 (SW) 参与成瘾服务的情况 环境。目前，缺乏针对同时发生的危害的综合干预措施的研究。 艾滋病毒/性传播感染和服药过量流行病，特别是在性工作者中，她们面临着不成比例的艾滋病毒和性传播感染 负担和获得基于证据的成瘾服务方面的严重差距。在结构和系统层面 诸如CE等干预措施和警务实践的改变具有减轻相关危害的巨大潜力 由于艾滋病毒/性传播感染和药物过量流行重叠，仍然缺乏关于如何实施的数据 此类干预措施影响艾滋病毒/性传播感染和服药过量的发生率以及对成瘾服务的参与 性工作者。从 2018 年开始，不列颠哥伦比亚省大温哥华地区启动了一项新颖的 CE 干预措施 包括： 对等导航；同行提供的纳洛酮和护理点 (POC) HIV/STI 筛查；和 系统级医疗保健提供者敏感性培训。应对针对社会工作者和社会工作者的高暴力行为 为了推动宣传工作，大温哥华地区的两个警务管辖区目前正在实施新的指导方针 不骚扰和逮捕社会工作者。 “自然发生的”结构和系统层面的干预措施都提供了 及时评估其单独和综合效果的机会。通过 R01，我们的团队招募了 自 2010 年以来，对大温哥华地区超过 800 名街头和非街头女性社会工作者进行了跟踪调查，其中 艾滋病毒/性传播感染和非致命性 OD 的发病率仍然高得惊人。我们建议利用稀有的 通过解决以下问题来评估“自然发生的”行政执法和当地警务干预措施的机会 温哥华大都会社区的前瞻性目标是：(1) 检查组合 CE 的效果 对 HIV/STI 和 OD 发病率的干预以及参与 OD 预防和服务； (2) 评估 基于同伴的 HIV/STI 护理点 (POC) 筛查 HIV/STI 的可行性、可接受性和实施情况 发生率及其与成瘾治疗的联系； (3) 衡量新的警察执法实践对使用的影响 成瘾服务以及艾滋病毒/性传播感染和服药过量的发生率，包括 CE 前后的潜在差异 执行; (4) 评估结构性和系统级CE和治安的综合影响 对 HIV/STI 和 OD 发病率的干预措施。为了实现这些目标，我们将继续跟踪和补充 AESHA 队列由 800 名 HIV 血清阴性女性 SW 组成，这是该国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调查问卷、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。艾滋病毒/性传播感染、阿片类药物使用和 OD 等综合症 在北美的社会工作者和残疾人士中，这项研究将为联合干预措施提供信息，以减少 边缘化人群中艾滋病毒/性传播感染和 OD 的发病率。