PrEP and MOUD Rapid Access for Persons who Inject Drugs: the CHORUS+ Study

注射毒品者的 PrEP 和 MOUD 快速获取：CHORUS 研究

• 批准号: 10682181
• 负责人: Sabrina A Assoumou
• 金额: $ 95.29万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10682181
• 关键词: AIDS prevention; Acceleration; Address; Adherence; Adopted; Adoption; Affect; Automobile Driving; Behavior Therapy; Behavioral; Biometry; Blood; Boston; Buprenorphine; Caring; Cellular Phone; Clinic; Clinical Laboratory Improvement Amendments; Communicable Diseases; Communities; Control Groups; County; Data; Diphosphates; Dose; Drug user; Dryness; Effectiveness; Enrollment; Epidemic; Evaluation; Evidence based intervention; Foundations; Future; Goals; HIV; HIV risk; Home; Human; Human immunodeficiency virus test; Immunologic Deficiency Syndromes; Individual; Infection; Injecting drug user; Intervention; Laboratories; Measures; Medical; Medical center; Methadone; Methods; Mission; Modeling; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Participant; Patients; Persons; Pharmaceutical Preparations; Pharmacy facility; Phase; Pilot Projects; Population; Populations at Risk; Prevention strategy; Privacy; Public Health; Qualitative Methods; Qualitative Research; Randomized; Randomized, Controlled Trials; Recommendation; Records; Recovery; Research; Research Methodology; Self Efficacy; Self Perception; Site; Social Behavior; Spottings; Substance Use Disorder; Tenofovir; Testing; Training; Treatment Efficacy; United States National Institutes of Health; Venous blood sampling; Walking; acceptability and feasibility; addiction; arm; care fragmentation; cocaine use; contextual factors; efficacy evaluation; evidence base; experimental study; heroin use; improved; improved outcome; informant; interest; long term recovery; medication for opioid use disorder; mortality; motivational enhancement therapy; motivational intervention; multidisciplinary; novel; opioid epidemic; opioid overdose; opioid use disorder; outreach; participant interview; peer; peer coaching; peer recovery; pilot test; point of care; pre-exposure prophylaxis; prevent; primary outcome; process evaluation; programs; rapid test; rapid testing; recruit; response; scale up; secondary outcome; self testing; skills; social stigma; substance use; syndemic; theories; therapy development; treatment as usual; trial design; uptake

PROJECT SUMMARY / ABSTRACT The US opioid overdose epidemic has been accompanied by an increase in human immunodeficiency (HIV) among persons who inject drugs. The co-occurrence of HIV and opioid use disorder (OUD) suggests that a comprehensive approach to OUD and its infectious complications has the potential to improve outcomes. HIV pre-exposure prophylaxis (PrEP) and medication for opioid use disorder (MOUD) are evidence-based approaches that are recommended for persons who inject drugs. Unfortunately, these measures have not been widely adopted in real-world settings or accessed by persons at-risk. Foundation for the Proposal: The CHORUS intervention (Comprehensive HIV and Opioid use disorder Response to the Unaddressed Syndemic) is informed by preliminary research, including: (a) quantitative and qualitative research with persons with substance use disorder, (b) a randomized controlled trial of a peer-delivered motivational intervention demonstrating effectiveness in reducing heroin and/or cocaine use, and (c) preliminary studies demonstrating the feasibility and acceptability of peer-delivered motivational interventions in non-traditional settings. During the CHORUS pilot phase, we uncovered that PrEP was initiated late in the intervention. Therefore, we are attempting to accelerate PrEP initiation by providing HIV self-testing (CHORUS +) at baseline. The CHORUS+ intervention includes HIV self-testing, rapid initiation of PrEP and MOUD, and a 6-month peer recovery coach to support adherence to these medications. Conceptual Model: CHORUS+ is a theory-based, peer-delivered, mobile phone-supported intervention focused on enhancing uptake and adherence to HIV PrEP (primary outcome), and receipt of MOUD (secondary outcome) among persons who inject opioids. CHORUS+ aims to improve behavioral skills and self-efficacy while addressing structural barriers. Summary: The current proposal seeks to determine the efficacy of a novel intervention to increase the uptake of evidence-based measures to prevent HIV and treat opioid use disorder. We will compare the CHORUS+ intervention to usual care (passive referral) among persons who inject opioids (aim 1). In addition, we will examine study implementation to facilitate potential future dissemination using a mixed-methods process evaluation of CHORUS+ (aim 2). The study will be performed at Boston Medical Center’s Faster Paths clinic, a low-barrier substance use disorder bridge clinic, and through Victory Programs, which utilizes a mobile outreach van. The proposed intervention will recruit from non-traditional settings in order to reach participants who might not be comfortable in office- based clinics. This project specifically addresses NIDA’s mission of developing effective socio-behavioral interventions to increase uptake of HIV prevention strategies, and accelerating the adoption of evidence-based interventions to address substance use and its infectious complications.

项目总结/摘要 美国阿片类药物过量流行伴随着人类免疫缺陷病毒（HIV）的增加 注射毒品的人。艾滋病毒和阿片类药物使用障碍（OUD）的共同发生表明， OUD及其感染并发症的综合治疗有可能改善结局。艾滋病毒 暴露前预防（PrEP）和阿片类药物使用障碍（MOUD）的药物治疗是基于证据的 建议注射吸毒者采用的方法。不幸的是，这些措施没有 在现实世界中被广泛采用或被处于危险中的人访问。提案的基础： CHORUS干预（艾滋病毒和阿片类药物使用综合障碍对未解决的综合征的反应） 通过初步研究提供信息，包括：（a）对患有糖尿病的人进行定量和定性研究， 物质使用障碍，（B）一项同伴传递激励干预的随机对照试验 证明在减少海洛因和/或可卡因使用方面的有效性，以及（c）初步研究表明， 在非传统环境中，同侪提供的激励性干预措施的可行性和可接受性。期间 在CHORUS试点阶段，我们发现PrEP是在干预后期启动的。因此我们 试图通过在基线时提供HIV自我检测（CHORUS +）来加速PrEP启动。合唱团+ 干预措施包括艾滋病毒自我检测，快速启动PrEP和MOUD，以及为期6个月的同伴康复教练 来支持对这些药物的坚持。概念模型：CHORUS+是一个以理论为基础，同行交付， 移动的电话支持的干预措施侧重于提高对艾滋病毒PrEP（初级 结果），以及注射阿片类药物的人中MOUD（次要结果）的接收。合唱团+的目标是 提高行为技能和自我效能，同时解决结构性障碍。摘要：目前的提案 旨在确定一种新的干预措施的有效性，以增加基于证据的措施的采用， 预防艾滋病毒和治疗阿片类药物使用障碍。我们将比较CHORUS+干预与常规护理（被动 在注射阿片类药物者中（目标1）。此外，我们亦会检讨研究的推行情况， 利用对CHORUS+的混合方法过程评价，促进未来可能的传播（目标2）。的 研究将在波士顿医学中心的快速路径诊所进行，这是一种低障碍物质使用障碍， 桥梁诊所，并通过胜利方案，利用移动的外展货车。拟议的干预 将从非传统环境中招募人员，以接触那些可能在办公室不舒服的参与者- 基于诊所该项目专门针对NIDA的使命，即开发有效的社会行为 采取干预措施，以增加艾滋病毒预防战略的采用，并加快采用循证 采取干预措施，解决药物使用及其感染并发症。