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

7.项目总结/摘要 印度的艾滋病毒流行病正在因注射阿片类药物的惊人增长而加剧。注射的年轻人 吸毒者（YPWID; 18-29岁）对阿片类药物使用障碍的治疗和艾滋病毒预防的参与程度很低 艾滋病毒/艾滋病是一个严重的问题，因为艾滋病毒/艾滋病服务的普及和新的艾滋病毒感染的负担不成比例。增加参与治疗 阿片类药物使用障碍和YPWID中艾滋病毒预防服务的接受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 提供阿片类药物使用障碍（MOUD）药物和其他艾滋病毒预防服务，包括艾滋病毒 给注射毒品的人提供检测、清洁针头和避孕套。YPWID在综合护理中启动MOUD 由于各种障碍，中心在治疗方面的参与程度很低，这些障碍也限制了艾滋病毒预防服务的接受。 未充分参与MOUD的YPWID具有高风险行为，低HIV检测和高HIV血清转换。几 在印度的YPWID中，存在支持药物使用治疗和艾滋病毒预防的干预措施。 Ganapathi博士是一名儿科传染病医生，他渴望领导严格的研究，以解决 这个差距。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（K23）奖：1）发展行为方面的专业知识 干预开发，2）获得先进的统计方法和干预研究设计的技能 研究，和3）发展的实施科学的原则的理解。 Ganapathi博士将开发和试点“Yuva Sath”，这是一种简短的，同伴主导的行为干预，以支持MOUD 在已在综合医院启动MOUD的YPWID中参与和接受艾滋病毒预防服务 护理中心，但参与治疗不足。以成功青年的经验法则为基础- 量身定制的干预措施，Yuva Sath将根据发展情况定制，利用同行支持，并雇用 方便的移动的电话传送。Yuva Sath的发展将需要调整“生活步骤”， 支持解决问题的干预措施，最初是为了支持抗逆转录病毒疗法的坚持而开发的。 干预措施的制定将通过以下方式获得信息：1）分析从 在8个综合护理中心启动MOUD的YPWID回顾性队列，以及2）收集 定性数据，以了解YPWID对干预内容和交付的偏好。加纳帕蒂博士将 在YPWID中进行一项初步的Yuva Sath随机对照试验，与常规治疗相比， 印度东北部艾扎维尔市的综合护理中心，为未来的全动力有效性试验提供信息。 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 由O 'Cleiigh、所罗门和Mayer博士领导。通过开发一种新的艾滋病毒预防干预措施， YPWID，这项工作有可能影响公共卫生，同时促进她向独立过渡。

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.