Interventions with HIV+ and HIV- IDUs in Ukraine

说明(申请人提供)：背景：乌克兰是东欧和西欧艾滋病毒/艾滋病的中心，估计有23万人感染，其中大多数是注射吸毒者。该项目的目标是比较两种干预措施在乌克兰三个以艾滋病毒血清阳性率高著称的地点减少艾滋病毒感染传播的有效性：基辅、敖德萨和马克耶夫卡/顿涅茨克。这些干预措施包括在NIDA《合作协议》期间制定的艾滋病毒咨询和教育干预模式和土著领袖外联模式。目的：比较两种方法在以下方面的相对有效性：1)增加对HIV/AIDS传播的认识；2)提高自我效能感，实行更安全的药物和性行为，以及戒毒动机；3)减少或取消注射吸毒，减少HIV相关药物和性危险行为。其他目标是：4)评估艾滋病毒阳性者和艾滋病毒阴性者在每项干预措施(ILOM和ILOM+C&E)内以及在适当情况下跨干预措施在减少或消除注射吸毒和减少艾滋病毒相关药物和性危险行为方面的差异；以及5)评估与减少注射毒品使用和减少艾滋病毒相关药物和性危险行为有关的因素。基于这一努力的成功，我们的长期目标是，在研究结束后，乌克兰政府将至少维持其中一项干预措施。方法：与Sergiy Dvoryak博士和三个非政府组织的负责人合作，采用交叉实验设计，来自三个城市的600名静脉吸毒者将接受社区干预或社区干预+ILOM。受试者将通过街头外展招募，在6个月和12个月时接受采访、干预和跟踪。在基线访谈和两次后续评估之后，双方的受试者都将接受艾滋病毒检测和咨询(使用C&E模式)。使用考虑到每个受试者重复测量的相关性的方差和Logistic回归的混合模型分析，分析将评估单独的C&E和C&E+ILOM以及其他因素在增加知识、自我效能、动机和减少与艾滋病毒相关的危险行为方面的有效性。分析还将评估感染艾滋病毒的注射吸毒者(估计为42%)与未感染的注射吸毒者之间的差异。

DESCRIPTION (provided by applicant): Background: Ukraine is the epicenter of HIV/AIDS in Eastern and Western Europe, with an estimated 230,000 infected, most of whom are injection drug users (IDUs). The goal of this project is to compare the effectiveness of two interventions in reducing the spread of HIV infection in three Ukrainian locations noted for their high HIV seroprevalence: Kiev, Odessa and Makeevka/Donetsk. The interventions include the HIV Counseling and Education (C & E) intervention model developed during NIDA's Cooperative Agreement and the Indigenous Leader Outreach Model (ILOM). Aims: To compare the relative effectiveness of the two approaches in: 1) increasing knowledge about HIV and AIDS transmission; 2) increasing self-efficacy to practice safer drug and sex HIVor related behaviors and motivation to quit drug use; and 3) decreasing or eliminating injection drug use and reducing HIV-related drug and sex risk behaviors. Other aims are: 4) to evaluate differences between individuals who are HIV positive and those who are HIV negative in decreasing or eliminating injection drug use and reducing HIV-related drug and sex risk behaviors within each intervention (ILOM and ILOM+C & E) and across interventions as appropriate; and 5) to assess factors associated with reduced injection drug use and reduced HIV-related drug and sex risk behaviors. Based on the success of this effort, it is our long-term goal that at least one of these interventions will be sustained by the government of Ukraine following the conclusion of the research. Methods: In collaboration with Dr. Sergiy Dvoryak and the Directors of three nongovernmental organizations, 600 IDUs from each of the three cities will receive the C & E intervention or the C & E plus the ILOM, using a crossover experimental design. Subjects will be recruited through street outreach, interviewed, intervened with and followed at six and 12 months. Subjects in both arms will be offered HIV testing and counseling (using the C & E model) following the baseline interview and at both follow-up assessments. Using mixed model analysis of variance and logistic regressions accounting for the relatedness of repeated measures on each subject, analyses will assess the extent to which the C & E alone and the C & E plus the ILOM, as well as other factors, are effective in increasing knowledge, self-efficacy, motivation and reducing risk behaviors associated with HIV. Analyses will also evaluate differences between IDUs who are HIV infected (estimated at 42%) and those who are not infected.