Identifying Intersectional Stigma Intervention Targets for People Who Inject Drugs in a High-Risk International Setting

确定在高风险国际环境中注射吸毒者的交叉耻辱干预目标

• 批准号: 10256032
• 负责人: Laramie Rae Smith
• 金额: $ 18.58万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-10 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10256032
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adult; Affect; Anti-Retroviral Agents; Behavior; Capital; Caring; Central Asia; Cessation of life; Cities; Collaborations; Communities; Complex; Country; Data; Decentralization; Drug usage; Eastern Europe; Educational workshop; Epidemic; Equation; Fright; Future; General Population; Geography; Government; HIV; HIV Infections; HIV risk; Harm Reduction; Health Personnel; Heroin; Incidence; Individual; Injecting drug user; International; Intervention; Kyrgyzstan; Law Enforcement; Link; Measures; Methadone; Methods; Modeling; Needle-Exchange Programs; Needles; Participant; Pharmacotherapy; Population; Preparation; Prevalence; Prisons; Process; Program Development; Protocols documentation; Qualitative Research; Research; Research Personnel; Respondent; Risk; Role; Route; Rural; Russia; Sampling; Science; Series; Services; Stigmatization; Structure; Substance Use Disorder; Syringes; Time; Training; Work; antiretroviral therapy; care seeking; comorbidity; efficacy trial; evidence base; experience; follow up assessment; follow-up; gaps in access; high risk; improved; innovation; methadone treatment; mortality; next generation; novel; opioid use disorder; prevent; prevention service; preventive intervention; primary outcome; programs; recruit; response; rural area; rural environment; rural setting; secondary outcome; service engagement; social determinants; social stigma; social structure; success; trafficking; transmission process; treatment services; uptake; urban area; urban setting

220.7 PROJECT SUMMARY/ABSTRACT Stigma is a pervasive barrier to preventing HIV among persons who inject drugs (PWID). Kyrgyzstan is part of the world’s most rapidly expanding HIV epidemic in the Eastern Europe and Central Asia region, where HIV is predominantly concentrated among PWID. Improving PWID engagement in needle and syringe programs (NSP), methadone to treat opioid use disorder (MMT), and antiretrovirals (ART) to treat HIV (among HIV+ PWID) is essential to ending the HIV epidemic in this region. Substantial qualitative research documents that PWID contend with stigmas related to HIV, drug use, and drug treatment (i.e. methadone), which undermine engagement in these key HIV prevention services. Yet, less is known about which of these intersecting stigmas are most critical to intervene on to improve engagement in HIV prevention services. Further, the focus of intersectional stigma has not been extended to rural PWID in the region despite increased HIV incidence in rural areas. Structural equation modeling–a robust quantitative method–can identify which of these stigmas are most critical to intervene on to optimize engagement in HIV prevention services among urban and rural PWID. The current study will recruit urban (n = 102) and rural (n = 102) adult PWID using respondent driven sampling. Experiences with HIV, drug use, and methadone stigma, and level of engagement in NSP, MMT (primary outcome) and ART (secondary outcome) services will be measured at baseline. Structural equation modeling will be used to identify optimal points to reduce stigma and improve engagement in HIV prevention service s (Aim 1). A follow up assessment will be conducted 3 months post-baseline to obtain study retention estimates and refine protocols for retaining urban and rural PWID in a future efficacy trial (Aim 2). A series of four data-driven and community-informed workshops with PWID (n = 20) and key stakeholders (n =2 0) will be held to develop stigma reduction interventions tailored to urban and rural regions in Kyrgyzstan (Aim 3). Kyrgyz co-investigators will be substantially involved at every level of this project to build in-country capacities in stigma and HIV science. This will enable our Kyrgyz team to develop the next generation of research scholars in a region where the HIV epidemic is rapidly expanding, and the incidence of AIDS-related mortality is climbing. This project will lay the groundwork to implement a future stigma reduction intervention among urban and rural PWID in Kyrgyzstan. As the first study to quantify the impact of intersecting stigmas (HIV, drug use, methadone) on HIV prevention among urban and rural PWID, this study is significant because stigma is a key sociostructural driver of a rapidly expanding HIV epidemic in EECA–due to low engagement in HIV prevention services (including HIV treatment). This study is highly innovative because it reflects a substantial departure from how intersecting HIV, drug use, and methadone stigma has been studied among PWID, opening new opportunities reverse a rapidly expanding HIV epidemic in the region.

220.7项目概要/摘要 污名是注射毒品者预防艾滋病毒的普遍障碍。吉尔吉斯斯坦是 东欧和中亚地区是世界上艾滋病毒蔓延最快的地区， 主要集中在PWID中。改善PWID参与针头和注射器计划（NSP）， 美沙酮治疗阿片类药物使用障碍（MMT）和抗逆转录病毒药物（ART）治疗艾滋病毒（艾滋病毒+ PWID）， 这对结束该地区的艾滋病毒流行至关重要。实质性的定性研究文件， 与艾滋病毒、吸毒和药物治疗（即美沙酮）有关的耻辱作斗争，这些耻辱破坏了 参与这些关键的艾滋病毒预防服务。然而，我们对这些交叉的柱头中 对改善艾滋病毒预防服务的参与至关重要。此外， 尽管该地区农村艾滋病发病率有所增加，但该地区农村艾滋病感染者并未受到交叉羞辱。 地区结构方程模型-一种强大的定量方法-可以识别这些柱头中的哪一个最重要 至关重要的是，要进行干预，以优化城市和农村艾滋病毒感染者对艾滋病毒预防服务的参与。 目前的研究将招募城市（n = 102）和农村（n = 102）的成年PWID使用受访者驱动的抽样。 艾滋病毒、吸毒和美沙酮污名化方面的经验，以及参与国家战略计划、美沙酮维持疗法（初级）的程度 结果）和ART（次要结果）服务将在基线进行测量。结构方程模型 将用于确定最佳点，以减少耻辱并改善对艾滋病毒预防服务的参与（Aim 1）。将在基线后3个月进行随访评估，以获得研究保留估计值， 在未来的疗效试验中，完善保留城市和农村PWID的方案（目标2）。四个数据驱动的系列 将与残疾人（n = 20）和主要利益相关者（n = 20）举行社区知情研讨会， 针对吉尔吉斯斯坦城市和农村地区的减少耻辱化干预措施（目标3）。吉尔吉斯斯坦共同调查员 将充分参与该项目的各个层面，以建立国内在污名化和艾滋病毒科学方面的能力。 这将使我们的吉尔吉斯团队能够在艾滋病毒肆虐的地区培养下一代研究学者。 流行病正在迅速蔓延，与艾滋病有关的死亡率正在上升。该项目将奠定 为在吉尔吉斯斯坦城市和农村残疾人中实施未来减少耻辱干预奠定基础。 作为第一项量化交叉污名（艾滋病毒，吸毒，美沙酮）对艾滋病毒预防影响的研究 在城市和农村的PWID中，这项研究意义重大，因为耻辱感是快速发展的关键社会结构驱动力。 由于艾滋病毒预防服务（包括艾滋病毒治疗）的参与程度低，艾滋病毒在EECA的流行不断扩大。 这项研究是高度创新的，因为它反映了一个实质性的偏离如何交叉艾滋病毒，吸毒， 在PWID中研究了美沙酮污名，开辟了新的机会，扭转了迅速扩大的 艾滋病毒在该地区蔓延。