Prison Interventions and HIV Prevention Collaboration

描述(由申请人提供)：注射吸毒在前苏联(FSU)国家，特别是在乌克兰，极大地助长了爆炸性和不稳定的艾滋病毒流行。由于与北美类似的原因，该地区的吸毒者入狱人数是世界上最高的之一。因此，艾滋病毒/艾滋病和其他传染病(乙肝、丙型肝炎、结核病、性传播感染)集中在刑事司法系统内。在许多FSU国家，监狱内的高危性行为和注射行为导致了艾滋病毒在监狱内的严重传播。因此，CJS不仅是在吸毒者及其性伴侣中发现和治疗艾滋病毒的哨所，而且是调整和实施有效降低艾滋病毒相关发病率和死亡率的循证干预措施的哨所。在这项申请中，我们建议在乌克兰创建一个名为PROID(监狱相关研究、干预开发和评估)的创新和新的合作研究计划，该计划旨在解决FSU地区与艾滋病毒、药物滥用和CJS相关的研究和实施问题。Pride创建了一个研究基础设施，让研究人员和CJS合作伙伴参与，并包括来自乌克兰、哈萨克斯坦和格鲁吉亚的合作者。研究人员和CJS合作伙伴之间的协同作用允许进行公开对话，并有机会利用可能产生最有效结果的计划-研究-法案(PDSA)纳入执行研究。第一阶段提供了一份监测活动清单，可供选择用于乌克兰CJS内的研究活动。有不同的方法战略可用于回答不同的问题，包括传染病的负担和囚犯之间的共病、艾滋病毒危险行为和艾滋病毒在监狱内的传播、艾滋病毒携带者的释放前需求、药物依赖和/或结核病。第二阶段审查所有监测和需求评估活动，并从若干循证干预措施中进行选择，这些干预措施应在囚犯中加以调整和试点。虽然事先不知道，但选项菜单包括监禁的替代方案，行为干预措施，如整体健康恢复计划(HHRP)，阿片类药物替代疗法(OST)，要么在监禁期间实施，要么作为释放前或释放后的干预措施，监狱释放干预措施改编自耶鲁大学调查人员或其他值得探索并通过骄傲达成一致的全国公认的模型。第三阶段涉及选定干预措施的适应和试点测试。这些试点的结果将用于进一步的研究，包括申请新的赠款。Pride成功的可能性基于：1)在药物滥用、艾滋病毒/艾滋病和CJS的界面上进行了20多年的创新研究；2)耶鲁大学和乌克兰之间广泛的研究历史；3)在乌克兰进行研究，那里的疾病负担很重，而且在FSU的活动中发挥着相当大的核心作用。公共卫生相关性：刑事司法系统是在注射吸毒者中发现和治疗艾滋病毒的哨所，需要向社区有效过渡。这项申请旨在通过研究人员与CJS之间的伙伴关系和开展循证研究，以创新的方式促进和便利前苏联国家的研究，以阻止乌克兰注射吸毒者中艾滋病毒的流行。

DESCRIPTION (provided by applicant): Injection drug use (IDU) has greatly contributed to an explosive and volatile HIV epidemic in states of the former Soviet Union (FSU) - especially in Ukraine. This region, for reasons similar in North America, incarceration of drug users is among the highest in the world. As a result, there is a concentration of HIV/AIDS and other infectious diseases (HBV, HCV, TB, STIs) within the criminal justice system (CJS). In many FSU countries, high-risk sexual and injection behaviors within prisons have resulted in significant intra-prison HIV transmission. The CJS is therefore a sentinel place not only to detect and treat HIV among drug users and their sexual partners, but to adapt and implement evidence-based interventions that are effective in decreasing HIV-related morbidity and mortality. In this application, we propose to create an innovative and new collaborative research program in Ukraine called PRIDE (Prison-related Research, Intervention Development and Evaluation), which addresses research and implementation issues in the FSU region associated with HIV, substance abuse and the CJS. PRIDE creates an infrastructure for research that involves both researchers and the CJS partners and includes collaborators from Ukraine, Kazakhstan and Georgia. The synergy between researchers and CJS partners allows an open dialogue and opportunity to incorporate implementation research using the Plan-Do-Study-Act (PDSA) that is likely to yield the most effective outcomes. Phase I provides a menu of surveillance activities that can be selected for research activities within the Ukraine CJS. Differing methodological strategies are available to answer different questions, including burden of infectious diseases and co-morbidity among prisoners, HIV risk behaviors and HIV transmission within prison, pre-release needs of prisoners with HIV, drug dependence and/or TB. Phase II reviews all surveillance and needs assessment activities and to select from a number of evidence-based interventions that should be adapted and pilot-tested among prisoners. Though not known a priori, the menu of options includes alternatives to incarceration, behavioral interventions such as the Holistic Health Recovery Program (HHRP), opioid substitution therapy (OST) administered either during incarceration or as a pre- or post-release intervention, prison-release interventions adapted from nationally-recognized models created by Yale investigators or others worthy of exploration and agreed upon through PRIDE. Phase III involves adaptation and pilot testing of selected interventions. Results from these pilots are to be used for further research, including application for new grants. The likelihood of success for PRIDE is based upon: 1) over 20 years of innovative research at the interface of substance abuse, HIV/AIDS and the CJS; 2) an extensive research history between Yale and Ukraine; and 3) conducting research in Ukraine where the burden of disease is great and its central role in FSU activities is considerable. PUBLIC HEALTH RELEVANCE: Criminal justice systems (CJS) are sentinels sites for the detection and treatment of HIV among IDUs and require effective transition to the community. This application seeks to innovatively promote and facilitate research in countries of the former Soviet Union through partnerships between researchers and the CJS and the conduct of evidence-based research to impede the HIV epidemic among IDUs in Ukraine.