Improving HIV Service Delivery for People who Inject Drugs in Kazakhstan

改善哈萨克斯坦注射吸毒者的艾滋病毒服务

• 批准号: 9321424
• 负责人: Nabila El-Bassel
• 金额: $ 101.35万
• 依托单位: COLUMBIA UNIV NEW YORK MORNINGSIDE
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-30 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9321424
• 关键词: Acquired Immunodeficiency Syndrome; Acute; Address; Adherence; Asians; Attitude; Awareness; Caring; Case Management; Case Manager; Centers for Disease Control and Prevention (U.S.); Cities; Client; Clinic; Collaborations; Communities; Continuity of Patient Care; Counseling; Country; Data; Drops; Drug usage; Effectiveness; Eligibility Determination; Enrollment; Epidemic; Failure; Geography; Government; HIV; HIV Seropositivity; Human immunodeficiency virus test; Incidence; Injecting drug user; Injection of therapeutic agent; Intervention Studies; Kazakhstan; Letters; Link; Methods; Modeling; Needles; Nurses; Office Nursing; Outcome; Pharmaceutical Preparations; Process; Provider; Public Health; Quality of life; Recruitment Activity; Reporting; Research; Resources; Risk; Sampling; Services; Site; Social Network; Supervision; Syringes; System; Testing; Training; Treatment Protocols; Viral; antiretroviral therapy; community organizations; cost; cost effectiveness; cost efficient; design; effectiveness research; experience; follow-up; implementation research; improved; injection drug use; innovation; low and middle-income countries; mortality; peer; prevent; primary outcome; programs; public health relevance; scale up; sex risk; social stigma; theories; transmission process; virology

 DESCRIPTION (provided by applicant): Driven by injection drug use, Kazakhstan and other Central Asian nations are currently experiencing the fastest growing HIV incidence in the world and continue to report huge gaps in the continuum of HIV care for PWID. According to 2014 national data, only one-third of the estimated 19,000 HIV-positive PWID in Kazakhstan are ever linked to HIV care and only 10% initiate ART with 4% achieving viral suppression. As Kazakhstan is expanding eligibility for ART from <350 CD4 to <500 CD4 in 2015, there is an urgency to enroll previously ineligible HIV-positive PWID in ART. Large gaps in Kazakhstan's continuum of care for PWID mirror gaps found in other countries in which only a small proportion of PWID initiate ART. Mounting research demonstrates that improving rates of ART among PWID may be an effective strategy to prevent HIV transmission, lower mortality, improve quality of life, and reduce drug and sexual risk behaviors. There is a critical need for effectiveness and implementation research to identify how best to improve HIV service delivery to close the critical "Treat" gap in the continuum of care. This will occur by identifying and linkng HIV-positive PWID to HIV care, and reaching out to those who have never been in HIV care, are intermittent users of care, or have dropped out of treatment. The proposed study is designed to evaluate the implementation and effectiveness of an enhanced HIV service integration package (BRIDGE) that may be scaled up in Kazakhstan's vast network of needle-syringe programs (NSPs) for PWID. This package includes low threshold strategies of peer-driven recruitment, HIV counseling and rapid testing (HCT) in NSPs conducted by HIV care clinic nurses, and ARTAS, CDC's highly effective case management strategies for linking PWID to HIV care. BRIDGE is systematically designed to address specific service barriers to testing PWID for HIV, linking them to HIV care, and promoting ART initiation. This study will employ an innovative stepped wedge design to evaluate implementation and effectiveness of BRIDGE on improving linkage to HIV care and initiation of ART in 24 NSPs located in 4 geographically disparate Kazakhstani cities using site-level data collected from NSPs and HIV clinics. We will also conduct a longitudinal panel study with a random sample of HIV-positive PWID (N=600) from four cities in Kazakhstan using repeated assessments at baseline, 6-, and 12-months follow-up. This study will employ mixed methods to identify multi-level structural, community, and organizational factors that influence the implementation and effectiveness of BRIDGE and the cost of BRIDGE, examining implications for cost-effectiveness, feasibility of expansion, and sustainability. The study builds on the investigative team's extensive HIV intervention research among PWID in Kazakhstan in collaboration with the Republican AIDS Center over the past decade. It addresses implementation research questions to improve and integrate HIV service delivery systems for PWID that are not only important to the region, but have relevance to other countries that have concurrent injection drug use and HIV epidemics.

 描述(申请人提供)：在注射吸毒的推动下，哈萨克斯坦和其他中亚国家目前正经历着世界上艾滋病毒发病率增长最快的时期，并继续报告说，在为PWID提供艾滋病毒护理的连续过程中存在巨大缺口。根据2014年的国家数据，在哈萨克斯坦估计的19,000名艾滋病毒阳性的PWID中，只有三分之一与艾滋病毒护理有关，只有10%的人启动了抗逆转录病毒疗法，4%的人实现了病毒抑制。随着哈萨克斯坦在2015年将接受抗逆转录病毒治疗的资格从350人扩大到500人，迫切需要将以前不符合条件的艾滋病毒阳性的PWID纳入抗逆转录病毒治疗。哈萨克斯坦对残疾人的持续照顾存在很大差距，这反映了在其他国家发现的差距，在这些国家中，只有一小部分残疾人发起抗逆转录病毒治疗。越来越多的研究表明，提高PWID患者的ART率可能是预防HIV传播、降低死亡率、提高生活质量、减少毒品和性危险行为的有效策略。迫切需要进行有效性和执行情况研究，以确定如何最好地改进艾滋病毒服务的提供，以弥合连续护理中的关键“治疗”差距。这将通过确定并将艾滋病毒阳性的PWID与艾滋病毒护理联系起来，并向那些从未接受过艾滋病毒护理、间歇性使用护理或退出治疗的人伸出援手。这项拟议的研究旨在评估增强型艾滋病毒服务集成方案(桥)的实施情况和有效性，该方案可在哈萨克斯坦庞大的针对PWID的针头注射器项目(NSP)网络中扩大规模。这套方案包括由艾滋病护理诊所护士在NSP中进行的同行驱动招聘、艾滋病毒咨询和快速检测(HCT)的低门槛战略，以及CDC将PWID与艾滋病毒护理联系起来的高效病例管理战略ARTAS。Bridge的系统设计是为了解决在检测PWID检测艾滋病毒方面的具体服务障碍，将它们与艾滋病毒护理联系起来，并促进ART的启动。这项研究将采用一种创新的阶梯式楔形设计，使用从国家卫生服务机构和艾滋病毒诊所收集的现场数据，在哈萨克斯坦4个地理位置不同的城市的24个国家卫生服务机构中，评估桥梁在改善与艾滋病毒护理的联系和启动抗逆转录病毒疗法方面的实施和有效性。我们还将对哈萨克斯坦四个城市的HIV阳性PWID(N=600)随机抽样进行一项纵向小组研究，在基线、6个月和12个月的随访中进行重复评估。这项研究将使用混合方法来确定影响桥梁的实施和有效性的多层次结构、社区和组织因素以及桥梁的成本，检查对成本效益、扩展的可行性和可持续性的影响。这项研究建立在调查团队过去十年来与共和党艾滋病中心合作，在哈萨克斯坦PWID中进行的广泛的艾滋病毒干预研究的基础上。它涉及执行研究问题，以改进和整合为PWID提供艾滋病毒服务的系统，这些系统不仅对本区域重要，而且与同时存在注射吸毒和艾滋病毒流行的其他国家相关。