Identifying Intersectional Stigma Intervention Targets for People Who Inject Drugs in a High-Risk International Setting

确定在高风险国际环境中注射吸毒者的交叉耻辱干预目标

基本信息

批准号：
10055707
负责人：
Laramie Rae Smith
金额：
$ 23.25万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-10 至 2022-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10055707
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Adult Affect Anti-Retroviral Agents Behavior Capital Caring Central Asia Cessation of life Cities Collaborations Communities Complex Country Data Decentralization Drug usage Eastern Europe Educational workshop Epidemic Equation Fright Future General Population Geography Government HIV HIV Infections HIV risk Harm Reduction Health Personnel Heroin Incidence Individual Injecting drug user International Intervention Kyrgyzstan Law Enforcement Link Measures Methadone Methods Modeling Needle-Exchange Programs Needles Participant Pharmacotherapy Population Preparation Prevalence Preventive Intervention Prisons Process Program Development Protocols documentation Qualitative Research Research Research Personnel Respondent Risk Role Route Rural Russia Sampling Science Series Services Stigmatization Structure Substance Use Disorder Syringes Time Training Work antiretroviral therapy care seeking comorbidity efficacy trial evidence base experience follow up assessment follow-up high risk improved innovation methadone treatment mortality next generation novel opioid use disorder prevent prevention service primary outcome programs recruit response rural area rural environment rural setting secondary outcome service engagement social determinants social stigma social structure success trafficking transmission process treatment services uptake

项目摘要

220.7 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 region, where HIV is predominantly concentrated among PWID. Improving PWID engagement in needle and syringe programs (NSP), methadone to treat opioid use disorder (MMT), and antiretrovirals (ART) to treat HIV (among HIV+ PWID) is essential to ending the HIV epidemic in this region. Substantial qualitative research documents that PWID contend with stigmas related to HIV, drug use, and drug treatment (i.e. methadone), which undermine engagement in these key HIV prevention services. Yet, less is known about which of these intersecting stigmas are most critical to intervene on to improve engagement in HIV prevention services. Further, the focus of intersectional stigma has not been extended to rural PWID in the region despite increased HIV incidence in rural areas. Structural equation modeling–a robust quantitative method–can identify which of these stigmas are most critical to intervene on to optimize engagement in HIV prevention services among urban and rural PWID. The current study will recruit urban (n = 102) and rural (n = 102) adult PWID using respondent driven sampling. Experiences with HIV, drug use, and methadone stigma, and level of engagement in NSP, MMT (primary outcome) and ART (secondary outcome) services will be measured at baseline. Structural equation modeling will be used to identify optimal points to reduce stigma and improve engagement in HIV prevention service s (Aim 1). A follow up assessment will be conducted 3 months post-baseline to obtain study retention estimates and refine protocols for retaining urban and rural PWID in a future efficacy trial (Aim 2). A series of four data-driven and community-informed workshops with PWID (n = 20) and key stakeholders (n =2 0) will be held to develop stigma reduction interventions tailored to urban and rural regions in Kyrgyzstan (Aim 3). Kyrgyz co-investigators will be substantially involved at every level of this project to build in-country capacities in stigma and HIV science. This will enable our Kyrgyz team to develop the next generation of research scholars in a region where the HIV epidemic is rapidly expanding, and the incidence of AIDS-related mortality is climbing. This project will lay the groundwork to implement a future stigma reduction intervention among urban and rural PWID in Kyrgyzstan. As the first study to quantify the impact of intersecting stigmas (HIV, drug use, methadone) on HIV prevention among urban and rural PWID, this study is significant because stigma is a key sociostructural driver of a rapidly expanding HIV epidemic in EECA–due to low engagement in HIV prevention services (including HIV treatment). This study is highly innovative because it reflects a substantial departure from how intersecting HIV, drug use, and methadone stigma has been studied among PWID, opening new opportunities reverse a rapidly expanding HIV epidemic in the region.

220.7 项目概要/摘要耻辱是注射吸毒者（PWID）中预防艾滋病毒的普遍障碍。世界上艾滋病毒流行最迅速的地区是东欧和中亚地区，艾滋病毒在这些地区提高注射吸毒者对针头和注射器项目 (NSP) 的参与，美沙酮用于治疗阿片类药物使用障碍 (MMT)，抗逆转录病毒药物 (ART) 用于治疗 HIV（在 HIV+ 吸毒者中）大量定性研究表明，对于结束该地区的艾滋病毒流行至关重要。应对与艾滋病毒、吸毒和药物治疗（即美沙酮）相关的耻辱，这些耻辱破坏了然而，人们对这些相互交叉的耻辱中的哪一个知之甚少。对于提高艾滋病毒预防服务的参与度而言，最重要的是进行干预。尽管农村地区艾滋病毒发病率有所上升，但该地区农村吸毒者并未受到跨部门耻辱感的影响结构方程模型——一种稳健的定量方法——可以识别哪些耻辱最严重。对于优化城乡吸毒者参与艾滋病毒预防服务的干预措施至关重要。本研究将采用受访者驱动抽样的方式招募城市（n = 102）和农村（n = 102）成年注射吸毒者。 HIV、吸毒和美沙酮耻辱的经历，以及 NSP、MMT 的参与程度（主要结果）和 ART（次要结果）服务将在基线时进行测量。将用于确定减少耻辱并提高艾滋病毒预防服务参与度的最佳点（目标 1). 将在基线后 3 个月进行后续评估，以获得研究保留估计值和在未来的功效试验中完善保留城市和农村注射吸毒者的方案（目标 2）一系列四个数据驱动的方案。将与注射吸毒者 (n = 20) 和主要利益相关者 (n = 2 0) 举行社区知情研讨会，以制定针对吉尔吉斯斯坦城市和农村的减少耻辱地区干预措施（目标 3）。将大力参与该项目的各个层面，以建设国内在耻辱和艾滋病毒科学方面的能力。这将使我们的吉尔吉斯团队能够在艾滋病毒流行地区培养下一代研究学者艾滋病疫情正在迅速蔓延，艾滋病相关死亡率不断上升，该项目将奠定这一基础。为吉尔吉斯斯坦城乡吸毒者未来实施减少耻辱干预措施奠定基础。作为第一项量化交叉耻辱（艾滋病毒、吸毒、美沙酮）对艾滋病毒预防影响的研究在城市和农村注射吸毒者中，这项研究意义重大，因为耻辱感是快速吸毒者社会结构的一个关键驱动因素。东欧中亚地区的艾滋病毒流行——由于艾滋病毒预防服务（包括艾滋病毒治疗）参与度低而扩大。这项研究极具创新性，因为它反映了艾滋病毒、吸毒、已经对注射吸毒者中的美沙酮污名进行了研究，这开启了新的机遇，扭转了快速扩大的趋势该地区艾滋病毒流行。