Peer-based HIV Self-testing among High Risk Women Who Inject or Use Drugs in Kazakhstan, Central Asia

哈萨克斯坦、中亚地区注射或吸毒高危女性中基于同伴的艾滋病毒自我检测

• 批准号: 10082944
• 负责人: Nabila El-Bassel
• 金额: $ 25.2万
• 依托单位: CITY COLLEGE OF NEW YORK
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10082944
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Advocacy; Africa; Alcohol or Other Drugs use; Amelia; Attention; Awareness; Behavioral; Biological; Caring; Central Asia; Cessation of life; Client; Communicable Diseases; Communities; Counseling; Country; Data; Dermatology; Development; Drug usage; Drug user; Early Diagnosis; Epidemic; Focus Groups; Goals; HIV; HIV Infections; HIV Seronegativity; HIV/STD; Health Personnel; High Risk Woman; Human immunodeficiency virus test; Incidence; Individual; Infection; Injecting drug user; Intention; Intervention; Interview; Kazakhstan; Knowledge; Link; Persons; Pharmaceutical Preparations; Phase; Play; Population; Population Intervention; Prevalence; Prevention; Prevention strategy; Privatization; Public Health; Randomized; Research; Research Infrastructure; Risk; Risk Reduction; Role; Services; Sexual Partners; Site; Technology; Testing; Text; Thinking; Time; Training; Treatment Efficacy; United States; Validation; Viral; Vulnerable Populations; Woman; Work; advocacy organizations; antiretroviral therapy; arm; base; behavior change; case finding; coping; cost; design; empowerment; evidence base; experience; experimental arm; female sex worker; follow-up; improved; injection drug use; innovation; knowledge base; novel; peer; peer support; pre-exposure prophylaxis; preference; primary outcome; response; secondary outcome; sex; social stigma; success; theories; tool; uptake

ABSTRACT Central Asia (CA) has one of the world’s fastest growing HIV epidemics, increasing 30% since 2010. By 2017, key populations and their sex partners made up 95% of new HIV infections, including 9% among female sex workers (FSW), 39% among people who inject drugs (PWID), and 28% among clients/sex partners of sex workers/other key populations. In Kazakhstan, a major CA regional economy, there was a 106% increase in new HIV infections from 2010 to 2017. FSW who also inject drugs (FSWID) are at significantly increased risk of HIV infection, but are less likely to engage in HIV testing and receive care. HIV testing is the key point of entry to HIV care and ART, and, for HIV-negative individuals, to PrEP/PEP. In Kazakhstan, barriers to HIV testing for FSWID, include stigma, inconvenience, and health care provider bias against women who are FSW and/or drug users. Although HST is recommended by the WHO, very limited research on FSW and PWID exists. Reviews of interventions to increase testing suggest that HST can increase consistent or frequent testing, but that linkage to care rates can be lower with HST. Importantly, no studies have been conducted in CA or, to our knowledge, among FSWID, a vital population to target given their elevated risk for HIV, low uptake of HIV testing, and experiences of dual stigma. The primary goal of this study is to assess acceptability, feasibility, preliminary efficacy and cost of a peer-based HIV self-testing intervention to increase consistent HIV testing and linkage to care or prevention among women who exchange sex and inject drugs in Kazakhstan using the R34 mechanism. In Phase 1, we will conduct in-depth interviews and focus groups with 40 FSWID to identify responses to HST components from efficacious HST and linkage to care interventions with FSW. In Phase 2, we will engage design thinking approaches and intervention adaptation to optimize fidelity and fit of existing components and develop novel components reflecting our theoretical approaches; we will component test (N=20) and pre-pilot components (N=20). In Phase 3, we will randomize 90 HIV-uninfected FSWID to either the adapted experimental condition (4 sessions) or a time- and attention-controlled standard HIV test-counseling condition and follow for 18 months for impacts on consistent HIV testing, HST and linkage to care/prevention. The RCT will be conducted in partnership with Amelia, a non-profit, FSW advocacy organization, and KSCDID, which leads national HIV treatment/prevention strategy. Results will fill key gaps in the knowledge base around optimal HST implementation among FSWID in CA, through analysis of an innovative intervention with an explicit focus on stigma reduction and peer support with substance using populations. Results will have relevance for HST and linkage programming in other CA countries, as well as the 120 countries that have HIV epidemics where FSW and PWID play important roles, including the United States.

摘要 中亚是世界上艾滋病疫情增长最快的地区之一，自2010年以来增长了30%。到2017年， 关键人群及其性伴侣占艾滋病毒新感染者的95%，其中女性占9% 注射毒品者（PWID）中为39%，嫖客/性伴侣中为28%。 工人/其他关键人群。在哈萨克斯坦，一个主要的CA区域经济体，新的增长了106%， 2010年至2017年的艾滋病毒感染情况。FSW谁也注射毒品（FSWID）在显着增加艾滋病毒的风险 艾滋病毒感染者中，有一部分人感染了艾滋病毒，但不太可能进行艾滋病毒检测和接受护理。艾滋病毒检测是进入艾滋病毒的关键点 护理和抗逆转录病毒疗法，以及对艾滋病毒阴性者，PrEP/PEP。在哈萨克斯坦，FSWID的艾滋病毒检测障碍， 包括耻辱、不便和保健提供者对身为FSW妇女和/或吸毒者的偏见。 尽管WHO推荐HST，但对FSW和PWID的研究非常有限。审查 增加检测的干预措施表明，HST可以增加一致或频繁的检测，但这种联系 护理率可以降低与HST。重要的是，没有在CA中进行研究，或者据我们所知， 在FSWID中，由于其艾滋病毒风险高，艾滋病毒检测率低， 双重耻辱的经历。本研究的主要目标是评估可接受性、可行性、初步 以同伴为基础的艾滋病毒自我检测干预措施的有效性和成本，以提高艾滋病毒检测的一致性， 利用R34机制，对哈萨克斯坦境内进行性交易和注射毒品的妇女进行护理或预防。 在第一阶段，我们会与40名家庭福利工作者进行深入访谈和焦点小组讨论，以确定他们对健康教育计划的反应 有效的HST的组成部分和与FSW护理干预的联系。在第二阶段，我们将设计 思维方法和干预适应，以优化现有组件的保真度和适合性并开发 反映我们理论方法的新组件;我们将进行组件测试（N=20）和预试验 组分（N=20）。在第3阶段，我们将90名未感染HIV的FSWID随机分配到适应性实验组， 条件（4个疗程）或时间和注意力控制的标准HIV检测咨询条件，并随访 18个月的影响，一致的艾滋病毒检测，卫生和社会服务以及与护理/预防的联系。将进行RCT 与Amelia（一个非营利的FSW倡导组织）和KSCDID（领导国家艾滋病毒）合作， 治疗/预防策略。结果将填补围绕最佳HST的知识库中的关键空白 通过分析一项创新性干预措施，明确侧重于 减少吸毒人群的耻辱感和同伴支持。结果将与HST相关， * 在其他合作与援助国家以及120个艾滋病毒流行国家开展联系方案， 和PWID发挥重要作用，包括美国。