Peer-based HIV Self-testing among High Risk Women Who Inject or Use Drugs in Kazakhstan, Central Asia

哈萨克斯坦、中亚地区注射或吸毒高危女性中基于同伴的艾滋病毒自我检测

基本信息

批准号：
10458069
负责人：
Nabila El-Bassel
金额：
$ 14.42万
依托单位：
CITY COLLEGE OF NEW YORK
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-01 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10458069
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Advocacy Africa Amelia Attention Awareness Behavioral Caring Central Asia Cessation of life Client Communicable Diseases Communities Counseling Country Data Dermatology Development Drug usage Drug user Early Diagnosis Epidemic Focus Groups Goals HIV HIV Infections HIV Seronegativity HIV/STD Health Personnel High Risk Woman Human immunodeficiency virus test Incidence Individual Infection Injecting drug user Intention Intervention Interview Kazakhstan Knowledge Link Persons Pharmaceutical Preparations Phase Play Population Population Intervention Prevalence Prevention Prevention strategy Privatization Public Health Randomized Research Research Infrastructure Risk Risk Reduction Role Services Sexual Partners Site Technology Testing Text Thinking Time Training Treatment Efficacy United States Validation Viral Vulnerable Populations Woman Work advocacy organizations antiretroviral therapy arm base behavior change case finding coping cost design empowerment evidence base experience experimental arm female sex worker follow-up improved injection drug use innovation internalized stigma knowledge base novel peer peer support pre-exposure prophylaxis preference primary outcome response secondary outcome self testing sex social stigma substance use success theories tool uptake

项目摘要

ABSTRACT Central Asia (CA) has one of the world’s fastest growing HIV epidemics, increasing 30% since 2010. By 2017, key populations and their sex partners made up 95% of new HIV infections, including 9% among female sex workers (FSW), 39% among people who inject drugs (PWID), and 28% among clients/sex partners of sex workers/other key populations. In Kazakhstan, a major CA regional economy, there was a 106% increase in new HIV infections from 2010 to 2017. FSW who also inject drugs (FSWID) are at significantly increased risk of HIV infection, but are less likely to engage in HIV testing and receive care. HIV testing is the key point of entry to HIV care and ART, and, for HIV-negative individuals, to PrEP/PEP. In Kazakhstan, barriers to HIV testing for FSWID, include stigma, inconvenience, and health care provider bias against women who are FSW and/or drug users. Although HST is recommended by the WHO, very limited research on FSW and PWID exists. Reviews of interventions to increase testing suggest that HST can increase consistent or frequent testing, but that linkage to care rates can be lower with HST. Importantly, no studies have been conducted in CA or, to our knowledge, among FSWID, a vital population to target given their elevated risk for HIV, low uptake of HIV testing, and experiences of dual stigma. The primary goal of this study is to assess acceptability, feasibility, preliminary efficacy and cost of a peer-based HIV self-testing intervention to increase consistent HIV testing and linkage to care or prevention among women who exchange sex and inject drugs in Kazakhstan using the R34 mechanism. In Phase 1, we will conduct in-depth interviews and focus groups with 40 FSWID to identify responses to HST components from efficacious HST and linkage to care interventions with FSW. In Phase 2, we will engage design thinking approaches and intervention adaptation to optimize fidelity and fit of existing components and develop novel components reflecting our theoretical approaches; we will component test (N=20) and pre-pilot components (N=20). In Phase 3, we will randomize 90 HIV-uninfected FSWID to either the adapted experimental condition (4 sessions) or a time- and attention-controlled standard HIV test-counseling condition and follow for 18 months for impacts on consistent HIV testing, HST and linkage to care/prevention. The RCT will be conducted in partnership with Amelia, a non-profit, FSW advocacy organization, and KSCDID, which leads national HIV treatment/prevention strategy. Results will fill key gaps in the knowledge base around optimal HST implementation among FSWID in CA, through analysis of an innovative intervention with an explicit focus on stigma reduction and peer support with substance using populations. Results will have relevance for HST and linkage programming in other CA countries, as well as the 120 countries that have HIV epidemics where FSW and PWID play important roles, including the United States.

抽象的中亚（CA）拥有世界上增长最快的HIV情节之一，自2010年以来增长了30％。到2017年，关键人群及其性伴侣占新艾滋病毒感染的95％，包括女性中的9％工人（FSW），注射毒品的人中有39％（PWID），在性爱的客户/性伴侣中有28％工人/其他关键人群。在哈萨克斯坦，主要是CA地区经济，新的增长了106％从2010年到2017年的艾滋病毒感染。也注射药物（FSWID）的FSW显着增加了艾滋病毒的风险感染，但不太可能从事艾滋病毒测试和接受护理。艾滋病毒测试是艾滋病毒的关键点护理和艺术，以及对艾滋病毒阴性的个体进行准备/PEP。在哈萨克斯坦包括污名，影响力和医疗保健提供者对FSW和/或吸毒者的妇女的偏见。尽管WHO推荐HST，但对FSW和PWID的研究非常有限。评论增加测试的干预措施表明HST可以增加一致或经常测试，但是这种联系 HST可以较低。重要的是，据我们所知，没有在CA进行研究在FSWID中，鉴于其艾滋病毒风险升高，艾滋病毒测试的摄取低以及双重污名的经历。这项研究的主要目标是评估可接受性，可行性，初步基于同伴的艾滋病毒自我测试干预措施的功效和成本，以增加一致的艾滋病毒测试和联系使用R34机制在哈萨克斯坦交换性和注入毒品的妇女的护理或预防。在第1阶段，我们将进行深入的访谈，并拥有40个FSWID的焦点小组来确定对HST的回应从高效的HST和链接到与FSW的护理干预措施的组成部分。在第二阶段，我们将参与设计思维方法和干预适应以优化现有组件的保真度和拟合度并发展反映我们理论方法的新颖组成部分；我们将组件测试（n = 20）和前杆组件（n = 20）。在第3阶段，我们将随机将90个HIV未感染的FSWID与适应的实验病情（4个会议）或时间和注意力控制的标准艾滋病毒测试表条件，遵循 18个月对持续的HIV测试，HST和与护理/预防联系的影响有18个月。 RCT将进行与非营利组织，FST倡导组织和KSCDID的Amelia合作，领导国家艾滋病毒治疗/预防策略。结果将填补最佳HST知识库中的关键空白通过分析创新干预措施，在CA中实施FSWID，并明确关注使用种群的物质减少污名和同伴支持。结果将与HST和在其他CA国家 /地区以及有HIV发作的120个国家 /地区的连锁节目 PWID在包括美国在内的重要角色。