HIV and Drug Use in Georgian Women

格鲁吉亚妇女的艾滋病毒和吸毒情况

• 批准号: 8145624
• 负责人: Hendree E Jones
• 金额: $ 46.3万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8145624
• 关键词: AIDS prevention; AIDS/HIV problem; Adult; Aftercare; Behavioral; Case Management; Collaborations; Country; DA10; Data; Development; Discrimination; Drug Addiction; Drug Rehabilitation Centers; Drug abuse; Drug usage; Drug user; Eastern Europe; Effectiveness; Epidemic; European; Focus Groups; Frequencies; Gender; General Population; Goals; HIV; HIV Infections; HIV Seropositivity; Health; Health Personnel; Hepatitis C; Hepatitis C Transmission; Hepatitis C virus; Infection; Injecting drug user; Injection of therapeutic agent; International; Interpersonal Violence; Intervention; Knowledge; Low Prevalence; Mental disorders; Modeling; Needle Sharing; Pattern; Perception; Pharmaceutical Preparations; Pilot Projects; Prevalence; Prevention approach; Provider; Psychological reinforcement; Public Health; Relative (related person); Reporting; Research; Research Personnel; Risk; Risk Behaviors; Risk Factors; Russia; Sex Behavior; System; Testing; Time; United States; Western Asia Georgia; Woman; Work; base; evidence base; experience; follow-up; high risk behavior; interest; meetings; men; randomized trial; sex risk; substance abuse treatment; treatment program

DESCRIPTION (provided by applicant): Eastern Europe is an emerging epicenter of injection drug use and HIV infection, among women. Within Eastern Europe, the Republic of Georgia is one of the last countries where an HIV epidemic can still be averted. This proposal responds to RFA-DA-10-008 International Research Collaborations on HIV/AIDS and Drug Use by building on the successful collaboration among US and Eastern European investigators from the Republic of Georgia and Russia. Recent data from Georgia's neighbor, Russia, reported 59% of IDU women HIV seropositive; this is a threat that looms over Georgia. Understanding the risk factors that operate in Russia that drive this epidemic may help forestall such a catastrophe in Georgia. As such, this proposal directly responds to the Eastern European Region RFA-specific question of "How can drug abuse treatment interventions be integrated with established HIV prevention approaches to optimize their combined effectiveness?" Injection drug using (IDU) Georgian women show prevalence rates of 2% for HIV and 25% for hepatitis C (HCV). The low prevalence of HIV in Georgian women provides an important window of opportunity to intervene and avoid the possibility of an HIV epidemic. In Georgia, women's expected subordination to men makes women vulnerable to HIV/HCV infection. The proposed study will proceed by meeting four sequential aims. Aim 1. Explore drug use (e.g., types and patterns), HIV and HCV injection and sexual risk behaviors, comorbid conditions (e.g., interpersonal violence, comorbid psychiatric disorders), and treatment barriers and experiences (e.g., gender discrimination) among n=54 IDU Georgian women. Aim 2. Identify from n=34 treatment providers their practices and perceptions regarding IDU women in the current Georgian drug-treatment system. Aim 3. We will adapt and pretest both a drug abuse treatment approach of Reinforcement-Based Treatment (RBT) that integrates the evidence based Women's Co-Op HIV prevention and a case management approach for IDU Georgian women. This aim includes n=16 IDU women and n=16 providers in separate focus groups followed by n=20 IDU women completing pretesting. Aim 4. In a small- scale randomized trial (n=128), determine the feasibility and initial efficacy of our Georgian RBT model relative to a case management model in terms of their respective impacts on the frequency of unprotected sexual acts and syringe sharing at post-treatment and 3-month post-treatment follow-up. The public health impact of the proposed project is far-reaching. Taken to scale, our Georgian RBT treatment model holds the promise not only to lessen the possibility of an HIV epidemic and slow the increase in the HCV transmission rate in Georgia, but also to strongly influence the development of women-focused drug abuse intervention models for treatment tailoring and dissemination in other nations. PUBLIC HEALTH RELEVANCE: This is an opportune time for United States, Republic of Georgia, and Russian collaborators to further identify the patterns of drug use and cultural contexts of risks in order to adapt and test a comprehensive treatment model for women injection drug users to avert an HIV epidemic and further increases in HCV in the Republic of Georgia.

描述(申请人提供)：东欧是注射毒品使用和艾滋病毒感染在妇女中的新兴中心。在东欧，乔治亚共和国是仍可避免艾滋病毒流行的最后几个国家之一。该提案响应了RFA-DA-10-008关于艾滋病毒/艾滋病和药物使用的国际研究合作，建立在乔治亚共和国和俄罗斯的美国和东欧调查人员之间成功合作的基础上。来自格鲁吉亚邻国俄罗斯的最新数据显示，59%的注射吸毒者妇女艾滋病毒血清呈阳性；这是一个笼罩着格鲁吉亚的威胁。了解在俄罗斯引发这种流行病的风险因素可能有助于预防格鲁吉亚发生这样的灾难。因此，这项建议直接回应了东欧地区特定的RFA问题，即“如何将药物滥用治疗干预措施与既定的艾滋病毒预防方法相结合，以优化其综合效力？”注射吸毒(IDU)格鲁吉亚妇女的艾滋病毒流行率为2%，丙型肝炎流行率为25%。格鲁吉亚妇女中艾滋病毒的低流行率为干预和避免艾滋病毒流行的可能性提供了一个重要的机会之窗。在格鲁吉亚，女性预期从属于男性，这使得女性容易感染艾滋病毒/丙型肝炎病毒。拟议的研究将通过实现四个相继的目标来进行。目的1.调查54名注射吸毒者格鲁吉亚妇女的药物使用(例如，类型和模式)、艾滋病毒和丙型肝炎注射和性危险行为、共病情况(例如人际暴力、并存精神障碍)以及治疗障碍和经历(例如性别歧视)。目的2.从n=34个治疗提供者中确定他们在格鲁吉亚目前的药物治疗系统中对注射吸毒者妇女的做法和看法。目的3.我们将采用和预测一种药物滥用治疗方法，一种是以强化治疗为基础的药物滥用治疗方法，它结合了循证妇女合作预防艾滋病毒的方法，另一种是针对注射吸毒者格鲁吉亚妇女的病例管理方法。这一目标包括n=16名注射吸毒者妇女和n=16个不同重点小组的提供者，然后是n=20名注射吸毒者妇女完成预测试。目的4.在一项小规模随机试验中(n=128)，确定我们的格鲁吉亚RBT模式相对于病例管理模式的可行性和初步疗效，以分别在治疗后和治疗后3个月随访时对无保护性行为和共用注射器的频率产生影响。拟议中的项目对公众健康的影响是深远的。从规模上看，我们格鲁吉亚的RBT治疗模式不仅有望减少艾滋病毒在格鲁吉亚流行的可能性和减缓丙型肝炎传播率的增加，而且还将有力地影响以妇女为重点的药物滥用干预模式的发展，以便在其他国家进行治疗定制和传播。公共卫生相关性：对于美国、乔治亚共和国和俄罗斯的合作者来说，现在是进一步确定毒品使用模式和风险文化背景的适当时机，以便调整和测试女性注射吸毒者的综合治疗模式，以避免艾滋病毒在格鲁吉亚的流行和丙型肝炎病毒的进一步增加。