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

项目摘要 与普通人群相比，注射毒品的人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 这一人群的吸食率仍然很低。近年来，物质使用服务已扩大规模，以解决 然而，在PWID中过量使用，它们仍然是PrEP的一个未被充分利用的切入点。在以下方面取得的关键收益 由于持续的阿片类药物导致的PWID人口不断扩大，减少艾滋病毒的工作可能会迅速受到侵蚀 流行病，新注射器中新爆发的艾滋病毒，以及紧急出现的新冠肺炎大流行，它已经 中断了关键的艾滋病毒预防服务，包括注射器服务项目、治疗和避孕套分发。 雷达(通过药物分析和响应快速警报)研究的总体目标是设计， 实施和评估提供现场PrEP、同行导航和代管药品的移动医疗车 检查服务(分布式控制系统)。这项研究将通过提供一种新的干预措施来扩大PrEP服务的覆盖范围 旨在提高PrEP的意识和参与度。分布式控制系统使PWID能够了解准确的 药物中的化学成分，以告知更安全的药物做法，并在非法芬太尼 会导致服药过量致死。对等导航的集成将有助于满足多个紧迫的需求 并随后加强他们在PrEP连续体中的参与度。我们的具体目标是：(一) 开发社区级、移动、集成的PrEP干预措施，旨在提高PWID在 准备护理连续体；(2)通过阶梯式楔形整群随机试验实施干预 评估其对最近六个月在PrEP上或在PWID中见过PrEP提供商的影响 (n=600)；(2a)测量干预措施对艾滋病毒危险行为的影响(例如， 共用注射器、无避孕套的性行为)；和(3)确定干预措施的增量成本效益 在18个月的过程中，PWID(N=600)中避免了艾滋病毒病例。干预(现场) 准备、同行导航、短信提醒、分布式控制系统和相关的降低风险咨询、护理标准 服务)将仅与标准护理(艾滋病毒检测、PrEP转诊、芬太尼试纸、 纳洛酮)状态。该提案直接回应了PAR-18-915，S的目标是利用实施 科学来改进PWUD的寻找、测试、治疗和保留(STTR)连续体的每一步 更广泛的NIH优先事项，以减少艾滋病毒发病率，并制定、检测和实施改善艾滋病毒的战略 检测并进入预防和护理阶段。这项研究是创新的，因为它关注了多种并发症，它是 包括PWID在研究的所有组成部分中的专业知识，并建立在我们在提供 新冠肺炎期间的外展服务。

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.