Reducing HIV-related Intersectional Stigma and Risk among People who Inject Drugs in a High Risk International Setting

减少高风险国际环境中注射吸毒者与艾滋病毒相关的交叉耻辱和风险

• 批准号: 10762623
• 负责人: Laramie Rae Smith
• 金额: $ 30.14万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762623
• 关键词: Abstinence; Acceleration; Address; Adopted; Automobile Driving; Awareness; Behavior; Capital; Caring; Central Asia; Cities; Client; Clinic; Communities; Data; Drug Addiction; Drug usage; Eastern Europe; Effectiveness; Effectiveness of Interventions; Epidemic; Future; Geography; Goals; HIV; HIV Seropositivity; HIV diagnosis; HIV risk; Health; Health Personnel; Health care facility; Hearing; Human immunodeficiency virus test; Hybrids; Incidence; Injecting drug user; Injections; International; Intervention; Intervention Studies; Kyrgyzstan; Left; Measures; Methadone; Methods; Modeling; National Institute of Drug Abuse; Needle-Exchange Programs; Outcome; Persons; Pharmacotherapy; Policies; Population; Practical Robust Implementation and Sustainability Model; Prevention; Randomized; Reporting; Research Design; Risk; Risk Behaviors; Risk Reduction; Services; Stigmatization; Syringes; Technology; Testing; Time; Waiting Lists; Work; antiretroviral therapy; control trial; cost; design; drug maintenance; evidence base; experience; follow-up; high risk; implementation outcomes; implementation science; implementation strategy; implementation/effectiveness; improved; injection drug use; innovation; methadone treatment; opioid use disorder; post intervention; pre-exposure prophylaxis; prevent; research to practice; response; scale up; service uptake; social stigma; standard of care; transmission process; treatment arm; treatment as prevention; treatment services; uptake

PROJECT SUMMARY/ABSTRACT Stigma is a pervasive barrier to preventing HIV among persons who inject drugs (PWID). Kyrgyzstan is part of the world’s most rapidly expanding HIV epidemic in the Eastern Europe and Central Asia (EECA) region, where HIV is predominantly concentrated among PWID. Our previous work with PWID in Kyrgyzstan found experiences of HIV, drug use, and drug treatment (i.e. methadone) stigmas were associated with greater HIV risk behavior and low use of evidence-based HIV services, including syringe service programs (SSP) and methadone to treat opioid use disorder (MMT), which limited, timely HIV diagnoses. Following the launch of pre-exposure prophylaxis (PrEP) services in Kyrgyzstan, PrEP awareness increased among PWID with limited uptake but was not associated with stigma suggesting integrating PrEP referrals in stigma reduction programming may increase PWIDs engagement in PrEP and other evidence-based HIV services. Yet there is little to no evidence base on the potential effectiveness and implementation needs of evidence-based stigma reduction strategies that address HIV-related intersectional stigma at multiple levels with PWID in the EECA region. In line with NIDA and OAR priorities, the long-term goal is to rapidly advance evidence-based stigma mitigation efforts among PWID to improve HIV service uptake and turn the tide on the rapidly expanding EECA HIV epidemic. To achieve this goal, the current study will use the ADAPT-ITT model to adapt and refine effective community-level and health facility-level HIV stigma reduction strategies to intervene on intersecting drug use, MMT, and HIV stigma in the local context among PWID and MMT clinic staff (AIM 1). We will pilot the resulting multilevel stigma reduction intervention – LIFT – using a randomized waitlist control trial study design to evaluate the preliminary effectiveness of the LIFT intervention on stigma reduction and MMT/PrEP use (AIM 2) among 68 PWID and all staff from two MMT clinics. In parallel, a sequential mixed methods design will evaluate LIFT implementation outcomes and needs among our local implementation partners and 25 key stakeholders (AIM 3) to develop implementation strategies that can accelerate the pace and scale up of EECA stigma reduction efforts. To reduce risk of contamination via injection and treatment networks, we will conduct all community- and health facility-level intervention and waitlist control activities in distinct geographic districts in the capital city of Bishkek. This R34 pilot is the first EECA study to evaluate intersectional stigma mitigation efforts among PWID to reduce HIV transmission risk. This R34 is significant because stigma remains a fundamental driver of HIV transmission globally. This R34 pilot is highly innovative because it extends the current state of HIV stigma intervention research by integrating strategies that target intersecting stigmas at multiple levels to improve the impact of evidence-based HIV services and advance the use of implementation science models, methods, and measures to accelerate our understanding of how to close the stigma reduction research to practice gap.

项目摘要/摘要 污名是防止注射毒品（PWID）的人的遗传障碍。吉尔吉斯斯坦是 在东欧和中亚地区（EECA）地区，世界上最迅速扩大的艾滋病毒流行 HIV主要集中在PWID之间。我们以前与吉尔吉斯斯坦PWID的工作找到了经验 艾滋病毒，药物使用和药物治疗（即甲基）的污名与更大的艾滋病毒风险行为有关 低使用基于证据的艾滋病毒服务，包括注射器服务计划（SSP）和Methodadone来治疗 Opioid使用障碍（MMT），限制了及时的HIV诊断。暴露前推出 吉尔吉斯斯坦的预防（PREP）服务，PWID的PREP意识提高，吸收有限，但 与污名无关，暗示在减少污名编程中整合PrEP转介可能会增加 PWIDS参与PREP和其他基于证据的艾滋病毒服务。然而，几乎没有证据的基础 基于证据的污名策略的潜在有效性和实施需求 在EECA区域中，请与PWID在多个级别上解决与HIV相关的交叉污名。 与NIDA和OAR优先级一致，长期目标是快速提高基于证据的污名 PWID努力改善艾滋病毒服务的吸收，并扭转迅速扩大的EECA HIV的潮流 流行性。为了实现这一目标，当前的研究将使用Adapt-ITT模型来适应和完善有效 社区级和卫生机构级别的艾滋病毒污名策略，以干预相交的药物使用， 在PWID和MMT诊所工作人员中，MMT和HIV污名（AIM 1）。我们将驾驶由此产生的 多级污名降低干预 - 提升 - 使用随机候补列表对照试验研究设计来评估 提升干预对减少污名和MMT/PREP使用的初步有效性（AIM 2）68 PWID和所有来自两个MMT诊所的员工。同时，连续的混合方法设计将评估升力 我们本地实施合作伙伴和25个主要利益相关者的实施成果和需求（AIM 3） 制定实施策略，可以加速降低EECA污名工作的步伐和扩展。 为了减少注射和治疗网络污染的风险，我们将进行所有社区和健康 在首都比什凯克（Bishkek）的不同地理区域中的设施级干预和候补控制活动。 这项R34飞行员是第一项EECA研究，用于评估PWID之间的相互污名缓解工作 HIV传播风险。该R34很重要，因为污名仍然是HIV传播的基本驱动力 全球。该R34飞行员具有高度创新性，因为它扩展了当前的HIV污名干预状态 通过整合针对多个层次相交污名的策略来研究的研究，以改善 基于证据的艾滋病毒服务并提高实施科学模型，方法和措施的使用 为了加速我们对如何关闭污名化研究的理解，以实践差距。