Reducing HIV-related Intersectional Stigma and Risk among People who Inject Drugs in a High Risk International Setting

减少高风险国际环境中注射吸毒者与艾滋病毒相关的交叉耻辱和风险

• 批准号: 10762623
• 负责人: Laramie Rae Smith
• 金额: $ 30.14万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 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 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762623
• 关键词: Abstinence; Acceleration; Address; Adopted; Automobile Driving; Awareness; Behavior; Capital; Caring; Central Asia; Cities; Client; Clinic; Communities; Data; Drug Addiction; Drug usage; Eastern Europe; Effectiveness; Effectiveness of Interventions; Epidemic; Future; Geography; Goals; HIV; HIV Seropositivity; HIV diagnosis; HIV risk; Health; Health Personnel; Health care facility; Hearing; Human immunodeficiency virus test; Hybrids; Incidence; Injecting drug user; Injections; International; Intervention; Intervention Studies; Kyrgyzstan; Left; Measures; Methadone; Methods; Modeling; National Institute of Drug Abuse; Needle-Exchange Programs; Outcome; Persons; Pharmacotherapy; Policies; Population; Practical Robust Implementation and Sustainability Model; Prevention; Randomized; Reporting; Research Design; Risk; Risk Behaviors; Risk Reduction; Services; Stigmatization; Syringes; Technology; Testing; Time; Waiting Lists; Work; antiretroviral therapy; control trial; cost; design; drug maintenance; evidence base; experience; follow-up; high risk; implementation outcomes; implementation science; implementation strategy; implementation/effectiveness; improved; injection drug use; innovation; methadone treatment; opioid use disorder; post intervention; pre-exposure prophylaxis; prevent; research to practice; response; scale up; service uptake; social stigma; standard of care; transmission process; treatment arm; treatment as prevention; treatment services; uptake

PROJECT SUMMARY/ABSTRACT Stigma is a pervasive barrier to preventing HIV among persons who inject drugs (PWID). Kyrgyzstan is part of the world’s most rapidly expanding HIV epidemic in the Eastern Europe and Central Asia (EECA) region, where HIV is predominantly concentrated among PWID. Our previous work with PWID in Kyrgyzstan found experiences of HIV, drug use, and drug treatment (i.e. methadone) stigmas were associated with greater HIV risk behavior and low use of evidence-based HIV services, including syringe service programs (SSP) and methadone to treat opioid use disorder (MMT), which limited, timely HIV diagnoses. Following the launch of pre-exposure prophylaxis (PrEP) services in Kyrgyzstan, PrEP awareness increased among PWID with limited uptake but was not associated with stigma suggesting integrating PrEP referrals in stigma reduction programming may increase PWIDs engagement in PrEP and other evidence-based HIV services. Yet there is little to no evidence base on the potential effectiveness and implementation needs of evidence-based stigma reduction strategies that address HIV-related intersectional stigma at multiple levels with PWID in the EECA region. In line with NIDA and OAR priorities, the long-term goal is to rapidly advance evidence-based stigma mitigation efforts among PWID to improve HIV service uptake and turn the tide on the rapidly expanding EECA HIV epidemic. To achieve this goal, the current study will use the ADAPT-ITT model to adapt and refine effective community-level and health facility-level HIV stigma reduction strategies to intervene on intersecting drug use, MMT, and HIV stigma in the local context among PWID and MMT clinic staff (AIM 1). We will pilot the resulting multilevel stigma reduction intervention – LIFT – using a randomized waitlist control trial study design to evaluate the preliminary effectiveness of the LIFT intervention on stigma reduction and MMT/PrEP use (AIM 2) among 68 PWID and all staff from two MMT clinics. In parallel, a sequential mixed methods design will evaluate LIFT implementation outcomes and needs among our local implementation partners and 25 key stakeholders (AIM 3) to develop implementation strategies that can accelerate the pace and scale up of EECA stigma reduction efforts. To reduce risk of contamination via injection and treatment networks, we will conduct all community- and health facility-level intervention and waitlist control activities in distinct geographic districts in the capital city of Bishkek. This R34 pilot is the first EECA study to evaluate intersectional stigma mitigation efforts among PWID to reduce HIV transmission risk. This R34 is significant because stigma remains a fundamental driver of HIV transmission globally. This R34 pilot is highly innovative because it extends the current state of HIV stigma intervention research by integrating strategies that target intersecting stigmas at multiple levels to improve the impact of evidence-based HIV services and advance the use of implementation science models, methods, and measures to accelerate our understanding of how to close the stigma reduction research to practice gap.

项目总结/摘要 污名是注射毒品者预防艾滋病毒的普遍障碍。吉尔吉斯斯坦是 东欧和中亚地区是世界上艾滋病毒蔓延最快的地区， 艾滋病毒主要集中在艾滋病感染者中。我们以前在吉尔吉斯斯坦与PWID的工作发现了经验， 艾滋病毒，吸毒和药物治疗（即美沙酮）的耻辱与更大的艾滋病毒风险行为有关 基于证据的艾滋病毒服务使用率低，包括注射器服务计划（SSP）和美沙酮治疗 阿片类药物使用障碍（MMT）限制了及时的艾滋病毒诊断。继推出预曝光后 在吉尔吉斯斯坦的预防（PrEP）服务中，PWID的PrEP意识有所提高，但吸收有限， 与污名无关，表明将PrEP转介纳入减少污名的规划可能会增加 艾滋病毒感染者参与PrEP和其他循证艾滋病毒服务。然而，几乎没有证据表明 以证据为基础的减少污名战略的潜在有效性和执行需求， 在EECA区域，与艾滋病毒感染者协会一起在多个层面解决与艾滋病毒有关的交叉污名问题。 根据NIDA和OAR的优先事项，长期目标是迅速推进基于证据的污名缓解 艾滋病毒感染者努力提高艾滋病毒服务的接受率，扭转艾滋病毒感染者迅速扩大的EECA的趋势 疫情为了实现这一目标，本研究将使用ADAPT-ITT模型进行调整和改进， 社区一级和卫生设施一级减少艾滋病毒污名化战略，以干预交叉吸毒， MMT和艾滋病毒污名在当地的背景下，在PWID和MMT诊所工作人员（目的1）。我们将驾驶由此产生的 多层次污名减少干预- LIFT -使用随机等待列表对照试验设计，以评估 LIFT干预对减少污名和MMT/PrEP使用（AIM 2）的初步有效性， PWID和来自两个MMT诊所的所有工作人员。同时，顺序混合方法设计将评估LIFT 我们的地方执行伙伴和25个主要利益攸关方的执行成果和需求（目标3） 制定实施战略，加快EECA减少污名化工作的步伐和规模。 为了减少通过注射和治疗网络造成污染的风险，我们将对所有社区和卫生部门进行 在首都比什凯克的不同地理区域开展设施一级的干预和候补控制活动。 这项R34试验是第一项EECA研究，旨在评估PWID之间的交叉污名缓解工作， 艾滋病毒传播风险。这一R34意义重大，因为耻辱感仍然是艾滋病毒传播的基本驱动力 在全球这项R34试点项目具有高度创新性，因为它扩展了艾滋病毒污名干预的现状 通过整合针对多层次交叉柱头的战略进行研究，以提高 以证据为基础的艾滋病毒服务，并推动使用实施科学模型，方法和措施 加快我们对如何缩小减少污名研究与实践差距的理解。