Implementation of telemedicine and social network driven HIV service uptake for comprehensive HIV service integration in rural syringe service programs

实施远程医疗和社交网络驱动的艾滋病毒服务，将艾滋病毒服务全面纳入农村注射器服务计划

• 批准号: 10682889
• 负责人: Oluwaseun Falade-Nwulia
• 金额: $ 92.04万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10682889
• 关键词: AIDS prevention; Adoption; Africa South of the Sahara; Awareness; Biological Testing; Caring; Communication; Communities; Data; Diagnostic Reagent Kits; Effectiveness; Evidence based intervention; FDA approved; Face; Food; Goals; HIV; HIV diagnosis; HIV risk; HIV/HCV; Health; Health Services Accessibility; Hepatitis C Therapy; High Prevalence; Housing; Human immunodeficiency virus test; Individual; Information Dissemination; Injecting drug user; Intervention; Knowledge; Mediator; Medical; Methods; Modeling; Modification; Needle-Exchange Programs; Network-based; Outcome; Participant; Patient Self-Report; Pharmaceutical Preparations; Population; Provider; Public Health; Questionnaires; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Resources; Risk; Risk Reduction; Rural; Self Efficacy; Service provision; Services; Social Network; Specialist; Structure; Surveys; Telemedicine; Testing; Training; Trust; Work; World Health Organization; addiction; antiretroviral therapy; attentional control; community organizations; comparison control; comparison intervention; effectiveness evaluation; effectiveness/implementation hybrid; empowerment; evidence base; experience; implementation measures; implementation outcomes; implementation process; improved; indexing; innovation; marginalized population; medication for opioid use disorder; member; men who have sex with men; pandemic disease; peer; pragmatic trial; pre-exposure prophylaxis; prevention service; primary outcome; programs; randomized trial; recruit; rural area; scale up; self testing; service programs; service uptake; skills training; social influence; social stigma; telehealth; treatment services; trial design; uptake; virtual

7. PROJECT SUMMARY / ABSTRACT People who inject drugs (PWID) face multilevel barriers to accessing HIV-related services, including low demand for services, resulting from stigma, low knowledge/awareness of services, and prioritization of immediate basic needs (e.g., food, housing, addiction) over remote health concerns. In rural areas, these barriers are exacerbated by service scarcity. Syringe service programs (SSPs), a cornerstone of HIV prevention among PWID, are trusted by this population and have the potential to extend the reach of other evidence-based services (pre-exposure prophylaxis [PrEP], medication for opioid use disorder [MOUD], HIV treatment, etc.). Telemedicine provides a sustainable method to deliver services where they are scarce. We successfully piloted telehealth delivery of HCV treatment and MOUD for PWID at rural SSPs. We will adapt and expand on our telemedicine pilot to bring HIV prevention and treatment services to rural SSPs. However, service availability does not equate to uptake. Social network-based interventions have proven effective in disseminating health information and HIV risk reduction among PWID. Peer-based interventions have an unparalleled potential to overcome stigma and trust barriers in marginalized groups, reach “hidden” group members (i.e., those who do not access services at the SSP), and empower individuals to make positive changes. Low rates of HIV testing and diagnosis among PWID remain a barrier to linkage to antiretroviral therapy initiation (for HIV infected) and PrEP (for HIV-uninfected). A key innovation of our intervention will be to combine dissemination of information with distribution of HIV self-testing kits through PWID networks. HIV self-testing strategies are endorsed by the World Health Organization and have been shown to increase testing coverage and new HIV diagnoses in high prevalence regions of sub-Saharan Africa and among MSM, but have been little explored among PWID. We propose to evaluate a model that leverages peer educators to disseminate HIV self-testing kits and information while also providing peer navigation to network members for HIV prevention and treatment services uptake via telemedicine at rural SSPs We plan a hybrid effectiveness/implementation approach. Aim 1a: We will use a community-engaged approach to adapt a preexisting PWID-focused network intervention to a rural context with the goal of increasing HIV self-testing and HIV service uptake. Aim 1b: We will determine the effectiveness of the intervention compared with an equal-attention control condition, using a rigorous randomized trial design. Aim 2a: In contemplation of adoption and sustainability, we will use mixed methods to characterize implementation processes and outcomes. Aim 2b: to explore intervention mechanisms, we will establish the extent to which SSP and HIV service uptake are related to experiences of social influence and stigma.

7. 项目概要/摘要 注射吸毒者 (PWID) 在获得艾滋病毒相关服务方面面临多层次障碍，包括低收入 由于耻辱、服务知识/意识低以及优先考虑服务而产生的服务需求 眼前的基本需求（例如食物、住房、成瘾）胜过遥远的健康问题。在农村地区，这些 服务匮乏加剧了障碍。注射器服务计划 (SSP)，艾滋病毒的基石 注射吸毒者中的预防，受到该人群的信任，并有可能扩大其他群体的影响范围 循证服务（暴露前预防 [PrEP]、阿片类药物使用障碍药物 [MOUD]、艾滋病毒 治疗等）。远程医疗提供了一种可持续的方法来在缺乏服务的地方提供服务。我们 在农村 SSP 成功试点了针对吸毒者的 HCV 治疗和 MOUD 远程医疗服务。我们会适应 扩大我们的远程医疗试点，为农村小型服务提供商提供艾滋病毒预防和治疗服务。 然而，服务的可用性并不等于接受度。基于社交网络的干预措施已被证明 有效地向吸毒者传播健康信息和减少艾滋病毒风险。基于同伴的干预 具有无与伦比的潜力来克服边缘群体的耻辱和信任障碍，达到“隐藏” 团体成员（即那些没有在 SSP 获得服务的人），并授权个人做出积极的贡献 变化。吸毒者中艾滋病毒检测和诊断率低仍然是与抗逆转录病毒药物联系的障碍 治疗开始（针对 HIV 感染者）和 PrEP（针对 HIV 未感染者）。我们干预措施的一个关键创新是 通过注射吸毒者网络将信息传播与艾滋病毒自我检测工具包的分发结合起来。艾滋病病毒 自我测试策略得到了世界卫生组织的认可，并已被证明可以增加测试 撒哈拉以南非洲高流行地区和 MSM 的覆盖率和新的艾滋病毒诊断，但是 在注射吸毒者中很少有人对此进行探讨。我们建议评估一个利用同伴教育者的模型 传播艾滋病毒自我检测套件和信息，同时提供网络同行导航 农村 SSP 通过远程医疗获得艾滋病毒预防和治疗服务的成员 我们计划采用混合有效性/实施方法。目标 1a：我们将采用社区参与的方法 使现有的以吸毒者为中心的网络干预措施适应农村环境，以提高艾滋病毒感染率 自我检测和艾滋病毒服务的采用。目标 1b：我们将确定比较干预措施的有效性 在同等关注的控制条件下，采用严格的随机试验设计。目标 2a：考虑到 采用和可持续性，我们将使用混合方法来描述实施过程和 结果。目标 2b：为了探索干预机制，我们将确定 SSP 和 HIV 的影响程度 服务的接受与社会影响和耻辱的经历有关。