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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

基本信息

批准号：
10241546
负责人：
Nabila El-Bassel
金额：
$ 23.77万
依托单位：
CITY COLLEGE OF NEW YORK
依托单位国家：
美国
项目类别：
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/10241546
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Advocacy Africa 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 self testing sex social stigma substance use success theories tool uptake

项目摘要

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