PWID Opportunities to Improve TrEat and Retain (POINTER)

注射吸毒者改善治疗和保留的机会 (POINTER)

• 批准号: 10237849
• 负责人: GREGORY M LUCAS
• 金额: $ 104.33万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10237849
• 关键词: Address; Adoption; Africa; African; Caring; Cities; Clinic; Communities; Continuity of Patient Care; Cost Effectiveness Analysis; Country; Data; Decentralization; Diagnosis; Effectiveness; Epidemic; Evaluation; Evidence based intervention; Foundations; Government; HIV; HIV Infections; HIV Seropositivity; Health; Health Policy; Human immunodeficiency virus test; Incidence; Income; India; Individual; Injecting drug user; Injections; Intervention; Link; Modeling; Needle Sharing; Opioid; Opium; Pathway interactions; Patients; Persons; Pharmaceutical Preparations; Policies; Population; Prevalence; Price; Production; Publishing; Randomized; Randomized Controlled Trials; Respondent; Sampling; Site; Social Network; System; Testing; Time; Treatment outcome; Viral; Visit; Work; arm; base; community based care; cost; cost effectiveness; design; effectiveness implementation study; eligible participant; experience; follow-up; high risk; implementation facilitators; implementation science; improved; insight; intervention cost; intervention effect; low and middle-income countries; motivational enhancement therapy; novel; opioid use; opioid user; primary outcome; psychosocial; randomized trial; recruit; response; scale up; skills; testing uptake

7. PROJECT SUMMARY/ABSTRACT People who inject drugs (PWID) are at high risk for HIV infection and experience worse treatment outcomes than other key populations, particularly in low to middle income countries (LMIC). Opioid use is common in India and new injection drug epidemics have emerged in the North and Central regions of the country in the last 5-10 years. In these regions, we have documented high rates of needle sharing, high HIV prevalence and incidence, and low access to HIV testing and treatment. Our team demonstrated the potential of respondent- driven sampling (RDS) to leverage social networks and identify unaware and out-of-care HIV-positive PWID. In response to RFA-DA-18-017, we propose to build on our experience with RDS as the foundation of “seek and test”, by rigorously assessing three scalable strategies aimed at improving the “treat and retain” steps of the HIV care continuum among PWID in a LMIC setting. Aim 1 is to conduct a factorial randomized controlled trial to evaluate the individual and combined effects of a policy intervention (same-day ART), a structural intervention (community-based care) and an individual-level intervention (psychosocial/ navigation) to improve treatment outcomes among HIV-positive PWID. A factorial design can assess both the main effects of multiple interventions and interactions between the interventions, offering the potential for trial efficiency (effectively getting 3 trials for the price of one) and novel insights on how interventions with different mechanisms may influence the effectiveness of one another. We will test 3 hypotheses: Hypothesis 1A - Same-day ART initiation will increase 12-month survival with viral suppression among HIV-positive PWID, compared with standard ART initiation. Same-day ART has been found effective in Africa, but has never been evaluated in PWID. Hypothesis 1B - Community-based care will increase 12-month survival with viral suppression among HIV-positive PWID, compared with government-based care. In prior work, we found that PWID-centric integrated care centers (ICCs) were highly effective at engaging the population, providing opioid treatment and increasing HIV testing uptake. Here we propose to scale-up the ICC model to provide community-based HIV care in an accessible and non-discriminatory setting. Hypothesis 1C - A psychosocial/navigation intervention (enhanced support) will increase 12-month survival with viral suppression among HIV-positive PWID, compared with standard support. Patient navigators will provide PWID-focused motivational interviewing, skills building, and field-based systems navigation and retention. We propose to adapt and build upon evidence-based interventions for PWID. Durability of intervention effects will be assessed at 18 months. Aim 2 is to characterize the barriers and facilitators to implementation of the proposed interventions, and determine the intervention costs and potential cost-effectiveness. We will characterize implementation pathways with a dedicated implementation science evaluation following the Curran type-1 model of an effectiveness-implementation hybrid study and will conduct formal cost-effectiveness analyses.

7。项目摘要/摘要 注射药物（PWID）的人患HIV HIV感染的风险很高，并且经历了更严重的治疗结果 比其他主要的爆炸案，特别是在低至中收入国家（LMIC）。 印度和新的注射药物流行病已经出现在该国的北部和中央法规 在这些地区，过去5至10年，我们已经记录了针头共享的高度 发病率和对艾滋病毒测试和治疗的机会较低。 驱动采样（RDS）利用社交网络并确定未知和疾病阳性的PWID 对RFA-DA-18-017的回应，我们建议以RDS的经验为基础，以此为基础 “寻求和测试”，通过严格评估AT AT AT AT的可扩展策略 在LMIC环境中保留“在PWID之间的HIB连续步骤。目标1是联系阶乘 随机对照试验评估政策干预的个体和综合效果（当天 艺术），结构性干预（基于社区的护理）和个人级别的干预措施（心理社会/ 导航）以改善HIV阳性PWID的治疗科目。 多种干预措施和国际性的主要影响干预措施，提供了试验的潜力 有效地获得3次试验的价格），并就不同的方式进行了新的见解 机制可能会影响彼此的有效性。 当天的艺术启动将在HIV阳性PWID中随着病毒的支持增加12个月的生存， 与标准艺术启动相比。 在PWID中进行评估。 与政府的护理相比，艾滋病毒阳性的PWID中的支持。 以PWID为中心的综合护理中心（ICC）非常有效地吸引人群，提供阿片类药物 治疗和增加HIV测试的吸收。 基于社区的艾滋病毒护理在可访问的非歧视环境中 社会心理/导航干预（增强支持）将通过抑制病毒抑制增加12个月的生存 在HIV阳性的PWID中，与标准支持者相比将提供PWID的支持。 动机访谈，技能建设以及基于现场的系统导航和保留。 适应并基于基于证据的PWID干预措施。 在18个月中。 干预措施，并确定我们将表征的干预成本和潜在的成本效益 实施途径，具有dec省的含义科学评估Currance type-1 有效实施混合研究的模型，并将进行正式的成本效益分析。