Expanding Medication Assisted Therapies in Central Asia

中亚(CA)是全球增长最快的艾滋病毒流行地区，集中在 注射毒品者(PWID)及其性伴侣。在CA中推广阿片类激动剂疗法(OAT)是 预防新的艾滋病毒感染的最具成本效益的战略，与 抗逆转录病毒疗法(ART)。CA国家的燕麦片(和ART)覆盖率特别低，而且是独一无二的 受靠近阿片类药物贸易路线的影响，患者、提供者、医疗保健和政策障碍数不胜数 和次优实施。CA国家共享类似的僵化的Semashko医疗系统，这可能是 对于实施循证实践(EBP)来说尤其具有挑战性。此外，艾滋病毒治疗的级联 在哈萨克斯坦(KZ)、吉尔吉斯斯坦(KY)和塔吉克斯坦(TJ)三个国家不同，一般水平较低 病例检测、抗逆转录病毒药物处方和病毒抑制。它们在OAT覆盖范围上也不同，所有这些都是 次优和远低于国际指标，分别为120,500，25,000和22,500。我们 建议利用网络改善成瘾治疗(NIATx)实施战略 在EPIS(探索-规划-实施)的指导下，在三个不同的CA国家扩大OAT 维持)框架。利用我们使用NIATx的经验来扩展OAT，我们将使用EPIS框架 在那里，我们将首先评估OAT扩展的障碍和促进者，包括以下内部和外部环境 以及桥梁因素。这些发现将指导使用NIATx的准备和实施工作。 协作学习是NIATx的关键功能，可以在不同的环境中使用，是一个迭代的过程 这促进了变革。了解实施的轨迹，这是EPIS的核心特征，可能会在这方面 背景通过创建实践社区而出现，特别是当凝聚力和/或能力发展时 通过这一进程，并可能指导该区域的其他医疗保健提供挑战(例如艾滋病毒、结核病)。vbl.使用 NIATX将建立重要的区域专门知识和能力，并了解#年的实施轨迹 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性的一部分 计划，并与NIATx保持一致，我们将召开利益相关者会议，沟通内外因素，以指导 初步和持续实施，审查我们的研究结果，并使用信息为政策提供信息 在每个加利福尼亚州国家扩大燕麦片。这些会议将通知执行情况并指导政策变化 促进可持续发展。预防艾滋病的区域需求和他们的性行为证明了这一意义 合作伙伴和缺乏扩大EBPS的能力。创新不仅通过在新的环境中使用NIATx来增强，而且 通过更全面地了解这一背景下的放大轨迹。考虑到成功的可能性很大 美国和中亚团队的经验，他们之前的合作研究，以及一个共同的目标 控制该地区的艾滋病毒。公共卫生收益应该很高，因为研究结果可能会缓解不断演变的地区性艾滋病毒 燕麦片对艾滋病毒一级预防和二级预防均有益处的流行病。

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.