Increasing Involvement of MSM in the Continuum of Care in Kazakhstan

哈萨克斯坦 MSM 越来越多地参与连续护理

• 批准号: 9285749
• 负责人: Elwin Wu
• 金额: $ 68.93万
• 依托单位: COLUMBIA UNIV NEW YORK MORNINGSIDE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-03 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9285749
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Adult; Affect; Africa South of the Sahara; Behavior; Caring; Central Asia; Cities; Climate; Clinical Trials; Communities; Continuity of Patient Care; Country; Data; Diagnosis; Diffusion; Disease; Drug abuse; Drug usage; Effectiveness; Employee Strikes; Environment; Epidemic; Evidence based intervention; Expressed Sequence Tags; Goals; Government; Growth; HIV; HIV Infections; HIV Seropositivity; Health; Hepatitis C; Human Rights; Human immunodeficiency virus test; Incidence; Individual; Infection; Information Dissemination; Injectable; Intervention; Intervention Studies; Intervention Trial; Kazakhstan; Life; Literature; Morbidity - disease rate; National Institute of Drug Abuse; Network-based; Outcome; Participant; Pharmaceutical Preparations; Pilot Projects; Population; Prevalence; Prevention; Provider; Recruitment Activity; Reporting; Research; Research Infrastructure; Research Personnel; Services; Sexual Health; Sexual and Gender Minorities; Sexually Transmitted Diseases; Social Environment; Social Network; Social Work; Social support; Structure; Testing; Treatment Efficacy; Tuberculosis; United States National Institutes of Health; Viral; Visit; Vulnerable Populations; antiretroviral therapy; black men who have sex with men; density; design; efficacy testing; evidence base; experience; illicit drug use; improved; innovation; insight; intervention effect; member; men who have sex with men; mortality; outreach; pandemic disease; prevention service; program dissemination; public health relevance; self help; social stigma; success; therapy design; transmission process

 DESCRIPTION (provided by applicant): This study will test the efficacy of a social network-based HIV intervention designed to increase the number of men who have sex with men (MSM) who use drugs across Kazakhstan into the continuum of care. From the start of the HIV/AIDS pandemic, MSM have been disproportionately affected-both in terms of morbidity and mortality-by HIV/AIDS. Success against HIV in general has progressed to the point where "getting to zero" new HIV infections entered the public discourse. Whereas HIV infection rates have been decreasing over the last decade for key affected populations globally, we have witnessed increasing infection among MSM, a so-called "re-emergent epidemic" for MSM. Kazakhstan is one of the few countries that saw a >25% HIV incidence increase in the 2000s and had the largest increase in rate of new infections among countries in the region. A recent study estimated HIV prevalence among MSM in Almaty to be 20.2%, a rate which exceeds HIV prevalence among adults in Sub-Saharan Africa and the most vulnerable populations in the U.S. HIV transmission in the region is driven largely by illicit drug use, and for MSM, this includes both injecting and non-injecting drug use. Kazakhstan has also been noted as lagging in ART coverage as well as adherence, especially for key populations that are vulnerable and marginalized such as MSM. Building upon the resourcefulness and strengths of MSM community members operating in a sociopolitical repressive environment, combined with the investigative team's success in adapting and pilot testing the evidence-based SHIELD social network intervention for outreach and recruitment with MSM in HIV research in the U.S. and Kazakhstan-a social network-based HIV intervention has promise to increase seek, test, treat, and retain-related behaviors. The proposed study involves a stepped wedge clinical trial across 4 cities in Kazakhstan with 1,000-1,400 drug-involved MSM to test the efficacy of the social network-based intervention for increasing the following outcomes among drug-involved MSM in Kazakhstan: (1) proportion of participants visiting a service provider to get tested for HIV; (2) proportion of HIV-infected participants initiating HIV-related care; (3) proportion of HIV-infected participants receiving ART; and (4) proportion of HIV-infected participants achieving 90% adherence to ART. In addition, the study will examine the intervention's effect on increasing use of services that address issues that co-occur with HIV, including drug abuse, HCV infection, and other sexually transmitted infections (STIs). The study has a secondary, exploratory aim designed to facilitate insight into social context (e.g., experienced stigma, social network attributes) and structural factors (e.g., number and density of services) that may moderate the impact of the intervention.

 描述（由适用提供）：本研究将测试基于社交网络的艾滋病毒干预措施的有效性，旨在增加与男性发生性关系的人数（MSM），这些男性（MSM）在整个哈萨克斯坦使用毒品的人数加入了护理的连续性。从艾滋病毒/艾滋病大流行开始，就发病率和艾滋病毒死亡率而言，MSM受到了不成比例的影响。一般来说，针对艾滋病毒的成功已经发展到“达到零”的新艾滋病毒感染进入公众话语的地步。在过去的十年中，全球关键受影响人群的艾滋病毒感染率一直在降低，但我们目睹了MSM的感染增加，MSM是MSM所谓的“重新出现的流行病”。哈萨克斯坦是少数在2000年代增加艾滋病毒感染> 25％的国家之一，并且该地区的新感染率增加最大。最近的一项研究估计，在阿里（Almaty）中，MSM中的HIV患病率为20.2％，这一比率超过了撒哈拉以南非洲成年人的HIV患病率，该地区美国艾滋病毒传播中最脆弱的人群在很大程度上是由非法吸毒的驱动的，对于MSM而言，这包括注射和非注射药物使用。哈萨克斯坦也被认为是艺术覆盖范围和依从性的滞后，尤其是对于易受伤害和边缘化的关键人群（例如MSM）。基于在社会政治反射环境中运作的MSM社区成员的机智和优势，再加上调查团队在适应和试点测试基于循证的盾牌社交网络干预和招募美国HIV研究中的HIV研究和基于哈萨克斯坦-A社交网络的HIV艾滋病毒hiv干预措施的成功和招募的成功，可以提高，以验证，待遇，进行了良好的态度，并进行了cypection和Recase ryavie candy and candy and candy and candy and test and social网络研究。拟议的研究涉及在哈萨克斯坦4个城市进行的楔形楔形临床试验，其中1,000-1,400名涉及药物的MSM，以测试基于社交网络的干预措施的效率，以增加哈萨克斯坦的药物涉及的MSM的以下结果：（1）参与者访问服务提供者的这一比例访问了HIV的服务提供者的比例。 （2）启动与HIV相关护理的HIV感染参与者的比例； （3）感染HIV的比例 参加艺术的参与者； （4）艾滋病毒感染的参与者的比例达到了90％的遵守艺术。此外，该研究将研究干预措施对解决与艾滋病毒共同发生的问题的增加的影响，包括药物滥用，HCV感染以及其他性传播感染（STIS）。这项研究具有次要的探索目的，旨在促进对社会环境（例如经验丰富的污名，社交网络属性）和结构性因素（例如服务的数量和密度）的见解，从而可能调节干预的影响。