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（由申请人提供）：在注射吸毒的推动下，哈萨克斯坦和其他中亚国家目前正在经历世界上艾滋病毒发病率增长最快的国家，并继续报告吸毒者艾滋病毒护理连续性方面存在巨大差距。根据 2014 年的国家数据，哈萨克斯坦估计有 19,000 名艾滋病毒呈阳性的吸毒者中，只有三分之一曾经接受过艾滋病毒护理，只有 10% 的人开始接受抗逆转录病毒治疗，4% 的人实现了病毒抑制。由于哈萨克斯坦在 2015 年将 ART 资格从 <350 CD4 扩大到 <500 CD4，因此迫切需要将以前不符合 ART 资格的 HIV 阳性吸毒者纳入 ART。哈萨克斯坦对注射吸毒者的持续护理方面存在巨大差距，这与其他国家的差距相似，只有一小部分注射吸毒者开始接受抗逆转录病毒治疗。越来越多的研究表明，提高吸毒者的抗逆转录病毒治疗率可能是预防艾滋病毒传播、降低死亡率、提高生活质量以及减少吸毒和性危险行为的有效策略。迫切需要进行有效性和实施研究，以确定如何最好地改善艾滋病毒服务提供，以缩小连续护理中的关键“治疗”差距。这将通过识别艾滋病毒阳性吸毒者并将其与艾滋病毒护理联系起来，并接触那些从未接受过艾滋病毒护理、间歇性使用护理或已经退出治疗的人来实现。拟议的研究旨在评估增强型艾滋病毒服务整合计划（BRIDGE）的实施和有效性，该计划可能会在哈萨克斯坦庞大的注射吸毒者针头注射器计划（NSP）网络中得到推广。该一揽子计划包括同行驱动招聘的低门槛策略、艾滋病毒咨询和由艾滋病毒护理诊所护士在 NSP 中进行的快速检测 (HCT)，以及 ARTAS（CDC 将吸毒者与艾滋病毒护理联系起来的高效病例管理策略）。 BRIDGE 旨在系统性地解决吸毒者艾滋病毒检测方面的特定服务障碍，将其与艾滋病毒护理联系起来，并促进 ART 的启动。本研究将采用创新的阶梯式楔形设计，利用从 NSP 和 HIV 诊所收集的站点级数据，评估 BRIDGE 在改善位于 4 个地理位置不同的哈萨克斯坦城市的 24 个 NSP 中与 HIV 护理和启动 ART 的联系的实施和有效性。我们还将对来自哈萨克斯坦四个城市的 HIV 阳性吸毒者 (N=600) 进行随机样本开展纵向小组研究，并在基线、6 个月和 12 个月的随访中进行重复评估。本研究将采用混合方法来确定影响 BRIDGE 实施和有效性以及 BRIDGE 成本的多层次结构、社区和组织因素，研究对成本效益、扩展可行性和可持续性的影响。该研究建立在调查小组过去十年与共和国艾滋病中心合作对哈萨克斯坦吸毒者进行广泛的艾滋病毒干预研究的基础上。它解决了实施研究问题，以改进和整合针对注射吸毒者的艾滋病毒服务提供系统，这不仅对该地区很重要，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。