A social network approach for improving medication assisted treatment and HIV prevention and medical care among people who inject drugs in Ukraine

项目摘要 注射毒品的人（PWID）感染艾滋病毒和传播以及致命的阿片类药物的风险很高 吸毒过量此R34的目标是试验更大的基于设置的 增加药物辅助治疗（MAT）和艾滋病毒医疗护理的随机临床试验（RCT）， 药物依从性。在拟议的研究中，我们将招募80名指数PWID（一半HIV血清阳性），他们具有： 1)在MAT上至少一年，2）能够招募使用毒品的活跃网络成员，3） 愿意将MAT推广到这些PWID。根据我们的试点数据，我们预计这80个指数参与者将 能够招募大约160名网络成员（每个网络成员两名）进行研究干预。基线后 评估指标和网络成员，指标及其各自的网络成员将 随机分配到实验干预或比较条件。实验 干预，索引将接受培训，了解如何与其网络成员合作，以促进MAT和艾滋病毒 为感染艾滋病毒的毒品网络成员提供护理，包括坚持抗逆转录病毒疗法。所有研究参与者将 在3个月时通过调查和药物测试进行评估。成果将包括网络中MAT的吸收 在索引和网络成员中保留美沙酮，减少艾滋病毒血清转化 在所有研究参与者中减少非法药物使用，以及与艾滋病毒医疗服务的联系 艾滋病毒感染者网络参与者的护理和抗逆转录病毒疗法坚持率。根据我们的调查结果， 在先前的研究中，我们还预计，随机分配到 实验组的学生会因同伴教育活动而有所进步。我们将进行定性过程， 对实验干预条件下的10项指标和10名网络成员进行结果访谈。我们 我还将采访8名MAT和艾滋病诊所工作人员，评估他们对干预可行性的看法 和可接受的。鉴于阿片类药物流行的范围和艾滋病毒在艾滋病患者中的持续流行， 开发新的干预措施以增加MAT的吸收和保留至关重要。

Project Summary People who inject drugs (PWID) are at high risk for HIV infection and transmission as well as fatal opioid overdoses. The goal of this R34 is to pilot the key components necessary for a larger setting-based randomized clinical trial (RCT) for increasing medication-assisted treatment (MAT) and HIV medical care and medication adherence. In the proposed study, we will recruit 80 index PWID (half HIV seropositive) who have: 1) been on MAT for at least one year, 2) are able to recruit active network members who use drugs, and 3) are willing to promote MAT to these PWID. Based on our pilot data, we anticipate these 80 index participants to be able to recruit approximately 160 network members (two each) for the study intervention. After the baseline assessment of the indexes and network members, the indexes and their respective network members will be randomly assigned to the experimental intervention or the comparison condition. In the experimental intervention, the indexes will be trained on how to work with their network members to promote MAT and HIV care, including ART adherence, for drug network members living with HIV. All study participants will be assessed at 3 months with surveys and drug testing. Outcomes will include MAT uptake among network members, retention on methadone amongst indexes and network members, reduced HIV seroconversions among network members, reduced illicit drug use among all study participants, and linkage to HIV medical care and ART adherence among network participants who are living with HIV. Based on findings from our prior studies, we also anticipate that the health behaviors of the index participants randomized to the experimental group will improve due to their peer education activities. We will conduct qualitative process and outcomes interviews with 10 indexes in the experimental intervention condition and 10 network members. We will also interview 8 MAT and HIV clinic staff members to assess their perspectives on intervention feasibility and acceptably. Given the scope of the opioid epidemic and continued HIV epidemic among PWID, development of novel interventions to increase MAT uptake and retention is critical.