Impacts of structural and system-level interventions on HIV/STI and overdose epidemics among SWs

项目摘要/摘要 这一竞争性更新的目标是评估两种“自然发生的”干预措施的影响-- 社区赋权(CE)和警务做法的变化--艾滋病毒/性传播感染、吸毒过量、 加拿大城市街道和室内性工作者(SWS)对成瘾服务的参与度 布景。目前，缺乏关于综合干预的研究，以解决与 艾滋病毒/性传播感染和吸毒过量流行，特别是在性工作者中，他们面临不成比例的艾滋病毒和性传播感染 在获得循证成瘾服务方面的负担和严重差距。而在结构和系统层面 行政长官等干预措施和警务做法的改变极有可能减轻相关的危害 由于艾滋病毒/性传播感染和吸毒过量流行的重叠，仍然缺乏关于如何实施 这类干预措施对艾滋病毒/性传播感染和吸毒过量发生率以及对成瘾服务的参与度有影响 性工作者。从2018年开始，不列颠哥伦比亚省温哥华大都会推出了一项新的行政长官干预 包括：同行导航；同行递送纳洛酮和护理点(POC)艾滋病毒/性传播感染筛查； 系统级医疗保健提供者敏感度培训。为应对针对西南地区和西南部的高暴力比率 宣传工作，两个温哥华大都会警察辖区目前正在实施新的指导方针 不骚扰和逮捕性暴力受害者。“自然发生”的结构性和系统一级干预措施都提供了 这是一个及时评估其单独和综合影响的机会。通过R01，我们团队招募了 自2010年以来，她跟踪了温哥华大都会800名街头和非街头女性SWS的队列，其中包括 艾滋病毒/性传播感染和非致命性吸毒的发病率仍然高得惊人。我们建议利用这一稀有的 有机会通过解决以下问题来评估“自然发生的”行政首长和地方警务干预 在温哥华大都会SWS中的前瞻性目标：(1)检查组合CE的影响 干预艾滋病毒/性传播感染和吸毒的发病率以及对吸毒预防和服务的参与；(2)评估 基于同伴的HIV/STI护理点(POC)筛查的可行性、可接受性和实施 发生率和与成瘾治疗的联系；(3)衡量新的警察执法做法对使用的影响 成瘾服务、艾滋病毒/性传播感染和过量用药的发生率，包括行政长官前后的潜在差异 执行；(4)评估接触结构和系统一级行政首长和警务的综合影响 艾滋病毒/性传播感染和吸毒发生率的干预措施。为达致这些目标，我们会继续跟进和补充 800名HIV血清阴性妇女的Aesha队列，这是 北美。数据收集将包括半年一次的问卷调查、艾滋病毒/性传播感染血清学和行政管理 与外部警务和死亡率数据库的联系。在艾滋病毒/性传播感染、阿片类药物使用和服药过量的综合征中 在北美的SWS和PWUD中，这项研究将提供联合干预措施，以减少 边缘人群中艾滋病毒/性传播感染和吸毒的发病率。

PROJECT SUMMARY/ABSTRACT The goal of this competing renewal is to evaluate impacts of two `naturally occurring' interventions - community empowerment (CE) and changes in policing practices - on incidence of HIV/STIs, overdose (OD), and engagement with addiction services among street and indoor sex workers (SWs) in an urban Canadian setting. Currently, there is a lack of research on integrated interventions to address co-occurring harms related to HIV/STI and overdose epidemics, particularly among sex workers, who face disproportionate HIV and STI burdens and severe gaps in access to evidence-based addiction services. While structural and system-level interventions such as CE and changes in policing practices have strong potential to mitigate harms associated with overlapping HIV/STI and overdose epidemics, there remains a scarcity of data on how the implementation of such interventions impacts HIV/STI and overdose incidence and engagement with addiction services among sex workers. Beginning in 2018, a novel CE intervention was launched in Metro Vancouver, British Columbia comprised of: peer navigation; peer-delivered naloxone and point-of-care (POC) HIV/STI screening; and system-level healthcare provider sensitivity training. In response to high rates of violence against SWs and SW advocacy efforts, two Metro Vancouver policing jurisdictions are currently implementing new guidelines for non-harassment and arrest of SWs. Both `naturally occurring' structural and system-level interventions provide a timely opportunity to evaluate their individual and combined effects. Through an R01, our team has recruited and followed a cohort of >800 street and off-street women SWs in Metro Vancouver since 2010, among whom incidence of HIV/STIs and non-fatal OD remain alarmingly high. We propose to take advantage of the rare opportunity to evaluate `naturally-occurring' CE and local policing interventions by addressing the following aims prospectively amongst SWs in Metro Vancouver: (1) Examine the effects of a combination CE intervention on HIV/STI and OD incidence and engagement with OD prevention and services; (2) Evaluate the feasibility, acceptability, and implementation of peer-based HIV/STI point-of-care (POC) screening on HIV/STI incidence and linkage to addiction treatment; (3) Measure impacts of new police enforcement practices on use of addiction services and incidence of HIV/STIs and overdose, including potential differences pre/post CE implementation; (4) Evaluate combined effects of exposure to structural and system-level CE and policing interventions on HIV/STI and OD incidence. To achieve these aims, we will continue to follow and replenish the AESHA cohort of 800 HIV-seronegative women SWs, which is the only ongoing longitudinal SW cohort in North America. Data collection will include semi-annual questionnaires, HIV/STI serology, and administrative linkages to external policing and mortality databases. Amidst syndemics of HIV/STIs, opioid use, and OD among SWs and PWUD in North America, this study will inform combination interventions to reduce the incidence of HIV/STIs and OD amongst marginalized populations.