Peer Leaders as HIV Risk Reduction Change Agents Among IDUs in Ukraine

乌克兰注射吸毒者中的同行领袖是降低艾滋病毒风险的变革推动者

基本信息

批准号：
8247131
负责人：
ROBERT Edwin BOOTH
金额：
$ 46.93万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-04-15 至 2015-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8247131
关键词：
AIDS/HIV problem Adult Affect Age-Years Area Behavior Behavioral Biological Biological Markers Characteristics Cities Clinical Trials Design Collaborations Communication Counseling Country Diffusion Disclosure Doctor of Medicine Doctor of Philosophy Drug user Education Educational Intervention Effectiveness Epidemic Ethics HIV HIV Seropositivity Health Heterosexuals Human immunodeficiency virus test Individual Infection Injecting drug user Injection of therapeutic agent Intervention Interview Knowledge Learning Letters Life Modeling National Institute of Drug Abuse Participant Pharmaceutical Preparations Population Prevalence Randomized Randomized Clinical Trials Recruitment Activity Resistance Risk Risk Behaviors Risk Reduction Risk Reduction Behavior Sampling Secondary to Self Efficacy Site Testing Translating U-Series Cooperative Agreements Ukraine Unsafe Sex Update Woman Work World Bank arm base cohort compare effectiveness design drug testing indexing member network models outreach peer primary outcome prospective public health relevance role model sex sex risk standard of care transmission process

项目摘要

DESCRIPTION (provided by applicant): In this 5-year prospective randomized clinical trial (RCT), the effectiveness of two interventions approaches will be evaluated in their ability to reduce HIV drug and sex-related risk behaviors among IDUs in Ukraine. Using an intent to treat design, we propose to compare a manually-driven HIV testing and counseling intervention, the Counseling and Education (C & E) model developed during NIDA's Cooperative Agreement (Coyle 1993), with the C & E plus a network-focused intervention that is also manually-driven developed by Latkin (2003) who has agreed to be a consultant. We have assessed both interventions in Ukraine and found them to be effective in reducing risks associated with HIV. They have not, however, been compared to one another and we have not employed a RCT design in our past work. We are proposing this test because: 1. in our recently completed 5-year Ukraine study the C & E intervention alone was as effective as the C & E plus a more intensive individual model; 2. this study also found that those who learned they were HIV infected when tested at baseline, regardless of intervention assignment, reduced their sex risks more than HIV negatives and those who already knew they were positive, underscoring the ethical necessity for testing and counseling and the merits of the C & E; 3. nevertheless, network interventions have the advantage over individually-focused interventions, including the C & E, in their potential to affect a much wider group of injectors, specifically, those who interact with indexes. We will also assess secondary diffusion by 'first wave' network members recruiting 'second wave' network members, something that heretofore has not been done. Assessing two steps out in the network will allow us to examine diffusion, overlap, contamination, and index and network characteristics that predict diffusion and resistance to behavioral change. Both interventions are theoretically- based, manually-driven, translated into Russian and both have been implemented successfully in Ukraine. In addition, because of the high HIV prevalence among IDUs in the sites selected (ranging from 20% to 65% in our past studies), we have included partner disclosure as part of both interventions and brought in Dr. Seth Kalichman, an expert in this area, as a consultant. In collaboration with our Ukraine Co-I, Sergiy Dvoryak, M.D., Ph.D., we will recruit 2250 IDUs, 750 each from Odessa, Makeevka/Donetsk and Nikolayev, who will receive either the network-focused network intervention plus C & E or C & E alone. Participants will be recruited through street outreach, interviewed, intervened with and followed at six and 12 months. In addition to the ACASI, biological samples will be taken to be assessed for HIV and the presence of drug metabolites. PUBLIC HEALTH RELEVANCE: In a randomized clinical trial (RCT) and using an ACASI and biological markers, we will compare the effectiveness of two interventions in reducing HIV drug and sex-related risk behaviors among drug injectors at three sites where we have previously worked and have established relationships. The sites included in this trial were selected because they have three of the four highest numbers of drug users and HIV rates in the country (World Bank 2006; Ministry of Health of Ukraine 2008) and because of their prior demonstration in recruiting and retaining cohorts of IDUs (Booth et al., 2006b).

描述（由申请人提供）：在这项为期 5 年的前瞻性随机临床试验 (RCT) 中，将评估两种干预方法减少乌克兰注射吸毒者中艾滋病毒药物和性相关危险行为的能力。使用意图治疗设计，我们建议比较手动驱动的艾滋病毒检测和咨询干预，即 NIDA 合作协议（Coyle 1993）期间开发的咨询和教育（C＆E）模型，以及 C＆E 加上网络-集中干预也是手动驱动的，由 Latkin (2003) 开发，他同意担任顾问。我们评估了乌克兰的这两项干预措施，发现它们可以有效降低与艾滋病毒相关的风险。然而，它们并没有被相互比较，而且我们在过去的工作中也没有采用 RCT 设计。我们提出这项测试是因为： 1. 在我们最近完成的为期 5 年的乌克兰研究中，单独的 C&E 干预与 C&E 加上更强化的个人模型一样有效； 2. 这项研究还发现，那些在基线检测时得知自己感染了艾滋病毒的人，无论干预分配如何，比艾滋病毒阴性者和那些已经知道自己感染艾滋病毒的人更能降低性风险，这强调了检测和咨询的道德必要性，以及收容教育的优点； 3. 尽管如此，网络干预措施比以个人为中心的干预措施（包括 C&E）具有优势，因为它们有可能影响更广泛的注射者群体，特别是那些与指标互动的人。我们还将通过“第一波”网络成员招募“第二波”网络成员来评估二次扩散，这是迄今为止尚未做过的事情。评估网络中的两个步骤将使我们能够检查扩散、重叠、污染以及预测扩散和行为改变阻力的索引和网络特征。这两种干预措施都是基于理论、手动驱动的，并翻译成俄语，并且都已在乌克兰成功实施。此外，由于所选地点的注射吸毒者中艾滋病毒感染率较高（在我们过去的研究中为 20% 至 65%），我们将伴侣披露作为这两项干预措施的一部分，并聘请了艾滋病毒专家 Seth Kalichman 博士。这个领域，作为顾问。我们将与乌克兰 Co-I、医学博士、博士 Sergiy Dvoryak 合作，招募 2250 名注射吸毒者，其中来自敖德萨、马克耶夫卡/顿涅茨克和尼古拉耶夫各 750 名，他们将接受以网络为中心的网络干预以及 C & E或单独的 C & E。参与者将通过街头宣传招募，并在 6 个月和 12 个月时接受采访、干预和跟踪。除了 ACASI 之外，还将采集生物样本来评估 HIV 和药物代谢物的存在。公共健康相关性：在一项随机临床试验 (RCT) 中，使用 ACASI 和生物标记物，我们将比较两种干预措施在减少我们以前工作过的三个地点的吸毒者中艾滋病毒药物和性相关风险行为的有效性。已建立关系。选择本次试验的地点是因为这些地点拥有该国吸毒者人数和艾滋病毒感染率最高的四个地点中的三个（世界银行，2006 年；乌克兰卫生部，2008 年），并且因为它们之前在招募和留住吸毒者群体方面表现出色。注射吸毒者（Booth 等人，2006b）。