Combination primary care and prevention services for women who inject drugs and exchange sex in Seattle, Washington

为华盛顿州西雅图注射吸毒和性交的女性提供初级保健和预防相结合的服务

• 批准号: 10681353
• 负责人: Maria Ann Corcorran
• 金额: $ 27.21万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10681353
• 关键词: AIDS prevention; Address; Adherence; Adopted; Adoption; Appointment; Biological; Buprenorphine; Caring; Cessation of life; Client; Clinic; Collaborations; Communities; Consolidated Framework for Implementation Research; Cost Analysis; Cost Effectiveness Analysis; Data; Data Collection; Development; Disease Outbreaks; Drops; Drug usage; Emergency department visit; Environment; Evidence based intervention; Exclusion; Goals; HIV; HIV diagnosis; HIV risk; Hair; Health Services; Health Services Accessibility; Healthcare; Healthcare Systems; Hospitalization; Hour; Inequity; Infection; Infection Control; Injecting drug user; International; Intervention; Interview; Laboratories; Location; Measures; Medical; Methods; Modeling; Needs Assessment; Neighborhoods; Participant; Pathway interactions; Patients; Pharmaceutical Preparations; Population; Prevention; Prevention strategy; Preventive care; Primary Care; Primary Prevention; Provider; Qualitative Research; Risk; Risk Factors; Risk Reduction; Science; Services; Sexual Health; Sexually Transmitted Diseases; Shelter facility; Sleep; Stigmatization; Surveys; Syphilis; Testing; Time; Transact; United States; Walking; Washington; Woman; Work; acceptability and feasibility; addiction; barrier to care; care systems; community engagement; cost effectiveness; design; empowerment; evidence base; experience; female sex worker; gaps in access; health care delivery; health care model; high risk population; housing instability; improved; informant; injection drug use; innovation; low and middle-income countries; marginalization; marginalized population; medication for opioid use disorder; multidisciplinary; novel; opioid overdose; opioid use disorder; overdose death; point of care; point of care testing; pre-exposure prophylaxis; premature; prescription opioid; prevent epidemics; prevention service; preventive intervention; primary care clinic; primary care services; randomized trial; response; screening; sex; social; social stigma; testing services; tool; uptake

ABSTRACT Women account for nearly 20% of new HIV cases in the United States but experience significant barriers to accessing HIV prevention, addiction, and sexual health services. Women who inject drugs (WWID) are particularly vulnerable to HIV due to a combination of social, biologic, and structural risk factors, and women comprise many of the new HIV diagnoses in recent outbreaks among people who inject drugs (PWID). Similarly, WWID are disproportionately impacted by major medical issues requiring hospitalization and leading to premature death, especially when injection drug use is compounded by transactional sex and unstable housing. HIV pre-exposure prophylaxis (PrEP), medications for opiate use disorder (MOUD), and treatment of sexually transmitted infections (STIs) are proven strategies for HIV prevention and addiction treatment among WWID; however, uptake remains low. Our preliminary data suggests that a co-located neighborhood clinic offeringwalk- in appointments dramatically improves uptake of HIV prevention and addiction treatment but does not result in sustained use of these evidenced-based interventions. Globally, delivery of HIV prevention and sexual healthcare at venues for exchange sex is an effectivetool for engaging marginalized populations, such as female sex workers; however, this strategy has not yet been implemented in the U.S. In direct contrast to traditional models of healthcare, an evening, drop-in clinic, co-located at a venue for exchange sex and drug use provides increased opportunity to access care in a client-centered environment. Leveraging a global to local approach, we propose a pilot venue-based pop-up primary and preventative care clinic for WWID. Formative, qualitative research and a bi-directional community engagement plan will inform the adoption of global models for HIV prevention and addiction services (e.g. PrEP, MOUD, STI screening, etc.), with the goal of supporting sustained us of evidence-based interventions. We hypothesize that venue-based care will be acceptable to WWID and improve uptake of preventive care. We also hypothesize that implementation of participant designed support strategies will improve adherence to PrEP, MOUD, and STI treatment. Aim 1 will assess barriers and facilitators to uptake and sustained use of PrEP and MOUD and inform conversations with our community advisory board to adapt a global to local venue-based care model, tested in Aim 2. In Aim 2, we will pilot a venue-based model of care for 50 WWID. Using novel rigorous laboratory science methods, we will measure the impact of venue- based care on sustained use of PrEP and MOUD (Aim 2a), and we will similarly measure the acceptability and feasibility associated with venue-based care for WWID. If successful, our study will provide data on a feasible model of care for reducing HIV acquisition among WWID, which can be assessed for cost-effectiveness and further tested at scale.

摘要 女性占美国新增艾滋病毒病例的近20%，但在 获得艾滋病毒预防、成瘾和性健康服务。注射毒品的女性(WWID)是 由于社会、生物和结构性风险因素的综合作用，特别容易感染艾滋病毒，以及妇女 包括最近在注射吸毒者(PWID)中暴发的许多新的艾滋病毒诊断病例。同样， WWID受到需要住院的重大医疗问题的不成比例的影响，并导致 过早死亡，特别是当注射毒品加上交易性行为和不稳定的住房时。 艾滋病毒暴露前预防(PrEP)、阿片使用障碍药物(Moud)和性传播疾病的治疗 在WWID中，传播感染(STI)是行之有效的艾滋病毒预防和成瘾治疗策略； 然而，吸纳量仍然很低。我们的初步数据显示，同一地点的一家社区诊所提供步行- 预约极大地提高了艾滋病毒预防和成瘾治疗的接受率，但不会导致 持续使用这些循证干预措施。在全球范围内，提供艾滋病毒预防和性服务 性交换场所的医疗保健是吸引边缘化人群(如女性)的有效工具 性工作者；然而，这一策略尚未在美国实施，这与传统的 医疗保健模型，晚上，顺便来看诊所，共同位于一个交流性和药物使用提供的场所 在以客户为中心的环境中增加获得护理的机会。利用全球到地方的方法， 我们建议为WWID设立一个试点地点的弹出式初级和预防性护理诊所。形成性、质量性 研究和双向社区参与计划将为全球艾滋病毒模型的采用提供信息 预防和成瘾服务(如PrEP、Moud、性传播感染筛查等)，目标是支持持续 美国对循证干预的信心。我们假设基于场地的护理将被WWID和 提高预防性护理的接受度。我们还假设实施参与者设计的支持 策略将提高对PrEP、Moud和STI治疗的依从性。目标1将评估障碍和促进者 接受并持续使用PrEP和Moud，并为与我们的社区顾问委员会的对话提供信息 在目标2中，我们将试行基于地点的模式，以适应全球和本地的基于地点的护理模式 关爱50个WWID。使用新颖严谨的实验室科学方法，我们将测量场地的影响- 基于持续使用PrEP和Moud的护理(目标2a)，我们将类似地衡量可接受性和 与基于场地的WWID护理相关的可行性。如果成功，我们的研究将为一种可行的 在世界卫生组织中减少艾滋病毒感染的护理模式，可以从成本效益和 进一步进行了规模测试。