Characterizing medication-assisted opioid use treatment and HIV care delivery for community re-entrants with HIV and opioid use disorder in South Africa

南非艾滋病毒和阿片类药物使用障碍社区重新进入者的药物辅助阿片类药物使用治疗和艾滋病毒护理服务的特点

• 批准号: 10259752
• 负责人: CHRISTOPHER J HOFFMANN
• 金额: $ 15.37万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-09 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10259752
• 关键词: Adult; Africa; Attention; Attitude; Caring; Cause of Death; Characteristics; Client; Collaborations; Communities; Consensus; Consolidated Framework for Implementation Research; Country; Economics; Educational workshop; Enrollment; Epidemic; Family; Funding; Future; Goals; Government; Grant; HIV; HIV Seropositivity; HIV diagnosis; Harm Reduction; Health; Health Services; Health Services Needs; Health system; Imprisonment; Individual; Infrastructure; Intervention; Interview; Knowledge; Leadership; Link; Maps; Methadone; Methods; Modeling; Morbidity - disease rate; Needle-Exchange Programs; Participant; Patient-Centered Care; Pharmaceutical Preparations; Policies; Population; Population Programs; Prevalence; Primary Health Care; Prior Therapy; Prisons; Process; Provider; Reporting; Research; Research Personnel; Retreatment; Services; Social Network; Social Work; South Africa; South African; Suboxone; Surveys; Universities; Viral Load result; Woman; antiretroviral therapy; barrier to care; base; care delivery; care systems; clinical care; cohort; community engaged research; community organizations; community reentry; correctional system; dual diagnosis; evidence base; follow-up; illicit opioid; implementation strategy; improved; informant; medication-assisted treatment; member; men; mortality; opioid use; opioid use disorder; programs; recruit; scale up; service programs; service providers; social capital; social stigma; substance use; substance use treatment; treatment program; treatment services; uptake

PROJECT SUMMARY The availability of antiretroviral therapy (ART) has markedly reduced HIV-related mortality and morbidity in Africa. Yet HIV remains the leading cause of death among adult men and women in South Africa due fails to initiated ART or remain in care. Between 2 and 3% of HIV-infected men in South Africa pass through the corrections system annually. During incarceration uptake of ART is excellent; unfortunately, during community re-entry most individuals who were on ART are lost from care. Qualitative and quantitative research conducted by this research group in South Africa indicates that this population encounters multiple barriers to care engagement. These barriers include lack of patient-centered care, family abandonment and limited social capital, enacted stigma, economic insecurity, and substance use. More than 55% of community re-entrants report illicit opioid use; this appears to the leading cause of loss from care. An evidence-based approach to help management this issue is long-term medication-assisted treatment (MAT) of substance use. In South Africa, methadone and buprenorphine/naloxone are available but have never been used specifically for re-entrants. This project seeks to characterize the needs of dual diagnosed re-entrants, their journey, and key components of implementing a MAT program for this population. We propose to recruit a cohort of 40 dual- diagnosed inmates, offer opioid use services and HIV linkage to care and follow them for 6 months post release. Post-release follow-up will include longitudinal in-depth interviews to generate a rich understanding of the dynamic process or community re-entry for dual-diagnosed inmates. This includes their relationships with opioid use and with opioid use management services. We will also interview key stakeholders to develop a clear understanding of implementation needs and convene workshops to reflect on findings with stakeholders, including dual diagnosed ex-inmates, to develop a feasible and acceptable working model for substance use management in this population. The current proposal will allow for the adaptation of an existing community MAT and harm reduction program to fit the needs of re-entrants. This project has the potential to develop considerable new knowledge on an population that has received little attention – dual diagnosed individuals in South Africa and community re-entrants in general.

项目摘要 抗逆转录病毒疗法的提供显著降低了艾滋病毒相关死亡率， 非洲的发病率。然而，艾滋病毒仍然是成年男女死亡的主要原因， 南非由于未能启动抗逆转录病毒疗法或继续护理。2%至3%的男性艾滋病毒感染者 每年都有1000多人通过监狱系统。在监禁期间， 抗逆转录病毒治疗效果很好;不幸的是，在重返社区期间，大多数接受抗逆转录病毒治疗的人 失去了照顾。本研究小组于年进行的定性和定量研究 南非表示，这一群体在参与护理方面遇到多重障碍。 这些障碍包括缺乏以病人为中心的护理，家庭遗弃和有限的社会 资本，制定的耻辱，经济不安全和物质使用。超过55%的社区 重新参加者报告非法使用类阿片;这似乎是失去护理的主要原因。一个 循证方法，以帮助管理这个问题是长期的药物辅助 物质使用治疗（MAT）。在南非，美沙酮和丁丙诺啡/纳洛酮是 但从未专门用于重新进入者。本项目谋求 描述双重诊断的重新进入者的需求，他们的旅程，以及 为这一人群实施MAT计划。我们建议招募40名双重- 诊断的囚犯，提供阿片类药物使用服务和艾滋病毒联系，以照顾和跟踪他们6 释放后的几个月释放后的后续行动将包括纵向深入访谈， 产生对动态过程或社区重新进入双重诊断的丰富理解 囚犯。这包括它们与阿片类药物使用和阿片类药物使用管理的关系 服务我们还将采访主要利益相关者，以明确了解 执行需要，并召开讲习班，与利益攸关方一起思考调查结果， 包括双重诊断的前囚犯，制定一个可行和可接受的工作模式， 这一人群中的物质使用管理。目前的建议将允许调整 现有的社区MAT和减少危害计划，以满足重新进入者的需求。这 该项目有潜力开发大量关于人口的新知识， 很少受到关注-南非的双重诊断个体和社区重新进入者 梗概.