Yuva Sath: A peer-led intervention to support substance use treatment and HIV prevention among young people who inject drugs in India

7.项目摘要/摘要 阿片类药物注射的惊人增长加剧了印度的艾滋病毒流行。打针的年轻人 药物(YPWID；18-29岁)在治疗阿片类药物使用障碍和预防艾滋病毒方面做得很差 并承担不成比例的新的艾滋病毒感染负担。增加对治疗的参与度 在青年会中，阿片类药物使用障碍和艾滋病毒预防服务的普及是一项紧迫的公共卫生优先事项。 印度非政府组织YRGCARE在8个城市建立了综合护理中心 提供治疗阿片类药物使用障碍的药物和包括艾滋病毒在内的其他艾滋病毒预防服务 对注射毒品的人进行检测、清洁针头和避孕套。YPWID在综合护理中心发起Moud 由于各种障碍也限制了艾滋病毒预防服务的接受，这些中心在治疗方面的参与度很低。 青年艾滋病感染者具有高危行为、低HIV检测和高HIV血清转换率。一些 现已采取干预措施，支持印度青年会药物使用治疗和艾滋病毒预防。 Ganapathi博士是一名儿科传染病内科医生，他渴望领导严格的研究来解决 这个缺口。基于她的艾滋病毒研究奖学金培训和独特的临床背景，她将利用这一点 指导以患者为导向的研究职业发展奖(K23)：1)培养行为学方面的专业知识 干预发展，2)掌握高级统计方法和干预研究设计的技能 研究，以及3)发展对实施科学原理的理解。 Ganapathi博士将开发和试验“Yuva Sath”，这是一种简短的、同行主导的行为干预措施，以支持穆德 青年会艾滋病预防服务的参与度和接受度 护理中心，但在治疗方面投入不足。以成功青年的经验法则为基础-- 量身定制的干预措施，Yuva Sath将在发展中量身定做，利用同行支持，并雇用 便捷的手机送货服务。尤娃·萨特的发展将需要适应“生命的脚步”，一个经验上的 支持性问题解决干预最初是为支持抗逆转录病毒治疗的坚持而开发的。 干预措施的制定将通过以下方式提供信息：1)分析从 8个综合护理中心的YPWID发起Moud的追溯队列，以及2)收集 定性数据，以了解YPWID对干预内容和交付的偏好。然后甘纳帕蒂医生就会 在YPWID中进行一项关于Yuva Sath的试点随机对照试验，与通常的护理进行比较 印度东北部艾扎尔市的综合护理中心，为未来的全功率疗效试验提供信息。 利用哈佛医学院和YRGCARE的研究基础设施，Ganapathi博士将 由一个多学科团队指导，具有行为医学、传染病和成瘾方面的专业知识 医学，由O‘Cleirigh博士、所罗门博士和Mayer博士领导。通过开发一种新的艾滋病毒预防干预措施 这项工作有可能影响公共卫生，同时促进她向独立的过渡。

7. PROJECT SUMMARY/ABSTRACT India’s HIV epidemic is being fueled by an alarming rise in injection of opioids. Young people who inject drugs (YPWID; 18-29 years of age) are poorly engaged in treatment for opioid use disorder and HIV prevention services and bear a disproportionate burden of new HIV infections. Increasing engagement in treatment for opioid use disorder and uptake of HIV prevention services among YPWID is an urgent public health priority. YRGCARE, an Indian non-governmental organization, has established Integrated Care Centers in 8 cities to deliver medications for opioid use disorder (MOUD) and other HIV prevention services, including HIV testing, clean needles, and condoms to people who inject drugs. YPWID initiating MOUD at Integrated Care Centers engage poorly in treatment due to diverse barriers that also limit uptake of HIV prevention services. YPWID under-engaged in MOUD have high risk behaviors, low HIV testing, and high HIV seroconversion. Few interventions exist to support substance use treatment and HIV prevention among Indian YPWID. Dr. Ganapathi is a pediatric infectious diseases physician who aspires to lead rigorous research to address this gap. Building upon her HIV research fellowship training and unique clinical background, she will utilize this Mentored Patient-Oriented Research Career Development (K23) Award to: 1) develop expertise in behavioral intervention development, 2) gain skills in advanced statistical methods and study design for intervention research, and 3) develop an understanding of the principles of implementation science. Dr. Ganapathi will develop and pilot “Yuva Sath”, a brief, peer-led behavioral intervention to support MOUD engagement and uptake of HIV prevention services among YPWID who have initiated MOUD at Integrated Care Centers but are under-engaged in treatment. Informed by empirical principles used in successful youth- tailored interventions, Yuva Sath will be developmentally tailored, leverage peer support, and employ convenient mobile phone delivery. Development of Yuva Sath will entail adapting “Life-Steps”, an empirically supported problem-solving intervention originally developed to support antiretroviral therapy adherence. Intervention development will be informed by: 1) analysis of existing quantitative data collected from a retrospective cohort of YPWID initiating MOUD across 8 Integrated Care Centers, and 2) collection of qualitative data to understand YPWID preferences for intervention content and delivery. Dr. Ganapathi will then conduct a pilot randomized controlled trial of Yuva Sath, compared to usual care, among YPWID at a single Integrated Care Center in Aizawl city in Northeast India, to inform a future fully powered effectiveness trial. Leveraging research infrastructure at Harvard Medical School and YRGCARE, Dr. Ganapathi will be mentored by a multidisciplinary team, with expertise in behavioral medicine, infectious diseases, and addiction medicine, led by Drs. O’Cleirigh, Solomon, and Mayer. By developing a novel HIV prevention intervention for YPWID, this work has potential to impact public health while facilitating her transition to independence.