Couples-Based HIV/STI Prevention for Injecting Drug Users in Kazakhstan

描述(申请人提供)：拟议的研究将严格测试创新的、以夫妇为基础的艾滋病毒/性传播感染风险降低干预(CHSR)的有效性，以减少新的艾滋病毒和丙型肝炎(丙型肝炎)病例和性传播感染(STI)的发生率，以及减少不安全的注射做法，并增加哈萨克斯坦舒邦注射吸毒者(IDU)及其异性恋、亲密伴侣的安全套使用量。由于注射毒品的使用急剧增加，中亚经历了艾滋病毒/艾滋病流行增长最快的地区之一。这个来自哥伦比亚大学社会干预小组和哈萨克斯坦舒邦临床针具交换项目的调查小组在哈萨克斯坦舒邦的40名吸毒者及其主要的异性伴侣(N=80)中完成了一项拟议的CHSR的试点随机对照试验。与被分配到健康促进比较条件(WP)的参与者(n=40)相比，CHSR参与者(n=40)报告的不安全注射行为明显减少，避孕套使用量增加，从基线到3个月的随访。在拟议的研究中，参与者将是400名吸毒者及其异性恋亲密伴侣，他们符合资格标准(例如，至少有一名伴侣报告在过去30天内进行了不安全注射和无保护的性行为)。参与者将从蜀国临床针具交换计划中招募，并通过蜀地的街头外展招募。蜀国位于一条主要的贩毒路线上，在3.5万人口中，估计有4500名吸毒者。在这项拟议的研究中，400对夫妇将被随机分配到两种干预措施中的一种：以夫妇为基础的5次HIV/STI风险降低干预或以夫妇为基础的5次健康促进干预，这将作为比较条件。参与者将在基线、干预后3个月、6个月和12个月时接受重复测量。主要的行为结果是自我报告的在过去30天内共用针头或注射器的注射行为的比例，以及在过去30天内保护避孕套的性行为的比例。主要的生物学结果是新的艾滋病毒病例和新的丙型肝炎病例的比率，以及干预后12个月内衣原体、淋病和梅毒的发生率。这项拟议的研究将促进注射吸毒者及其异性伴侣对降低艾滋病毒/丙型肝炎病毒/性传播感染风险的了解，从而有助于遏制哈萨克斯坦和中亚地区艾滋病毒、丙型肝炎病毒和性传播疾病日益流行的趋势。 公共卫生相关性拟议的研究针对哈萨克斯坦非常高风险的活跃注射吸毒者及其性伴侣人群中艾滋病毒、丙型肝炎病毒和其他性传播疾病对公共卫生的重大威胁--哈萨克斯坦是世界上艾滋病毒流行上升最快的地区之一。目前正在竞相为注射吸毒者及其性伴侣制定和实施有效的艾滋病毒预防干预措施，以阻止艾滋病毒、丙型肝炎病毒和其他性传播感染在舒邦和其他中亚贩毒路线沿线城镇的传播。

DESCRIPTION (provided by applicant): The proposed study will rigorously test the efficacy of an innovative, couples-based HIV/STI risk reduction intervention (CHSR) to decrease new cases of HIV and Hepatitis C (HCV) and incidence of sexually transmitted infections (STIs), as well as to reduce unsafe injection practices and increase condom use among injecting drug users (IDUs) and their heterosexual, intimate partners in Shu, Kazakhstan. Central Asia has experienced one of the fastest growing HIV/AIDS epidemics due to a sharp increase in injection drug use. This investigative team from the Social Intervention Group at Columbia University and the Shu Policlinic Needle Exchange Program in Kazakhstan completed a pilot randomized controlled trial of the proposed CHSR among 40 IDUs and their primary, heterosexual partners (N=80) in Shu, Kazakhstan. Compared to participants assigned to the wellness promotion comparison condition (WP) (n=40), CHSR participants (n=40) reported significantly fewer unsafe injection behaviors and greater condom use from baseline to the 3-month follow-up. For the proposed study, the participants will be 400 IDUs and their heterosexual, intimate partners, who meet eligibility criteria (e.g., at least one partner reports unsafe injection and unprotected sexual intercourse in the past 30 days). Participants will be recruited from the Shu Policlinic needle exchange program and through street outreach in Shu. Shu is located along a major drug trafficking route and has an estimated 4,500 IDUs out of a population of 35,000. In the proposed study, 400 couples will be randomized to one of two interventions: a 5-session couples-based HIV/STI risk reduction intervention or a 5- session couples-based wellness promotion intervention, which will serve as a comparison condition. Participants will be assessed with repeated measures at baseline, 3-, 6- and 12-months post-intervention. The primary behavioral outcomes are self- reported proportion of injection acts in which needles or syringes are shared in the past 30 days and proportion of condom-protected acts of sexual intercourse in the past 30 days. The primary biological outcomes are the rate of new HIV cases and new HCV cases, as well as the incidence of Chlamydia, gonorrhea, and syphilis over the 12-month post-intervention period. The proposed study will advance the understanding of HIV/HCV/STI risk reduction among a population of IDUs and their heterosexual partners, and thereby help to stem the rising epidemic of HIV, HCV, and STIs in Kazakhstan and Central Asia. PUBLIC HEALTH RELEVANCE The proposed study addresses a significant public health threat of HIV, HCV and other STIs among a very high risk population of active IDUs and their sexual partners in Kazakhstan - a region that is experiencing one of the fastest rising HIV epidemics in the world. There is a race to develop and implement effective HIV preventive interventions for IDUs and their sexual partners to stem the spread of HIV, HCV and other STIs in Shu and other Central Asian towns along drug trafficking routes.