Improving HIV Service Delivery for People who Inject Drugs in Kazakhstan

改善哈萨克斯坦注射吸毒者的艾滋病毒服务

• 批准号: 9054333
• 负责人: Nabila El-Bassel
• 金额: $ 86.93万
• 依托单位: COLUMBIA UNIV NEW YORK MORNINGSIDE
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-30 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9054333
• 关键词: Acquired Immunodeficiency Syndrome; Acute; Address; Adherence; Asians; Attitude; Caring; Case Management; Case Manager; Cities; Client; Clinic; Collaborations; Communities; Continuity of Patient Care; Counseling; Country; Data; Drops; Drug usage; Effectiveness; Eligibility Determination; Enrollment; Epidemic; Failure; Government; HIV; HIV Seropositivity; Human immunodeficiency virus test; Incidence; Income; Injection of therapeutic agent; Intervention Studies; Kazakhstan; Letters; Link; Methods; Modeling; Needles; Nurses; Office Nursing; Outcome; Pharmaceutical Preparations; Process; Provider; Public Health; Quality of life; Reporting; Research; Resources; Risk; Sampling; Services; Site; Social Network; Syringes; System; Testing; Training; Treatment Protocols; Viral; antiretroviral therapy; cost; cost effectiveness; design; effectiveness research; experience; follow-up; implementation research; improved; injection drug use; innovation; mortality; peer; prevent; primary outcome; programs; public health relevance; scale up; sex risk; social stigma; theories; transmission process

 DESCRIPTION (provided by applicant): Driven by injection drug use, Kazakhstan and other Central Asian nations are currently experiencing the fastest growing HIV incidence in the world and continue to report huge gaps in the continuum of HIV care for PWID. According to 2014 national data, only one-third of the estimated 19,000 HIV-positive PWID in Kazakhstan are ever linked to HIV care and only 10% initiate ART with 4% achieving viral suppression. As Kazakhstan is expanding eligibility for ART from <350 CD4 to <500 CD4 in 2015, there is an urgency to enroll previously ineligible HIV-positive PWID in ART. Large gaps in Kazakhstan's continuum of care for PWID mirror gaps found in other countries in which only a small proportion of PWID initiate ART. Mounting research demonstrates that improving rates of ART among PWID may be an effective strategy to prevent HIV transmission, lower mortality, improve quality of life, and reduce drug and sexual risk behaviors. There is a critical need for effectiveness and implementation research to identify how best to improve HIV service delivery to close the critical "Treat" gap in the continuum of care. This will occur by identifying and linkng HIV-positive PWID to HIV care, and reaching out to those who have never been in HIV care, are intermittent users of care, or have dropped out of treatment. The proposed study is designed to evaluate the implementation and effectiveness of an enhanced HIV service integration package (BRIDGE) that may be scaled up in Kazakhstan's vast network of needle-syringe programs (NSPs) for PWID. This package includes low threshold strategies of peer-driven recruitment, HIV counseling and rapid testing (HCT) in NSPs conducted by HIV care clinic nurses, and ARTAS, CDC's highly effective case management strategies for linking PWID to HIV care. BRIDGE is systematically designed to address specific service barriers to testing PWID for HIV, linking them to HIV care, and promoting ART initiation. This study will employ an innovative stepped wedge design to evaluate implementation and effectiveness of BRIDGE on improving linkage to HIV care and initiation of ART in 24 NSPs located in 4 geographically disparate Kazakhstani cities using site-level data collected from NSPs and HIV clinics. We will also conduct a longitudinal panel study with a random sample of HIV-positive PWID (N=600) from four cities in Kazakhstan using repeated assessments at baseline, 6-, and 12-months follow-up. This study will employ mixed methods to identify multi-level structural, community, and organizational factors that influence the implementation and effectiveness of BRIDGE and the cost of BRIDGE, examining implications for cost-effectiveness, feasibility of expansion, and sustainability. The study builds on the investigative team's extensive HIV intervention research among PWID in Kazakhstan in collaboration with the Republican AIDS Center over the past decade. It addresses implementation research questions to improve and integrate HIV service delivery systems for PWID that are not only important to the region, but have relevance to other countries that have concurrent injection drug use and HIV epidemics.

 描述（由适用提供）：在注射毒品使用的驱动下，哈萨克斯坦和其他中亚国家目前正在遭受世界上增长最快的艾滋病毒事件，并继续报告在PWID的HIV持续情况下差距。根据2014年的国家数据，哈萨克斯坦估计的19,000名HIV阳性PWID中只有三分之一与HIV护理有关，只有10％的人启动ART，有4％的人获得病毒抑制。由于哈萨克斯坦在2015年将ART的资格从<350 CD4扩展到<500 CD4，因此有迫切需要参加以前不合格的HIV阳性PWID。在哈萨克斯坦的连续性护理中，在其他国家 /地区发现的PWID镜面差距的差距很大，其中只有一小部分PWID启动艺术。越来越多的研究表明，提高PWID的艺术率可能是防止HIV传播，降低死亡率，改善生活质量以及减少药物和性风险行为的有效策略。迫切需要有效性和实施研究，以确定如何最好地改善艾滋病毒服务的服务，以缩小护理连续体中关键的“治疗”差距。这将通过将HIV阳性的PWID与艾滋病毒护理识别和链接，并与从未从事HIV护理的人接触，是间歇性的护理使用者，或者已经辍学了。拟议的研究旨在评估增强的HIV服务集成软件包（桥梁）的实施和有效性，该软件包可以在哈萨克斯坦的PWID庞大的针刺 - 丝氨酸计划（NSP）网络中扩展。该软件包包括艾滋病毒护理诊所护士进行的NSP的同行驱动招聘，艾滋病毒咨询和快速测试（HCT）的低阈值策略，以及CDC是将PWID与HIV CARE联系起来的高效案例管理策略ARTA。 Bridge是系统地设计的，旨在解决针对艾滋病毒的PWID，将其与艾滋病毒护理联系起来的特定服务障碍，并促进艺术倡议。这项研究将采用创新的梯级楔形设计来评估桥梁在改善位于4个地理位置截然不同的哈萨克斯坦城市中的24个NSP的纽带和ART倡议方面的实施和有效性，并使用NSPS和HIV诊所收集的现场数据。我们还将使用基线，6个月和12个月的随访时，使用重复评估来进行来自哈萨克斯坦四个城市的HIV阳性PWID（n = 600）的随机样本。这项研究将采用混合方法来确定影响桥梁的实施和有效性以及桥梁成本的多级结构，社区和组织因素，检查对成本效益，扩张的可行性和可持续性的影响。这项研究基于调查团队在过去十年与共和党艾滋病中心合作的调查小组在哈萨克斯坦的PWID中进行了广泛的HIV干预研究。它解决了实施研究问题，以改善和整合PWID的艾滋病毒服务提供系统，而PWID不仅对该地区很重要，而且与其他同时注射药物使用和HIV流行病的国家相关。