Expanding Medication Assisted Therapies in Central Asia

中亚（CA）是全球艾滋病毒疫情增长最快的地区，集中在 注射毒品者（PWID）及其性伴侣。在CA中扩大阿片类激动剂治疗（OAT）是 预防新的艾滋病毒感染的最具成本效益的战略， 抗逆转录病毒疗法（ART）。CA国家的OAT（和ART）覆盖率特别低， 受其靠近阿片类药物贸易路线的影响， 和次优实施。CA国家共享类似的严格的Semashko医疗保健系统， 尤其是实施循证实践（EBP）的挑战。此外，艾滋病毒治疗级联 哈萨克斯坦（KZ）、吉尔吉斯斯坦（KY）和塔吉克斯坦（TJ）三个国家的情况不同，总体水平较低 病例检测、ART处方和病毒抑制。它们也因OAT覆盖范围而有所不同， 分别为120，500、25，000和22，500个PWID的次优和远低于国际目标。我们 建议利用改善成瘾治疗网络执行战略， 在EPIS（探索-规划-实施- 维持）框架。利用我们在NIATx上的经验来扩展OAT，我们将使用EPIS框架 我们将首先评估OAT扩展的障碍和促进因素，包括内部和外部环境， 以及桥接因素。这些发现将指导使用NIATx的准备和实施工作。 协作学习是NIATx的关键特征，可以在不同的环境中使用，并且是一个迭代过程 促进变革的力量了解实施的轨迹，EPIS的核心特征，可以在这方面 通过创建实践社区，特别是在凝聚力和/或能力发展的情况下， 通过该过程，并且可以指导该区域中的其他医疗保健提供挑战（例如，艾滋病毒、结核病）。使用 NIATx建立重要的区域专门知识和能力，并了解 这一背景应有助于支持OAT计划的可持续性。作为我们实施和可持续发展的一部分， 计划，并与NIATx一致，我们将召开利益相关者会议，以弥合内部和外部因素， 初步和持续的实施，审查我们的研究结果，并利用信息为政策提供信息， 在每个CA国家扩大OAT。这些会议将通报执行情况并指导政策变化， 促进可持续性。重要性是合理的区域需要，以防止艾滋病毒在PWID和他们的性 合作伙伴和缺乏扩大的环境优先事项。创新不仅通过在新的环境中使用NIATx来增强， 通过更全面地理解这一背景下的规模扩大轨迹。成功率很可能很高， 美国和中亚团队的经验，他们以前的合作研究和共同目标， 控制该地区的艾滋病毒。公共卫生效益应该很高，因为调查结果可能会减轻不断变化的区域艾滋病毒 OAT对艾滋病毒的初级和二级预防都有好处。

Central Asia (CA) represents the most rapidly growing HIV epidemic region worldwide, concentrated in people who inject drugs (PWID) and their sexual partners. Scaling up opioid agonist therapies (OAT) in CA is the most cost-effective strategy to prevent new HIV infections, and more effective when combined with antiretroviral therapy (ART). CA countries have especially low OAT (and ART) coverage and are uniquely impacted by their proximity to opioid trade routes, a myriad of patient, provider, healthcare and policy barriers and suboptimal implementation. CA countries share a similar rigid Semashko healthcare system, which can be especially challenging for implementing evidence-based practices (EBPs). Moreover, the HIV treatment cascade differs in the three countries of Kazakhstan (KZ), Kyrgyzstan (KY) and Tajikistan (TJ), generally with low levels of case detection, ART prescription and viral suppression. They also differ by OAT coverage, with all being suboptimal and well-below international targets for the 120,500, 25,000 and 22,500 PWID, respectively. We propose to use the Network for the Improvement of Addiction Treatment (NIATx) implementation strategy to scale-up OAT in three diverse CA countries guided by the EPIS (Exploration-Planning-Implementation- Sustainment) framework. Using our experiences with NIATx to scale-up OAT, we will use the EPIS framework where we will first assess the barriers and facilitators to OAT scale-up, including the inner and outer contexts as well as bridging factors. These findings will guide preparation and implementation efforts using NIATx. Collaborative learning is key feature of NIATx that can be used in diverse contexts and is an iterative process that promotes change. Understanding the trajectories of implementation, a core feature of EPIS, may in this context emerge through creating communities of practice, especially when cohesion and/or competence evolves through this process, and may guide other healthcare delivery challenges in the region (e.g., HIV, TB). Using NIATx to build important regional expertise and competence and understanding implementation trajectories in this context should help support OAT program sustainability. As part of our implementation and sustainability plan, and consistent with NIATx, we will convene stakeholder meetings to bridge inner and outer factors to guide initial and ongoing implementation, review findings from our studies and use information to inform policies for expanding OAT in each CA country. These meeting will inform implementation and guide policy changes to promote sustainability. Significance is justified by the regional needs to prevent HIV in PWID and their sexual partners and the lack of scale-up of EBPs. Innovation is enhanced not only by using NIATx in a new context, but by more comprehensively understanding scale-up trajectories in this context. Success is likely to be high given the experience of the US and Central Asian teams, their previous collaborative research and a common goal to control HIV in the region. Public health benefit should be high as findings may mitigate the evolving regional HIV epidemics where OAT has benefits for both primary and secondary HIV prevention.