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

项目摘要/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 在注射毒品的人中。艾滋病毒和阿片类药物使用障碍(OUD)的并存表明 对OUD及其感染性并发症的综合治疗有可能改善结果。艾滋病病毒 暴露前预防(PrEP)和阿片类药物使用障碍(Moud)是循证的 推荐给注射吸毒者的方法。不幸的是，这些措施并没有 在现实世界中被广泛采用，或被有风险的人访问。该提案的基础： 合唱干预(全面的艾滋病毒和阿片类药物使用障碍对未解决的综合症患者的反应) 由初步研究提供信息，包括：(A)对患有以下疾病的人进行定量和定性研究 物质使用障碍，(B)同伴提供动机干预的随机对照试验 展示减少海洛因和/或可卡因使用的有效性；和(C)初步研究表明 非传统环境中同伴提供的激励干预的可行性和可接受性。在.期间 在合唱试点阶段，我们发现PrEP是在干预的后期启动的。因此，我们正在 试图通过在基线提供艾滋病毒自我检测(CHOUS+)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 以支持对这些药物的坚持。概念模型：合唱团+是一个基于理论、同行交付、 移动电话支持的干预措施侧重于加强对艾滋病毒PrEP的吸收和遵守(主要 在注射阿片类药物的人中接受Moud(次要结果)。合唱团+旨在 在解决结构性障碍的同时，提高行为技能和自我效能。摘要：当前的提案 寻求确定一种新的干预措施的有效性，以增加对循证措施的接受 预防艾滋病毒和治疗阿片类药物使用障碍。我们会将合唱+干预与常规护理(被动护理)进行比较 转诊)注射阿片类药物的人(目标1)。此外，我们将研究研究的实施情况，以 通过采用混合方法对合唱团+进行进程评估，促进未来的潜在传播(目标2)。这个 研究将在波士顿医疗中心的快速路径诊所进行，这是一种低障碍物质使用障碍 大桥诊所，以及使用流动外展面包车的胜利方案。拟议的干预措施 将从非传统环境中招聘，以接触到可能在办公室不舒服的参与者- 以诊所为基础。该项目专门针对NIDA发展有效的社会行为的使命 采取干预措施，增加对艾滋病毒预防战略的接受，并加快采用循证证据 针对药物使用及其感染性并发症的干预措施。

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.