Integration of buprenorphine into a multi-component harm reduction program fro people who inject drugs in Kampala, Uganda

将丁丙诺啡纳入针对乌干达坎帕拉注射吸毒者的多成分减害计划

• 批准号: 10075523
• 负责人: Julia B Dickson-Gomez
• 金额: $ 19.8万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10075523
• 关键词: AIDS prevention; Adherence; Africa; Africa South of the Sahara; African; Alcohols; Blood; Buprenorphine; Caring; Clinic; Cocaine; Collaborations; Computers; Country; Drops; Education; Ensure; Epidemic; Equipment; Female; Funding; HIV; HIV Infections; HIV Seronegativity; HIV Seropositivity; HIV risk; HIV/HCV; Harm Reduction; Hepatitis C; Hepatitis C Prevalence; Hepatitis C virus; Heroin; Heroin Users; High Prevalence; Human immunodeficiency virus test; Incidence; Infection; Injecting drug user; Injections; Intervention; Intervention Studies; Interview; Investments; Kenya; Link; Measures; Methods; Modeling; Naloxone; Needle Sharing; Needle-Exchange Programs; Outcome; Overdose; Participant; Pharmaceutical Preparations; Pharmacotherapy; Phase; Population; Prevalence; Preventive Intervention; Prophylactic treatment; Psychosocial Assessment and Care; Public Health Schools; Qualitative Research; Reporting; Research Personnel; Resources; Risk; Risk Behaviors; Risk Reduction; Self-Direction; Services; Social Network; Sterility; Surveys; Swab; Syringes; Tanzania; Testing; Tourniquets; Uganda; Universities; Viral; Water; Woman; antiretroviral therapy; base; condoms; cooking; drug market; illicit drug use; implementation science; injection drug use; innovation; methadone clinic/center; peer; pre-exposure prophylaxis; programs; recruit; scale up; sex; sexual risk behavior; transmission process; treatment program; uptake

ABSTRACT Since 2008, countries in Sub Saharan Africa have seen rapid increases in injection drug use including injection of heroin and cocaine [1-11] resulting in high prevalence of HIV and HCV infection, particularly in Tanzania and Kenya [1, 12, 13]. Uganda also has seen an increase in people who inject drugs [14-16] with recent estimates at approximately 4000 in Kampala [17]. HIV prevalence among PWID in Uganda is estimated to be around 17% in multiple studies [14, 17], with heroin being the most commonly injected drug. Despite the serious risk, interventions to reduce the harms associated with injection drug use and drug related sexual risk are just beginning to be developed and implemented in the region. Most researchers argue that a combination of approaches are needed to reduce HIV infection among PWID including: provision of clean syringes through syringe exchange programs (SEPs); frequent HIV testing and linkage to HIV care; antiretroviral therapy initiation after infection to reduce risk of onward transmission through viral suppression; medication assisted therapy; psychosocial support and pre- and post-exposure prophylaxis [22-24]. In the proposed application, we will collaborate with the Uganda Harm Reduction Network and Makerere University School of Public Health to develop, refine and pilot for feasibility and acceptability a combination HIV prevention intervention for PWID in two harm reduction Drop In Centers (DICs) in Kampala. We will use implementation science methods, the Consolidated Framework for Intervention Research (CFIR), to develop the intervention so that it can be feasibly implemented and sustained using the resources in DICs. The intervention will use social network HIV/HCV testing to bring PWID into the DICs. Participants will be given a small stipend for receiving HIV and HCV testing, and those who inject heroin will be offered naloxone, buprenorphine, a self-directed computer- based drug treatment program, CBT4CBT, and will complete a short interview to identify other PWID and receive coupons to recruit them for HIV/HCV testing. Participants will also be offered an array of services already offered in the DICs including syringes and other safe injection supplies, PrEP, and condoms. Finally, those who are HIV positive will be assigned a peer navigator who will link them into care and ensure continued attendance to HIV clinics and ART adherence. Specific aims of the proposed project include the following: 1) To develop a combination HIV prevention intervention for PWID in Kampala Uganda, using the Consolidated Framework for Intervention Research; 2) To refine the intervention through implementation cycles using the CFIR framework to identify barriers and find solutions to implementation and scale-up; 3) To assess feasibility, acceptability and initial promise of the intervention with a 6-month pilot test. We will collect quantitative implementation outcomes including the numbers of people tested for HIV/HCV, uptake of syringes and Naloxone, uptake and retention on buprenorphine, and uptake of CBT4CBT and conduct surveys at baseline and 3-months with pilot participants to measure changes in injection and sexual risk behaviors before and after receiving intervention components.

抽象的 自2008年以来，撒哈拉以南非洲的国家的注射毒品使用迅速增加，包括注射 海洛因和可卡因[1-11]导致艾滋病毒和HCV感染的高流行率，尤其是在坦桑尼亚和 肯尼亚[1，12，13]。乌干达还发现注射药物的人[14-16]有了最近的估计 在坎帕拉大约4000 [17]。乌干达的PWID中的艾滋病毒患病率估计在附近 在多项研究中17％[14，17]，海洛因是最常见的药物。尽管有严重的风险 减少注射药物使用和与药物相关的性风险相关的危害的干预措施只是 开始在该地区开发和实施。大多数研究人员认为 需要采取方法来减少PWID之间的艾滋病毒感染，包括：通过：通过 注射器交换计划（SEP）；频繁的艾滋病毒测试和与艾滋病毒护理的联系；抗逆转录病毒疗法 感染后的启动，以降低通过病毒抑制的向前传播的风险；药物协助 治疗;心理社会支持以及暴露前和暴露后预防[22-24]。在拟议的申请中 我们将与乌干达减少伤害网络和Makerere大学公共卫生学院合作 开发，完善和试点可行性和可接受性，预防艾滋病毒的艾滋病毒干预措施 在坎帕拉的中心（DICS）的两次损害下降中。我们将使用实施科学方法， 进行干预研究（CFIR）的合并框架，以开发干预措施，以便它可以是 使用DIC中的资源可行地实施和维持。干预将使用社交网络 HIV/HCV测试将PWID带入DIC。参与者将获得接受艾滋病毒的少量津贴和 HCV测试，那些注入海洛因的人将获得纳洛酮，丁丙诺啡，一种自我指导的计算机 - 基于药物治疗计划CBT4CBT，并将完成简短的面试，以识别其他PWID和 接收优惠券以招募艾滋病毒/HCV测试。参与者还将提供一系列服务 已经提供了包括注射器和其他安全注射用品，准备和避孕套在内的DIC。最后， 那些艾滋病毒阳性的人将被分配一个同伴导航员 参加HIV诊所和艺术依从性。拟议项目的具体目的包括以下内容：1） 使用合并 干预研究框架； 2）通过使用实施周期来完善干预措施 CFIR框架以识别障碍并找到实施和扩展的解决方案； 3）评估可行性， 可接受性和最初通过6个月的试点测试对干预的承诺。我们将收集定量 实施结果，包括接受艾滋病毒/HCV测试的人数，注射器的吸收和 纳洛酮，对丁丙诺啡的摄取和保留以及对CBT4CBT的摄取并在基线进行调查 和飞行员参与者的三个月来衡量注射和性风险行为的变化 接受干预组件。