Characterizing medication-assisted opioid use treatment and HIV care delivery for community re-entrants with HIV and opioid use disorder in South Africa

项目总结 抗逆转录病毒疗法(ART)的可获得性显著降低了艾滋病毒相关死亡率和 非洲的发病率。然而，艾滋病毒仍然是#年成年男女死亡的主要原因。 南非由于未能发起抗逆转录病毒治疗或继续接受治疗。2%到3%的感染艾滋病毒的男性 在南非，每年都要通过惩戒系统。在监禁期间摄取 艺术是极好的；不幸的是，在重新进入社区期间，大多数使用艺术的人 从照料中迷失。这个课题组在#年进行了定性和定量的研究 南非指出，这些人口在参与护理方面遇到了多种障碍。 这些障碍包括缺乏以病人为中心的护理、家庭遗弃和有限的社会 资本、制定的污名、经济不安全和物质使用。超过55%的社区 重返者报告非法使用阿片类药物；这似乎是护理损失的主要原因。一个 循证方法帮助管理这一问题是长期药物辅助的 物质使用的治疗(垫)。在南非，美沙酮和丁丙诺啡/纳洛酮是 可用，但从未专门用于重新进入者。这一项目旨在 描述双重诊断的返回者的需求、他们的旅程以及 为这一人群实施MAT计划。我们建议招募40名双胞胎- 确诊的囚犯，提供阿片类药物使用服务和艾滋病毒联系，以照顾和跟踪他们6年 释放后几个月。发布后的后续行动将包括纵向深入采访，以 对双重诊断的动态流程或社区重新进入产生丰富的理解 囚犯们。这包括它们与阿片类药物使用和阿片类药物使用管理的关系 服务。我们还将与主要利益相关者进行面谈，以加深对 执行需求，并召开研讨会，与利益攸关方一起反思调查结果， 包括被诊断为双重诊断的前囚犯，以制定可行和可接受的工作模式 这一人群中的药物使用管理。目前的建议将允许进行适应 现有的社区垫子和减少伤害计划，以满足重新进入者的需求。这 该项目有可能开发出关于一个拥有 很少受到关注-南非的双重诊断患者和重新进入社区的人 总体而言。

PROJECT SUMMARY The availability of antiretroviral therapy (ART) has markedly reduced HIV-related mortality and morbidity in Africa. Yet HIV remains the leading cause of death among adult men and women in South Africa due fails to initiated ART or remain in care. Between 2 and 3% of HIV-infected men in South Africa pass through the corrections system annually. During incarceration uptake of ART is excellent; unfortunately, during community re-entry most individuals who were on ART are lost from care. Qualitative and quantitative research conducted by this research group in South Africa indicates that this population encounters multiple barriers to care engagement. These barriers include lack of patient-centered care, family abandonment and limited social capital, enacted stigma, economic insecurity, and substance use. More than 55% of community re-entrants report illicit opioid use; this appears to the leading cause of loss from care. An evidence-based approach to help management this issue is long-term medication-assisted treatment (MAT) of substance use. In South Africa, methadone and buprenorphine/naloxone are available but have never been used specifically for re-entrants. This project seeks to characterize the needs of dual diagnosed re-entrants, their journey, and key components of implementing a MAT program for this population. We propose to recruit a cohort of 40 dual- diagnosed inmates, offer opioid use services and HIV linkage to care and follow them for 6 months post release. Post-release follow-up will include longitudinal in-depth interviews to generate a rich understanding of the dynamic process or community re-entry for dual-diagnosed inmates. This includes their relationships with opioid use and with opioid use management services. We will also interview key stakeholders to develop a clear understanding of implementation needs and convene workshops to reflect on findings with stakeholders, including dual diagnosed ex-inmates, to develop a feasible and acceptable working model for substance use management in this population. The current proposal will allow for the adaptation of an existing community MAT and harm reduction program to fit the needs of re-entrants. This project has the potential to develop considerable new knowledge on an population that has received little attention – dual diagnosed individuals in South Africa and community re-entrants in general.