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 在美国，妇女占艾滋病毒新发病例的近20%，但在感染艾滋病毒方面面临重大障碍。 获得艾滋病毒预防、成瘾和性健康服务。注射毒品的妇女（WWID） 由于社会、生物和结构性风险因素的结合， 包括最近在注射毒品者（PWID）中爆发的许多新的艾滋病毒诊断。同样地， WWID受到需要住院治疗的重大医疗问题的不成比例的影响， 过早死亡，特别是在注射吸毒加上性交易和住房不稳定的情况下。 艾滋病毒暴露前预防（PrEP），阿片类药物使用障碍（MOUD）和性行为治疗 经证实，传播感染是在吸毒成瘾者中预防艾滋病毒和治疗成瘾的战略; 然而，吸收率仍然很低。我们的初步数据显示一个提供步行服务的社区诊所- 在预约中大大提高了艾滋病毒预防和成瘾治疗的接受率， 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 性交易场所的卫生保健是吸引边缘化人群（如女性）参与的有效工具 性工作者;然而，这一战略尚未在美国实施。 医疗保健模式，一个晚上，下降诊所，共同设在一个场所，交换性和毒品使用提供 在以客户为中心的环境中获得护理的机会增加。利用从全球到地方的方法， 我们提出了一个试点场地为基础的弹出初级和预防保健诊所的WWID。形成性、质量性 研究和双向社区参与计划将为采用全球艾滋病毒模型提供信息 预防和成瘾服务（如PrEP、MOUD、性传播感染筛查等），目标是支持持续的 我们的循证干预。我们假设基于场地的护理将被WWID接受， 提高预防保健的利用率。我们还假设，参与者设计的支持， 这些策略将改善PrEP、MOUD和STI治疗的依从性。目标1将评估障碍和促进因素 吸收和持续使用PrEP和MOUD，并与我们的社区咨询委员会进行对话 调整全球到本地的基于场所的护理模式，在目标2中进行了测试。在目标2中，我们将试行以场地为基础的模式 关注50个WWID使用新的严格的实验室科学方法，我们将测量场地的影响- 基于持续使用PrEP和MOUD（目标2a）的护理，我们将同样衡量可接受性， 可行性与场地为基础的照顾WWID。如果成功，我们的研究将提供一个可行的数据， 减少艾滋病毒感染者的护理模式，可以评估其成本效益， 在规模上进一步测试。