Prison Interventions and HIV Prevention Collaboration

监狱干预和艾滋病毒预防合作

• 批准号: 10548569
• 负责人: FREDERICK LEWIS ALTICE
• 金额: $ 63.55万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10548569
• 关键词: AIDS prevention; Address; Adoption; Caring; Central Asia; Client; Collaborations; Commonwealth of Independent States; Communities; Country; Criminal Justice; Eastern Europe; Educational process of instructing; Effectiveness of Interventions; Ensure; Epidemic; Evaluation; Evaluation Research; Evidence based practice; Foundations; Goals; HIV; HIV Infections; Health; Health Benefit; Healthcare; High Prevalence; Human Rights; Imprisonment; Incidence; Individual; Infrastructure; Injecting drug user; Institutionalized Persons; International; Intervention; Intervention Studies; Justice; Kyrgyzstan; Learning; Legal; Link; Modeling; Moldova; Opioid replacement therapy; Outcome; Performance; Persons; Pharmaceutical Preparations; Pilot Projects; Policies; Politics; Prevalence; Prevention strategy; Primary Care; Prisons; Psychiatric therapeutic procedure; Public Health; Research; Research Personnel; Research Training; Safety; Services; Sexual Partners; Site; System; Tajikistan; Training; US State; USSR; Ukraine; United States Health Resources and Services Administration; Volatilization; Work; brief intervention; community setting; evidence base; implementation science; improved; innovation; insight; mortality; next generation; opioid agonist therapy; opioid use; opioid use disorder; pilot test; prevent; primary care clinic; probation; process improvement; research and development; routine care; scale up; screening, brief intervention, referral, and treatment; service delivery; skills; success; syndemic; therapy development; tool; transmission process; uptake

Eastern Europe and Central Asia (EECA) have among the highest (5 of the top 10) incarceration rates worldwide, with staggering numbers of people who inject drugs (PWID), mostly with opioid use disorder (OUD: 82%) and HIV (PWH: 18%). The HIV epidemic in EECA is primarily concentrated in PWID, who account for 56% of new HIV infections with a high HIV prevalence among PWID (7.3-53.4%). The prisons and probation settings provide an opportunity for HIV prevention using opioid agonist therapies (OAT). The newly (past 5 years) formed probation system in these countries presents new opportunities and challenges for HIV prevention as probation does not have an international mandate to ensure human rights access to HIV prevention and treatment. This proposal builds on our existing implementation science network in several EECA countries. Specifically, first, MAT-LINK used SBIRT (screening, brief intervention, and referral to treatment) with trained researchers to pilot test a strategy to scale-up opioid agonist therapies. Second, many EECA countries have recently introduced probation, providing opportunities to ensure access to trans-institutionalized persons in probation to better align public health with public safety. Third, real-world implementation using existing infrastructure and staffing across more sites is now needed to expand OAT throughout prisons and probation. Fourth, we developed the first Project ECHO in EECA to guide OAT integration into primary care and psychiatric care into OAT settings. We have successfully used the EPIS (Explore, Prepare, Implement and Sustain) framework combined with the NIATx model of process improvement to scale-up OAT. Also using EPIS, we used Project ECHO to integrate OAT and HIV care into primary care clinics in Ukraine to teach specialized care to non-specialists, which we propose to use to teach prison doctors. NIATx is an evidence-informed facilitation strategy with documented successes in the adoption and scale-up of evidence-based practices (EBPs), like OAT. Using the EPIS framework and the NIATx approach we propose to: AIM 1: Scale-up OAT as HIV prevention in prisons and pre- trial detention in EECA and for individuals with OUD and link them to community treatment after release; and AIM 2: Scale-up OAT as HIV prevention in the newly formed probation system in EECA and for individuals with OUD and link them to OAT treatment as part of routine care to align public safety and public health. We will continue using our network to achieve these goals through collaboration with our partners in EECA. Significance is high due to the need to reduce HIV transmission in EECA where HIV, PWID and incarceration are syndemic, which is primarily concentrated in PWID and where OAT coverage is low. Innovation is high by using the NIATx model to scale-up OAT in prisons and probation, along with collaborative learning tools like Project ECHO to teach and maintain skills. Feasibility is high due to longstanding collaborations between these many collaborators and buy-in from CJS settings. Public health benefit is high due to addressing the interface of health and justice where many of the most vulnerable exist.

东欧和中亚 (EECA) 的监禁率最高（前 10 名中的 5 名） 世界范围内，注射吸毒者 (PWID) 的数量惊人，其中大多数患有阿片类药物使用障碍 (OUD： 82%）和艾滋病毒（艾滋病毒感染者：18%）。 EECA的艾滋病毒流行主要集中在吸毒者中，占56% 吸毒者中艾滋病毒感染率较高（7.3-53.4%）。监狱和缓刑环境 为使用阿片类激动剂疗法（OAT）预防艾滋病毒提供了机会。新成立的（过去5年） 这些国家的缓刑制度为艾滋病毒预防带来了新的机遇和挑战 没有确保人权获得艾滋病毒预防和治疗的国际使命。 该提案建立在我们在几个欧洲经济区国家现有的实施科学网络的基础上。具体来说， 首先，MAT-LINK 与训练有素的研究人员一起使用 SBIRT（筛查、简短干预和转诊治疗）来 试点测试扩大阿片类激动剂疗法的策略。其次，许多EECA国家最近推出了 缓刑，提供机会确保接触跨机构缓刑人员，以更好地协调 公共卫生与公共安全。第三，利用现有基础设施和人员配置进行实际实施 现在需要更多的地点来将 OAT 扩展到整个监狱和缓刑期间。四、我们开发了第一个 EECA 的 ECHO 项目旨在指导 OAT 融入初级保健，并将精神科护理纳入 OAT 环境。 我们成功地将 EPIS（探索、准备、实施和维持）框架与 用于扩大 OAT 规模的流程改进 NIATx 模型。同样使用EPIS，我们使用Project ECHO来集成 将 OAT 和艾滋病毒护理纳入乌克兰的初级保健诊所，向非专家传授专业护理，我们 建议用来教监狱医生。 NIATx 是一种基于证据的促进策略，具有记录在案的 在采用和扩大循证实践 (EBP) 方面取得的成功，例如 OAT。使用EPIS 我们建议的框架和 NIATx 方法旨在： 目标 1：扩大 OAT 作为监狱和监狱前艾滋病毒预防的范围 在 EECA 和 OUD 患者中进行审判拘留，并将他们释放后与社区治疗联系起来；和 目标 2：在 EECA 新成立的缓刑系统中以及针对患有艾滋病毒的个人，扩大 OAT 作为艾滋病毒预防的范围 OUD 并将其与 OAT 治疗联系起来，作为常规护理的一部分，以协调公共安全和公共卫生。 我们将继续利用我们的网络与 EECA 的合作伙伴合作来实现这些目标。 由于需要减少艾滋病毒、吸毒者和监禁的东欧中亚地区的艾滋病毒传播，因此意义重大 是综合征性流行病，主要集中在吸毒者和 OAT 覆盖率较低的地区。创新高 使用 NIATx 模型以及协作学习工具（如 ECHO 项目旨在教授和维护技能。由于这些机构之间的长期合作，可行性很高 许多合作者和来自 CJS 设置的支持。由于解决了接口问题，公共卫生效益很高 许多最弱势群体都存在健康和正义。

项目成果

Drug injection within prison in Kyrgyzstan: elevated HIV risk and implications for scaling up opioid agonist treatments.

吉尔吉斯斯坦监狱内注射毒品：艾滋病毒风险升高以及扩大阿片类激动剂治疗的影响。

• 发表时间: 2018
• 作者: Azbel, Lyuba;Wegman, Martin P;Polonsky, Maxim;Bachireddy, Chethan;Meyer, Jaimie;Shumskaya, Natalya;Kurmanalieva, Ainura;Dvoryak, Sergey;Altice, Frederick L
• 通讯作者: Altice, Frederick L