Ending HIV and Taming HCV and Overdose Among Puerto Rican PWID in New York City: The Ganchero Intervention

项目总结/摘要 艾滋病毒对美国注射毒品者（PWID）的威胁还没有结束。多个HIV 从2015年起，美国印第安纳州的农村地区和城市地区都发生了PWID疫情 到2018年在马萨诸塞州的波士顿。属于少数种族/族裔的残疾人继续不成比例地 感染了艾滋病病毒其中，在波多黎各（PR）开始注射毒品的波多黎各（PR）PWID和 继续在纽约市注射毒品的人不仅容易感染艾滋病毒，而且容易感染丙型肝炎 (HCV)以及致命的阿片类药物过量在纽约市进行的分析发现，PR PWID，特别是那些移民 是最容易感染艾滋病毒的种族群体。2017年，美国出生的美国人和 PR出生的波多黎各人PWID超过了非西班牙裔白人的比率，纽约市也是如此。 最近的研究表明，PR PWID的HCV感染率明显高于非PR PWID， PR出生的移民PWID在所有三个组中具有最高的HCV患病率（86%）。帮助PR出生 PWID避免艾滋病毒将有助于防止艾滋病毒在纽约爆发。降低他们的HCV和过量风险将有助于 在纽约市的PWID中，降低总体HCV患病率（67%）和过量死亡率（21.2/10万）。 在这项为期3年的研究中，我们将开发一种创新的和文化上定制的HIV，HCV和过量风险- 减少纽约市移民PR PWID的干预，利用Ganchero的关键移民PWID作用， 经常使用的“注射医生”，以及移民强大的社会关系网。干预将是双重的：1） 它将对甘切罗斯进行艾滋病毒、丙型肝炎病毒和过量用药的基本知识培训， Gancheros传播以证据为基础的减少风险信息和资源， 注射的做法，因为他们提供他们的定期服务，以移民PWID客户。干预将使用 等候名单控制设计，涉及两个布朗克斯社区的10名Gancheros和60名客户。跨越两个时滞 干预实施周期（每个社区一个，每个周期由6个会议组成，小组 Ganchero培训和4个月的部署期）和5个评估时间点，我们将衡量 干预的可行性（通过Ganchero和客户参与率），可接受性（通过Ganchero和客户 视觉模拟量表[VAS]评分和定性反馈）和初步有效性， 无菌注射器使用率（主要有效性结局）和纳洛酮携带率（次要有效性结局 效果）。Gancheros的HIV，HCV和过量知识和个人药物使用的变化 在培训之前和之后也将评估行为。民族志观察 Gancheros部署干预战略将评估实施的保真度，障碍和Gancheros的 对障碍的反应，为完善干预措施及其实施战略提供信息。如果成功， 这种干预措施将降低HCV和过量的高发病率，并降低艾滋病毒感染的潜在可能性。 爆发然后，我们将在混合有效性-实施试验（R 01）中评估Ganchero干预。

Project Summary/Abstract The threat of HIV among people who inject drugs (PWID) in the United States (US) is not over. Multiple HIV outbreaks among PWID in rural and urban areas of the US have occurred recently, from 2015 in rural Indiana to 2018 in Boston, Massachusetts. PWID who are racial/ethnic minorities continue to be disproportionately infected with HIV. Among these, Puerto Rican (PR) PWID who started injecting drugs in Puerto Rico (PR) and continue to inject drugs in New York City (NYC) remain vulnerable not only to HIV, but also to hepatitis C (HCV) and fatal opioid overdose. Analyses conducted in NYC found PR PWID, especially those who migrated from PR, are the most HIV-vulnerable ethnic group. In 2017, the US overdose mortality rate for US-born and PR-born Puerto Rican PWID exceeded the rate for Non-Hispanic Whites, and the same holds true in NYC. Recent research showed that PR PWID have significantly higher prevalence of HCV than non-PR-PWID, and that PR-born migrant PWID have the highest HCV prevalence (86%) of all three groups. Helping PR-born PWID avoid HIV will help prevent HIV outbreaks in NYC. Lowering their HCV and overdose risk will help reduce overall HCV prevalence (67%) and overdose mortality rates (21.2 per 100,000) in NYC’s PWID. In this 3-year study, we will develop an innovative and culturally tailored HIV, HCV, and overdose risk- reduction intervention for migrant PR PWID in NYC that leverages the key migrant PWID role of the Ganchero, frequently used “injection doctors,” and migrants’ strong social network ties. The intervention will be twofold: 1) it will train Gancheros on the foundational HIV, HCV, and overdose knowledge required to, 2) deploy Gancheros to disseminate evidence-based risk-reduction messages and resources and to implement safer injection practices as they deliver their regular services to migrant PWID clients. The intervention will use a wait-list control design with 10 Gancheros and 60 clients in two Bronx neighborhoods. Across two time-lagged intervention implementation cycles (one per neighborhood, each consisting of a 6-session, small-group Ganchero training and a 4-month deployment period) and five assessment time points, we will measure the intervention’s feasibility (via Ganchero and client participation rates), acceptability (via Ganchero and client Visual Analog Scale [VAS] ratings and qualitative feedback) and preliminary effectiveness in increasing migrant clients’ rates of sterile syringe use (primary effectiveness outcome) and naloxone carriage (secondary effectiveness outcome). Changes in Gancheros’ HIV, HCV, and overdose knowledge and personal drug use behaviors will also be assessed before and after the training component. Ethnographic observations of Gancheros deploying intervention strategies will assess fidelity of implementation, barriers, and Gancheros’ responses to barriers, to inform refinements of the intervention and its implementation strategy. If successful, this intervention will reduce the high rates of HCV and overdose, and the significant potential for an HIV outbreak. We will then evaluate the Ganchero intervention in a hybrid effectiveness-implementation trial (R01).