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，注射毒品者（PWID）感染艾滋病毒的风险极高， 在美国，针对他们的暴露前预防（PrEP）计划很少，因此 这一人群的吸收率仍然很低。近年来，药物使用服务得到了扩大，以解决 然而，在PWID中过量使用，它们仍然是PrEP的一个未充分利用的切入点。 减少艾滋病毒可能会迅速侵蚀由于正在进行的阿片类药物 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， 中断了关键的艾滋病毒预防服务，包括注射器服务方案、治疗和避孕套分发。 RADAR（通过药物分析和响应快速警报）研究的首要目标是设计， 实施和评估一个移动的健康货车，提供现场PrEP，同伴导航和共同定位药物 检查服务（DCS）。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意识和参与度。DCS使PWID能够准确了解 他们的药物的化学成分，以告知更安全的药物实践，并在非法芬太尼 导致过量死亡对等导航的集成将有助于满足 PWID，并随后加强他们在PrEP连续体中的参与。我们的具体目标是：（1） 制定社区一级的、移动的、综合的PrEP干预措施，旨在增加PWID在 PrEP护理连续体;（2）通过阶梯式楔形分组随机试验实施干预， 评估其对PrEP的影响，或在过去六个月内在PWID中看到PrEP提供者 （N=600）在18个月的过程中;（2a）测量干预措施对艾滋病毒风险行为的影响（例如， 注射器共用，无避孕套性行为）;（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HIV病例。现场（On Site） PrEP、同伴导航、短信提醒、DCS和相关的风险降低咨询、标准护理 服务）将与仅护理标准（艾滋病毒检测，PrEP转诊，芬太尼试纸， 纳洛酮）状态。该提案直接响应PAR-18-915的目标， 科学，以改善每一个步骤的寻求，测试，治疗和保留（STTR）连续为PWUD以及 更广泛的NIH优先事项，以减少艾滋病毒的发病率和发展，测试和实施战略，以改善艾滋病毒 测试和进入预防和护理。该研究具有创新性，因为它涉及多种合并症， 包括PWID在研究的所有组成部分中的专业知识，并建立在我们提供 在COVID-19期间提供外展服务。

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.