Implementation of telemedicine and social network driven HIV service uptake for comprehensive HIV service integration in rural syringe service programs

实施远程医疗和社交网络驱动的艾滋病毒服务，将艾滋病毒服务全面纳入农村注射器服务计划

• 批准号: 10682889
• 负责人: Oluwaseun Falade-Nwulia
• 金额: $ 92.04万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10682889
• 关键词: AIDS prevention; Adoption; Africa South of the Sahara; Awareness; Biological Testing; Caring; Communication; Communities; Data; Diagnostic Reagent Kits; Effectiveness; Evidence based intervention; FDA approved; Face; Food; Goals; HIV; HIV diagnosis; HIV risk; HIV/HCV; Health; Health Services Accessibility; Hepatitis C Therapy; High Prevalence; Housing; Human immunodeficiency virus test; Individual; Information Dissemination; Injecting drug user; Intervention; Knowledge; Mediator; Medical; Methods; Modeling; Modification; Needle-Exchange Programs; Network-based; Outcome; Participant; Patient Self-Report; Pharmaceutical Preparations; Population; Provider; Public Health; Questionnaires; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Resources; Risk; Risk Reduction; Rural; Self Efficacy; Service provision; Services; Social Network; Specialist; Structure; Surveys; Telemedicine; Testing; Training; Trust; Work; World Health Organization; addiction; antiretroviral therapy; attentional control; community organizations; comparison control; comparison intervention; effectiveness evaluation; effectiveness/implementation hybrid; empowerment; evidence base; experience; implementation measures; implementation outcomes; implementation process; improved; indexing; innovation; marginalized population; medication for opioid use disorder; member; men who have sex with men; pandemic disease; peer; pragmatic trial; pre-exposure prophylaxis; prevention service; primary outcome; programs; randomized trial; recruit; rural area; scale up; self testing; service programs; service uptake; skills training; social influence; social stigma; telehealth; treatment services; trial design; uptake; virtual

7. PROJECT SUMMARY / ABSTRACT People who inject drugs (PWID) face multilevel barriers to accessing HIV-related services, including low demand for services, resulting from stigma, low knowledge/awareness of services, and prioritization of immediate basic needs (e.g., food, housing, addiction) over remote health concerns. In rural areas, these barriers are exacerbated by service scarcity. Syringe service programs (SSPs), a cornerstone of HIV prevention among PWID, are trusted by this population and have the potential to extend the reach of other evidence-based services (pre-exposure prophylaxis [PrEP], medication for opioid use disorder [MOUD], HIV treatment, etc.). Telemedicine provides a sustainable method to deliver services where they are scarce. We successfully piloted telehealth delivery of HCV treatment and MOUD for PWID at rural SSPs. We will adapt and expand on our telemedicine pilot to bring HIV prevention and treatment services to rural SSPs. However, service availability does not equate to uptake. Social network-based interventions have proven effective in disseminating health information and HIV risk reduction among PWID. Peer-based interventions have an unparalleled potential to overcome stigma and trust barriers in marginalized groups, reach “hidden” group members (i.e., those who do not access services at the SSP), and empower individuals to make positive changes. Low rates of HIV testing and diagnosis among PWID remain a barrier to linkage to antiretroviral therapy initiation (for HIV infected) and PrEP (for HIV-uninfected). A key innovation of our intervention will be to combine dissemination of information with distribution of HIV self-testing kits through PWID networks. HIV self-testing strategies are endorsed by the World Health Organization and have been shown to increase testing coverage and new HIV diagnoses in high prevalence regions of sub-Saharan Africa and among MSM, but have been little explored among PWID. We propose to evaluate a model that leverages peer educators to disseminate HIV self-testing kits and information while also providing peer navigation to network members for HIV prevention and treatment services uptake via telemedicine at rural SSPs We plan a hybrid effectiveness/implementation approach. Aim 1a: We will use a community-engaged approach to adapt a preexisting PWID-focused network intervention to a rural context with the goal of increasing HIV self-testing and HIV service uptake. Aim 1b: We will determine the effectiveness of the intervention compared with an equal-attention control condition, using a rigorous randomized trial design. Aim 2a: In contemplation of adoption and sustainability, we will use mixed methods to characterize implementation processes and outcomes. Aim 2b: to explore intervention mechanisms, we will establish the extent to which SSP and HIV service uptake are related to experiences of social influence and stigma.

7。项目摘要 /摘要 注射毒品（PWID）的人面临获得与HIV相关服务的多层次障碍，包括低 污名，低知识/服务的知识/认识以及优先级的服务需求 对远程健康问题的直接基本需求（例如食物，住房，成瘾）。在粗糙的地区，这些 服务稀缺会加剧障碍。注射器服务计划（SSP），艾滋病毒的基石 PWID之间的预防，受到该人群的信任，并有可能扩大其他人的影响力 基于证据的服务（预防前暴露[PREP]，阿片类药物使用障碍药物[MOUD]，HIV 治疗等）。远程医疗提供了一种可持续的方法，可以在稀缺的地方提供服务。我们 在Rough SSP上成功试用了HCV治疗和MOUD的远程医疗服务。我们会适应 并扩展我们的远程医疗飞行员，将艾滋病毒预防和治疗服务带到粗糙的SSP。 但是，服务可用性不等于吸收。基于社交网络的干预措施已证明 有效地传播PWID的健康信息和艾滋病毒风险降低。基于同行的干预措施 具有克服边缘群体中污名和信任障碍的无与伦比的潜力，达到“隐藏” 小组成员（即那些不在SSP访问服务的人），并授权个人使积极 更改。 PWID中艾滋病毒测试和诊断率低仍然是与抗逆转录病毒联系的障碍 治疗倡议（用于感染的HIV）和PREP（用于HIV未感染）。我们干预的关键创新将是 将信息的传播与通过PWID网络分布艾滋病毒自我测试套件的分布相结合。艾滋病病毒 自我测试策略得到世界卫生组织的认可，并已被证明可以增加测试 撒哈拉以南非洲和MSM中高流行地区的覆盖范围和新的HIV诊断，但 在PWID中很少探索。我们建议评估一个利用同伴教育工作者的模型 传播艾滋病毒自我测试套件和信息，同时还为网络提供同行导航 通过远程医疗在Rough SSPS通过远程医疗吸收艾滋病毒和治疗服务的成员 我们计划一种混合有效性/实施方法。 AIM 1A：我们将使用社区参与的方法 将以前的PWID网络干预调整到粗糙的环境中，以增加艾滋病毒 自我测试和艾滋病毒服务的吸收。 AIM 1B：我们将确定干预的有效性 使用严格的随机试验设计，具有同等注意的控制条件。目标2a：沉思 采用和可持续性，我们将使用混合方法来表征实施过程和 结果。目标2B：探索干预机制，我们将确定SSP和HIV的程度 服务吸收与社会影响力和污名的经历有关。