Improving HIV Service Delivery for People who Inject Drugs in Kazakhstan

改善哈萨克斯坦注射吸毒者的艾滋病毒服务

• 批准号: 9517840
• 负责人: Nabila El-Bassel
• 金额: $ 91.17万
• 依托单位: COLUMBIA UNIV NEW YORK MORNINGSIDE
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-30 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9517840
• 关键词: Acquired Immunodeficiency Syndrome; Acute; Address; Adherence; Asians; Attitude; Awareness; Caring; Case Management; Case Manager; Centers for Disease Control and Prevention (U.S.); Cities; Client; Clinic; Collaborations; Communities; Continuity of Patient Care; Counseling; Country; Data; Drops; Drug usage; Effectiveness; Eligibility Determination; Enrollment; Epidemic; Failure; Geography; Government; HIV; HIV Seropositivity; Human immunodeficiency virus test; Incidence; Injecting drug user; Injections; Intervention Studies; Kazakhstan; Letters; Link; Methods; Modeling; Needles; Nurses; Office Nursing; Outcome; Pharmaceutical Preparations; Process; Provider; Public Health; Quality of life; Reporting; Research; Resources; Risk; Sampling; Service delivery model; Services; Site; Social Network; Supervision; Syringes; System; Testing; Training; Treatment Protocols; Viral; antiretroviral therapy; community organizations; cost; cost effectiveness; cost efficient; design; effectiveness research; experience; follow-up; implementation research; improved; injection drug use; innovation; low and middle-income countries; mortality; peer; prevent; primary outcome; programs; public health relevance; recruit; scale up; service delivery; sex risk; social stigma; theories; transmission process; virology

 DESCRIPTION (provided by applicant): Driven by injection drug use, Kazakhstan and other Central Asian nations are currently experiencing the fastest growing HIV incidence in the world and continue to report huge gaps in the continuum of HIV care for PWID. According to 2014 national data, only one-third of the estimated 19,000 HIV-positive PWID in Kazakhstan are ever linked to HIV care and only 10% initiate ART with 4% achieving viral suppression. As Kazakhstan is expanding eligibility for ART from <350 CD4 to <500 CD4 in 2015, there is an urgency to enroll previously ineligible HIV-positive PWID in ART. Large gaps in Kazakhstan's continuum of care for PWID mirror gaps found in other countries in which only a small proportion of PWID initiate ART. Mounting research demonstrates that improving rates of ART among PWID may be an effective strategy to prevent HIV transmission, lower mortality, improve quality of life, and reduce drug and sexual risk behaviors. There is a critical need for effectiveness and implementation research to identify how best to improve HIV service delivery to close the critical "Treat" gap in the continuum of care. This will occur by identifying and linkng HIV-positive PWID to HIV care, and reaching out to those who have never been in HIV care, are intermittent users of care, or have dropped out of treatment. The proposed study is designed to evaluate the implementation and effectiveness of an enhanced HIV service integration package (BRIDGE) that may be scaled up in Kazakhstan's vast network of needle-syringe programs (NSPs) for PWID. This package includes low threshold strategies of peer-driven recruitment, HIV counseling and rapid testing (HCT) in NSPs conducted by HIV care clinic nurses, and ARTAS, CDC's highly effective case management strategies for linking PWID to HIV care. BRIDGE is systematically designed to address specific service barriers to testing PWID for HIV, linking them to HIV care, and promoting ART initiation. This study will employ an innovative stepped wedge design to evaluate implementation and effectiveness of BRIDGE on improving linkage to HIV care and initiation of ART in 24 NSPs located in 4 geographically disparate Kazakhstani cities using site-level data collected from NSPs and HIV clinics. We will also conduct a longitudinal panel study with a random sample of HIV-positive PWID (N=600) from four cities in Kazakhstan using repeated assessments at baseline, 6-, and 12-months follow-up. This study will employ mixed methods to identify multi-level structural, community, and organizational factors that influence the implementation and effectiveness of BRIDGE and the cost of BRIDGE, examining implications for cost-effectiveness, feasibility of expansion, and sustainability. The study builds on the investigative team's extensive HIV intervention research among PWID in Kazakhstan in collaboration with the Republican AIDS Center over the past decade. It addresses implementation research questions to improve and integrate HIV service delivery systems for PWID that are not only important to the region, but have relevance to other countries that have concurrent injection drug use and HIV epidemics.

 描述（由申请人提供）：根据 2014 年国家数据，在注射吸毒的推动下，哈萨克斯坦和其他中亚国家的艾滋病毒发病率目前是世界上增长最快的，并且继续报告吸毒者艾滋病毒护理方面存在巨大差距。哈萨克斯坦估计有 19,000 名 HIV 阳性吸毒者，其中只有三分之一曾接受过 HIV 护理，并且只有 10% 的人开始接受 ART，4% 的人实现了病毒治疗2015 年，哈萨克斯坦将 ART 的资格从 <350 CD4 扩大到 <500 CD4，因此迫切需要将以前不符合 ART 资格的 HIV 阳性吸毒者纳入 ART。哈萨克斯坦对吸毒者的连续护理存在巨大差距，这与其他国家的差距类似。其中只有一小部分注射吸毒者开始接受抗逆转录病毒治疗。越来越多的研究表明，提高注射吸毒者的抗逆转录病毒治疗率可能是预防艾滋病毒的有效策略。迫切需要进行有效性和实施研究，以确定如何最好地改善艾滋病毒服务提供，以缩小连续护理中的关键“治疗”差距。这将通过识别艾滋病毒阳性吸毒者并将其与艾滋病毒护理联系起来，并接触那些从未接受过艾滋病毒护理、间歇性使用护理或已经退出治疗的人来实现。拟议的研究旨在评估实施情况。加强艾滋病毒服务整合的有效性哈萨克斯坦针对注射吸毒者的庞大针头注射器计划（NSP）网络可能会扩大这一计划（BRIDGE）。该计划包括由艾滋病毒护理人员在 NSP 中进行的低门槛策略、同伴驱动的招募、艾滋病毒咨询和快速检测（HCT）。 CDC 将注射吸毒者与艾滋病毒护理联系起来的高效病例管理策略经过系统设计，旨在解决注射吸毒者艾滋病毒检测的特定服务障碍，将其与艾滋病毒护理联系起来。 HIV 护理和促进 ART 启动 本研究将采用创新的阶梯式楔形设计，使用收集的现场数据来评估 BRIDGE 在改善位于 4 个地理位置不同的哈萨克斯坦城市的 24 个 NSP 中与 HIV 护理和启动 ART 的联系的实施情况和有效性。我们还将对来自哈萨克斯坦四个城市的艾滋病毒阳性吸毒者（N = 600）进行一项纵向小组研究，并使用基线重复评估。 6 个月和 12 个月的后续研究将采用混合方法来确定影响 BRIDGE 实施和有效性以及 BRIDGE 成本的多层次结构、社区和组织因素，检查其对成本效益的影响。该研究建立在过去十年中调查小组与共和国艾滋病中心合作对哈萨克斯坦吸毒者进行的广泛的艾滋病毒干预研究的基础上，它解决了改善和整合艾滋病毒服务的实施研究问题。注射吸毒者的输送系统不仅对该地区很重要，而且与同时存在注射吸毒和艾滋病毒流行的其他国家也有相关性。