Impact of a novel HIV peer navigationand overdose prevention intervention on engagement in the HIV prevention and treatment cascade.

项目概要 与普通人群相比，注射吸毒者 (PWID) 感染艾滋病毒的风险极高，但 在美国，针对他们的暴露前预防 (PrEP) 计划很少，因此 PrEP 该人群的接受率仍然很低。近年来，物质使用服务已扩大规模，以解决 然而，它们仍然是 PrEP 的一个未被充分利用的切入点。取得的关键成果 由于持续使用阿片类药物导致吸毒者人数不断增加，减少艾滋病毒的努力可能会迅速受到侵蚀 流行病、新注射者中新的艾滋病毒爆发以及新出现的 COVID-19 大流行， 扰乱了关键的艾滋病毒预防服务，包括注射器服务计划、治疗和安全套分发。 RADAR（药物分析和反应快速警报）研究的总体目标是设计、 实施和评估移动医疗车，提供现场 PrEP、同伴导航和同地药物 检查服务（DCS）。这项研究将通过提供一种新颖的干预措施来扩大 PrEP 服务的范围 旨在提高 PrEP 意识和参与度。 DCS 使 PWID 能够准确了解 其药物的化学成分可以为更安全的药物实践提供信息，这对于非法芬太尼的地方至关重要 导致过量死亡。对等导航的集成将有助于满足多种紧迫的需求 PWID 并随后加强他们对 PrEP 连续体的参与。我们的具体目标是：（1） 制定社区层面的、移动的、综合的 PrEP 干预措施，旨在提高吸毒者对注射吸毒者的参与 PrEP 护理连续体； (2) 通过阶梯式楔形整群随机试验实施干预措施 评估其对注射吸毒者中使用 PrEP 或在过去六个月内见过 PrEP 提供者的影响 (N=600) 18 个月内； (2a) 衡量干预措施对艾滋病毒危险行为的影响（例如， 共用注射器、无套性行为）； (3) 确定干预措施的增量成本效益 18 个月内吸毒者 (N=600) 避免了艾滋病毒感染病例。干预（现场 PrEP、同伴导航、短信提醒、DCS 和相关风险降低咨询、护理标准 服务）将与仅标准护理（HIV 检测、PrEP 转诊、芬太尼试纸、 纳洛酮）条件。该提案直接响应 PAR-18-915 的杠杆实施目标 科学来改进 PWUD 的“寻求、测试、治疗和保留”(STTR) 连续体的每一步 NIH 更广泛的优先事项是降低艾滋病毒发病率，并制定、测试和实施改善艾滋病毒的策略 检测并进入预防和护理阶段。该研究具有创新性，因为它涉及多种合并症 包括注射吸毒者在研究的所有组成部分的专业知识，并以我们提供的经验为基础 COVID-19 期间的外展服务。

Project Summary People who inject drugs (PWID) are at exceedingly high risk of HIV compared to the general population, yet pre-exposure prophylaxis (PrEP) programs that target them in the U.S. are scarce and accordingly PrEP uptake in this population remains low. In recent years, substance use services have been scaled up to address overdose among PWID, however, they remain an underutilized entry point into PrEP. Pivotal gains made in reducing HIV could be rapidly eroded by the expanding population of PWID attributed to the ongoing opioid epidemic, new HIV outbreaks among new injectors, and the emergent COVID-19 pandemic, which has disrupted key HIV prevention services including syringe services programs, treatment and condom distribution. The overarching aim of the RADAR (Rapid Alerts through Drug Analysis and Response) study is to design, implement and evaluate a mobile health van that provides on-site PrEP, peer navigation and co-located drug checking services (DCS). This study will expand the reach of PrEP services by offering a novel intervention designed to increase PrEP awareness and engagement. DCS enable PWID to understand the precise chemical contents of their drugs to inform safer drug practices and are critical in places where illicit fentanyl drives overdose mortality. The integration of peer navigation will help attend to the multiple, pressing needs of PWID and subsequently enhance their engagement in the PrEP continuum. Our specific aims are: (1) to develop a community-level, mobile, integrated PrEP intervention aimed to increase PWID engagement in the PrEP care continuum; (2) to implement the intervention through a stepped wedge cluster randomized trial and evaluate its impact on being on PrEP or having seen a PrEP provider in the last six months among PWID (N=600) over the course of 18 months; (2a) to measure the intervention’s impact on HIV risk behaviors (e.g., syringe sharing, condomless sex); and (3) to determine the incremental cost-effectiveness of the intervention in terms of HIV cases averted among PWID (N=600) over the course of 18 months. The intervention (on-site PrEP, peer navigation, SMS reminders, DCS and associated risk reduction counseling, standard-of-care services) will be compared to the standard-of-care only (HIV testing, PrEP referrals, fentanyl test strips, naloxone) condition. The proposal is directly responsive to PAR-18-915’s aim to leverage implementation science to improve each step of the Seek, Test, Treat, and Retain (STTR) continuum for PWUD as well broader NIH priorities to reduce HIV incidence and develop, test, and implement strategies to improve HIV testing and entry into prevention and care. The study is innovative as it attends to multiple comorbidities, it is inclusive of the expertise of PWID in all components of the study and builds on our experience in delivering outreach services during COVID-19.