Implementation science research on PrEP delivery and costing within MAT andNSP services for PWUD in Uganda

摘要 在过去的十年里，乌干达的吸毒者人数增加了10倍。 (PWUD)和通过共用注射设备传播艾滋病毒的风险，这是这种情况下的常见做法 获得清洁设备的机会很少。据估计，PWUD中艾滋病毒的流行率高达 45%，突出了广泛获得艾滋病毒治疗和预防对PWUD的重要性， 包括口服暴露前预防(PrEP)。年，PREP被纳入艾滋病毒预防指南 2016年在乌干达，PEPFAR的资金一直在支持有针对性地向包括PWUD在内的关键人群推出。 然而，目前正在使用PrEP的250人被确认为PWUD，这表明在预防方面存在很大差距 以及为PWUD优化PrEP交付的机会。对于携带艾滋病毒的PWUD患者，抗逆转录病毒治疗已经 已整合到药物辅助治疗(MAT)计划和针头和注射器更换计划中 (NSP)，通过利用同情成瘾并具有与相关污名作斗争经验的提供者 与吸毒有关。我们假设，通过集成PrEP交付，可以对PrEP执行类似的方法 进入MAT和NSP计划，我们提出了一种分阶段的方法来进行形成性工作和提炼 两个综合方案(PrEP+MAT和PrEP+NSP)，以试行这些方案并评估PrEP的摄入量， 保留和遵守，并进行成本计算研究，以直接为政策指导提供信息。我们的工作 将注意实施综合框架内的几个结构 与最大的减少危害网络警察的成员进行研究并以参与式方法为基础 部队和乌干达的PWUD作为项目顾问。具体来说，我们的目标是：1)进行定性研究，以 了解PWUD和PUD人群对HIV预防服务的偏好和使用/处方PrEP的意愿 提供a)口头PrEP和b)为乌干达坎帕拉的PWUD提供服务；2)完善社区方案- 基于NSP+PrEP和基于设施的MAT+PrEP；3)比较PrEP在以下情况下的摄取率、保留率和依从性 将PREP集成到基于社区的NSP与基于设施的MAT到PWUD；以及4)估计 计划成本和预算影响分析，以便将PrEP整合到我们的MAT和NSP计划中。 冲击力。拟议的工作将提供关于如何优化综合减少危害和 准备交付到乌干达的PWUD和类似的环境。与乌干达成员的直接接触 卫生部对我们的调查小组的支持，我们的调查结果将立即用于政策指导和 引导程序性放大。这项工作将与美国和全球相关，作为一地两检的示范 为PWUD提供减少危害和艾滋病毒预防服务，它将提供一些关于PrEP的第一批数据 PWUD之间的粘附性和固位性。

ABSTRACT In the past decade, Uganda seen increases – as large as 10-fold – in the number of people who use drugs (PWUD) and the risk for HIV transmission through shared injection equipment, a common practice in this setting with low access to clean equipment. HIV prevalence among PWUD has been estimated to be as high as 45%, highlighting the importance of widescale access to HIV treatment and prevention for PWUD, including oral pre-exposure prophylaxis (PrEP). PrEP was integrated into HIV prevention guidelines in Uganda in 2016 and PEPFAR funding has been supporting targeted rollout to key populations, including PWUD. However, <250 people currently accessing PrEP have identified as PWUD, indicating a large gap in prevention and an opportunity to optimize PrEP delivery for PWUD. For PWUD living with HIV, antiretroviral treatment has been integrated into medication assisted treatment (MAT) programs and needle and syringe exchange programs (NSP), by leveraging providers who empathize with addiction and have experience combating stigma associated with drug use. We hypothesize that a similar approach can be done for PrEP by integrating PrEP delivery into MAT and NSP programs and we proposed a staged approach to conduct formative work and refine two integrated programs (PrEP + MAT and PrEP + NSP), to pilot these programs and assess PrEP uptake, retention, and adherence and to conduct costing research to directly inform policy guidance. Our work will be conducted with attention to several constructs within the Consolidated Framework for Implementation Research and grounded in a participatory approach with members of the largest harm reduction network, police force, and PWUD in Uganda as project advisors. Specifically, we aim to: 1) conduct qualitative research to explore preferences for HIV prevention services and willingness to use/prescribe PrEP among PWUD and providers of a) oral PrEP and b) services for PWUD in Kampala, Uganda; 2) refine programs for community- based NSP + PrEP and facility-based MAT + PrEP; 3) compare PrEP uptake, retention, and adherence when PrEP is integrated into community-based NSP versus facility-based MAT to PWUD; and 4) estimate the programmatic costs and conduct budget impact analysis for integrating PrEP into our MAT and NSP programs. Impact. The proposed work will provide robust evidence about how to optimize integrated harm reduction and PrEP delivery to PWUD in Uganda and similar settings. With direct engagement from members of the Ugandan Ministry of Health on our investigative team, our findings will be immediately useful for policy guidelines and to guide programmatic scale-up. This work will be relevant to the US and globally as a demonstration of co-located harm reduction and HIV prevention services for PWUD and it will provide some of the first data on PrEP adherence and retention among PWUD.