Expanding Medication Assisted Therapies in Central Asia

在中亚扩大药物辅助治疗

基本信息

批准号：
10403273
负责人：
FREDERICK LEWIS ALTICE
金额：
$ 62.54万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10403273
关键词：
AIDS prevention Address Adoption Advocacy Asian Central Asia Characteristics Client Clinic Community of Practice Competence Country Detection Economics Elements Epidemic Evidence based practice Goals Growth HIV HIV Infections HIV/TB Health Health Benefit Health Policy Health system Healthcare Systems Injecting drug user International Kazakhstan Kyrgyzstan Learning Modeling Opioid Outcome Patients Policies Politics Preparation Primary Prevention Process Program Sustainability Provider Public Health Research Resources Route Secondary Prevention Sexual Partners Tajikistan Techniques Training USSR Ukraine Viral addiction antiretroviral therapy base clinical care cohesion contextual factors cost effective experience health care delivery implementation barriers implementation efforts implementation strategy improved innovation medication-assisted treatment meetings member opioid agonist therapy opioid epidemic opioid use disorder prevent programs scale up success sustainability framework tool

项目摘要

Central Asia (CA) represents the most rapidly growing HIV epidemic region worldwide, concentrated in people who inject drugs (PWID) and their sexual partners. Scaling up opioid agonist therapies (OAT) in CA is the most cost-effective strategy to prevent new HIV infections, and more effective when combined with antiretroviral therapy (ART). CA countries have especially low OAT (and ART) coverage and are uniquely impacted by their proximity to opioid trade routes, a myriad of patient, provider, healthcare and policy barriers and suboptimal implementation. CA countries share a similar rigid Semashko healthcare system, which can be especially challenging for implementing evidence-based practices (EBPs). Moreover, the HIV treatment cascade differs in the three countries of Kazakhstan (KZ), Kyrgyzstan (KY) and Tajikistan (TJ), generally with low levels of case detection, ART prescription and viral suppression. They also differ by OAT coverage, with all being suboptimal and well-below international targets for the 120,500, 25,000 and 22,500 PWID, respectively. We propose to use the Network for the Improvement of Addiction Treatment (NIATx) implementation strategy to scale-up OAT in three diverse CA countries guided by the EPIS (Exploration-Planning-Implementation- Sustainment) framework. Using our experiences with NIATx to scale-up OAT, we will use the EPIS framework where we will first assess the barriers and facilitators to OAT scale-up, including the inner and outer contexts as well as bridging factors. These findings will guide preparation and implementation efforts using NIATx. Collaborative learning is key feature of NIATx that can be used in diverse contexts and is an iterative process that promotes change. Understanding the trajectories of implementation, a core feature of EPIS, may in this context emerge through creating communities of practice, especially when cohesion and/or competence evolves through this process, and may guide other healthcare delivery challenges in the region (e.g., HIV, TB). Using NIATx to build important regional expertise and competence and understanding implementation trajectories in this context should help support OAT program sustainability. As part of our implementation and sustainability plan, and consistent with NIATx, we will convene stakeholder meetings to bridge inner and outer factors to guide initial and ongoing implementation, review findings from our studies and use information to inform policies for expanding OAT in each CA country. These meeting will inform implementation and guide policy changes to promote sustainability. Significance is justified by the regional needs to prevent HIV in PWID and their sexual partners and the lack of scale-up of EBPs. Innovation is enhanced not only by using NIATx in a new context, but by more comprehensively understanding scale-up trajectories in this context. Success is likely to be high given the experience of the US and Central Asian teams, their previous collaborative research and a common goal to control HIV in the region. Public health benefit should be high as findings may mitigate the evolving regional HIV epidemics where OAT has benefits for both primary and secondary HIV prevention.

中亚（CA）代表了全世界最快增长的HIV流行地区，集中在注射毒品（PWID）及其性伴侣的人。在CA中扩展阿片类动力学疗法（OAT）为防止新的艾滋病毒感染的最具成本效益的策略，与抗逆转录病毒疗法（ART）。 CA国家的燕麦（和艺术）覆盖范围特别低，并且是独特的受阿片类药物贸易路线的距离的影响，无数患者，提供者，医疗保健和政策障碍和次优实施。 CA国家有类似的僵化的Semashko医疗保健系统，可以是在实施基于证据的实践（EBP）方面特别具有挑战性。此外，HIV治疗级联在哈萨克斯坦（KZ），吉尔吉斯斯坦（KY）和塔吉克斯坦（TJ）的三个国家 /地区有所不同，通常水平较低病例检测，ART处方和病毒抑制。它们也因燕麦覆盖而不同，所有它们都是分别针对120,500、25,000和22,500 PWID的次优和良好的国际目标。我们建议使用网络改善成瘾治疗（NIATX）实施策略在EPIP指导的三个不同的CA国家 /地区的燕麦（探索规划实施 - 维持框架。利用我们在NIATX的经验来扩展燕麦，我们将使用EPIS框架我们将首先评估障碍和促进者以燕麦片的扩大，包括内在和外部环境以及桥接因素。这些发现将使用NIATX指导准备和实施工作。协作学习是NIATX的关键特征，可以在不同的环境中使用，并且是一个迭代过程促进变化。了解实施的轨迹，这是EPIS的核心功能，可能在此中通过创建实践社区，尤其是在凝聚力和/或能力不断发展的情况下出现环境通过此过程，可以指导该地区其他医疗保健提供挑战（例如，艾滋病毒，结核病）。使用 NIATX建立重要的区域专业知识，能力和理解实施轨迹这种情况应该有助于支持燕麦计划的可持续性。作为我们实施和可持续性的一部分计划并与NIATX一致，我们将召集利益相关者会议以桥接内部和外部因素以指导初始和正在进行的实施，请审查我们的研究结果，并使用信息来告知政策在每个CA国家中膨胀燕麦。这些会议将为实施和指导政策更改提供信息促进可持续性。重要性是由防止艾滋病毒及其性行为的区域需求证明的合作伙伴和缺乏EBP的规模。不仅通过在新环境中使用NIATX，还可以增强创新通过在这种情况下更全面地了解扩大轨迹。成功可能很高美国和中亚团队的经验，他们以前的合作研究以及一个共同的目标该地区的控制艾滋病毒。公共卫生益处应该很高，因为发现可能减轻不断发展的地区艾滋病毒燕麦对原发性和继发艾滋病毒预防具有益处的流行病。