Exploring the Feasibility of a Peer-Driven Intervention to Improve HIV Prevention among Prisoners Who Inject Drugs

探索同伴驱动干预措施的可行性，以改善注射吸毒囚犯的艾滋病毒预防

• 批准号: 10089432
• 负责人: Julia Rozanova
• 金额: $ 13.72万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-15 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10089432
• 关键词: AIDS prevention; Address; Advocate; Attitude to Health; Behavioral; Biometry; Career Choice; Career Mobility; Caring; Central Asia; Characteristics; Collaborations; Communities; Country; Criminal Justice; Data; Drug abuse; Drug usage; Eastern Europe; Economics; Education; Educational process of instructing; Elements; Enrollment; Ensure; Environment; Epidemic; Epidemiology; Ethnography; Evaluation; Evidence based intervention; Funding; Future; Goals; HIV; HIV Infections; HIV Seronegativity; HIV risk; Health; Health Personnel; Health Policy; Health behavior; Imprisonment; Incentives; Incidence; Individual; Infection; Injecting drug user; Injections; Institutes; Intervention; Interview; Kyrgyzstan; Learning; Life; Link; Manuals; Mediating; Medical Sociology; Medical Staff; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Needle-Exchange Programs; Outcome; Participant; Peer Pressure; Persons; Pharmaceutical Preparations; Positioning Attribute; Preparation; Prevalence; Prevention; Prevention program; Prisoner; Prisons; Privacy; Procedures; Protocols documentation; Public Health; Quasi-experiment; Recommendation; Recording of previous events; Research; Research Activity; Research Personnel; Research Project Grants; Resources; Risk; Risk Behaviors; Risk Reduction; Role; Shapes; Social Controls; Social Interaction; Social Policies; Social stratification; Stigmatization; Structure; System; Testing; Training; Universities; Violence; Work; addiction; arm; base; biobehavior; career; career development; community setting; cost; cost effective; efficacious intervention; experience; experimental study; global health; health care delivery; health care service; improved; injection drug use; medical outreach; methadone treatment; mortality; opioid epidemic; opioid injection; outreach; patient oriented research; peer; peer influence; peer support; prevention service; prison population; programs; recruit; role model; scale up; skills; social; social stigma; stakeholder perspectives; structured data; success; theories; therapy development; transmission process; treatment as usual; treatment program; two-arm study; uptake

Abstract Summary: Eastern Europe and Central Asia (EECA) is the only region where HIV incidence and mortality has increased, primarily fueled by people who inject drugs (PWID) who interface regularly with prisons. In Kyrgyzstan’s (KYR) prisons, HIV prevalence among opioid injectors exceeds 30%, and within prison drug injection is associated with being HIV+. KYR presents a unique opportunity to develop an HIV prevention program for prison settings because all the 15 HIV prevention programs recommended for prisons are available there. Based on many commonalities shared by prisons globally, lessons learned in the KYR prisons can inform HIV prevention efforts in other countries, including the US that is experiencing an explosive opioid epidemic. Data suggests that prisoners who inject drugs may join addiction treatment programs, and influenced by peers. Harnessing these peer influences on prisoners to incorporate more effective use of formal healthcare services, especially of addiction treatment programs and syringe exchange within prison, is a WHO priority. Compared to professional outreach workers, peer-driven interventions (PDIs) are more efficient and cost-effective in recruiting and engaging PWID in HIV prevention, yet aside from scant peer education prison programs, PDIs have not involved prisoners or directly focused on reducing HIV risk through promoting engagement with addiction treatment or syringe exchange. To address these critical gaps, the mentored K01 Award will provide the candidate with training and mentoring, including a real-world two-arm study that focuses on primary HIV prevention among PWID in prisons. The first arm of the study (Project 1.1) develops, pilots, and assesses the feasibility of a 12-week in-prison PDI to reduce HIV risk among prisoners who inject drugs by increasing uptake of available prison addiction treatment programs. The study’s second arm (Project 1.2) uses ethnographic observation of the 12-week PDI, and qualitative interviews with study participants and prison staff after the PDI in both Experiment and Control prisons, to explore why the PDI is successful (or not), refine the PDI manual, and develop hypotheses attributing changes in outcomes to the PDI that will be tested within a future R01 to conduct a RCT. The candidate, Dr. Rozanova, is well-positioned to perform this work because of her strong medical sociology and qualitative skills that will be extended by further training in mixed-methods and biostatistics, and her commitment to more advanced training in HIV, addiction, and prison health after transitioning her career to the new field 2 years ago. Over 5 years, she will achieve her career goals to: 1) Gain experience in PDI development and implementation to address stigma-specific barriers to HIV prevention services in prison; 2) Master using ethnography and qualitative interviews combined with new quantitative skills to evaluate the success of an experiment from its stakeholders’ perspective, and ultimately 3) develop an independent career path in patient-oriented research focused on HIV prevention, prison and global health, and addiction treatment. She will achieve her goals from an interdisciplinary team of mentors with expertise in HIV, addiction, prison health, experiments in criminal justice settings, and biostatistics and epidemiology, and through completion of relevant didactic work and seminars and conduct related research to apply the skills needed to become an independent researcher within the rich intellectual environment available at Yale University.

摘要摘要： 东欧和中亚（EECA）是唯一一个艾滋病毒事件和死亡率增加的地区，主要加油 由注射毒品（PWID）定期与监狱交往的人。在吉尔吉斯斯坦（KYR）的监狱中，阿片类药物注射器中的艾滋病毒患病率超过30％，监狱注射剂与HIV+有关。凯尔（Kyr）提出了一个独特的 为监狱环境制定艾滋病毒预防计划的机会，因为所有15个艾滋病毒预防计划 建议在那里提供监狱。根据全球监狱共享的许多共同点，在凯尔监狱中汲取的经验教训可以为其他国家的艾滋病毒预防工作提供信息，包括美国正在经历爆炸性的Ooid 流行性。数据表明，注射毒品的囚犯可能会加入成瘾治疗计划，并受同龄人的影响。 利用这些对囚犯的同伴影响，以更有效地利用正式的医疗服务，尤其是 成瘾治疗计划和监狱中的注射器交换是WHO的优先事项。与专业外展相比 工人，同行驱动的干预措施（PDI）在招募和吸引艾滋病毒的PWID方面更有效，更具成本效益 预防措施，除了少数同行教育监狱计划外，PDI还没有涉及囚犯或直接关注 通过促进加入或注射器交换来降低艾滋病毒风险。为了解决这些关键的差距，修订的K01奖将为候选人提供培训和修补，包括一项现实世界中的双臂研究，该研究重点介绍了监狱中PWID的原发性艾滋病毒预防。研究的第一组（项目1.1）开发，皮洛特和 评估一个为期12周的监狱PDI的可行性，以减少通过增加摄取药物注射毒品的囚犯的艾滋病毒风险 可用的监狱成瘾治疗计划。该研究的第二臂（项目1.2）使用民族志观察为12周的PDI，以及PDI之后的研究参与者和监狱工作人员的定性访谈 监狱，探讨为什么PDI成功（或不成功），完善PDI手册，并提出假设，以归因于 PDI的结果将在未来的R01中进行测试以进行RCT。候选人Rozanova博士的位置很好 由于她的强大医学社会学和定性技能，可以通过进一步的培训来扩展这项工作 混合方法和生物统计学，以及她对艾滋病毒，成瘾和监狱健康培训的承诺 2年前将她的职业生涯转移到新领域。在5年的时间里，她将实现自己的职业目标：1）在PDI开发和实施方面获得经验，以应对监狱中验证疾病预防服务的特定污名障碍； 2）使用民族志和定性访谈的掌握以及新的定量技能，从其利益相关者的角度评估实验的成功，最终3）在以患者为导向的研究中发展独立的职业道路，该研究重点是预防HIV，监狱和全球健康和成瘾治疗。她将从具有艾滋病毒，成瘾，监狱健康，刑事司法环境的实验以及生物统计学和生物统计学的跨学科导师团队中实现自己的目标 流行病学，通过完成相关的教学工作和半手，并进行相关研究以运用技能 需要在耶鲁大学提供丰富的知识环境中成为独立研究人员。