Impact of a novel HIV peer navigationand overdose prevention intervention on engagement in the HIV prevention and treatment cascade.

新型艾滋病毒同行导航和过量预防干预对参与艾滋病毒预防和治疗级联的影响。

• 批准号: 10271704
• 负责人: Susan G. Sherman
• 金额: $ 79.45万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10271704
• 关键词: AIDS prevention; Address; Awareness; Baltimore; Behavioral Model; COVID-19; COVID-19 pandemic; Caring; Chemicals; Cities; Client; Cluster randomized trial; Communities; Continuity of Patient Care; Cost Effectiveness Analysis; Counseling; Country; Disease Outbreaks; Drug usage; Drug user; Effectiveness of Interventions; Environment; Epidemic; Exhibits; Fentanyl; Focus Groups; Foundations; Frequencies; General Population; HIV; HIV Infections; HIV risk; HIV/STD; Healthcare; Heroin; Human immunodeficiency virus test; Illicit Drugs; Incidence; Indiana; Injecting drug user; Injections; Intervention; Interview; Locales; Location; Maintenance; Market Research; Massachusetts; Measures; Modeling; Morbidity - disease rate; Naloxone; Needle Sharing; Needle-Exchange Programs; Nurse Practitioners; Outcome; Overdose; Pharmaceutical Preparations; Pharmacotherapy; Population; Populations at Risk; Prevention; Prospective cohort; Provider; Public Health; Radar; Reporting; Risk; Risk Behaviors; Risk Reduction; Service delivery model; Services; Site; Structure; Target Populations; Testing; Time; United States National Institutes of Health; Unsafe Sex; West Virginia; care systems; comorbidity; condoms; cost effectiveness; design; drug market; effectiveness evaluation; experience; health care service; high risk; housing instability; implementation science; improved; incremental cost-effectiveness; innovation; interest; mHealth; mortality; novel; opioid epidemic; opioid treatment program; opioid use; outreach services; overdose death; overdose prevention; peer; peer support; pre-exposure prophylaxis; prevent; prevention service; preventive intervention; primary outcome; programs; recruit; response; scale up; secondary outcome; service engagement; standard of care; substance use; test strip; therapy design; tool; treatment services; trend; two way texting; uptake

Project Summary People who inject drugs (PWID) are at exceedingly high risk of HIV compared to the general population, yet pre-exposure prophylaxis (PrEP) programs that target them in the U.S. are scarce and accordingly PrEP uptake in this population remains low. In recent years, substance use services have been scaled up to address overdose among PWID, however, they remain an underutilized entry point into PrEP. Pivotal gains made in reducing HIV could be rapidly eroded by the expanding population of PWID attributed to the ongoing opioid epidemic, new HIV outbreaks among new injectors, and the emergent COVID-19 pandemic, which has disrupted key HIV prevention services including syringe services programs, treatment and condom distribution. The overarching aim of the RADAR (Rapid Alerts through Drug Analysis and Response) study is to design, implement and evaluate a mobile health van that provides on-site PrEP, peer navigation and co-located drug checking services (DCS). This study will expand the reach of PrEP services by offering a novel intervention designed to increase PrEP awareness and engagement. DCS enable PWID to understand the precise chemical contents of their drugs to inform safer drug practices and are critical in places where illicit fentanyl drives overdose mortality. The integration of peer navigation will help attend to the multiple, pressing needs of PWID and subsequently enhance their engagement in the PrEP continuum. Our specific aims are: (1) to develop a community-level, mobile, integrated PrEP intervention aimed to increase PWID engagement in the PrEP care continuum; (2) to implement the intervention through a stepped wedge cluster randomized trial and evaluate its impact on being on PrEP or having seen a PrEP provider in the last six months among PWID (N=600) over the course of 18 months; (2a) to measure the intervention’s impact on HIV risk behaviors (e.g., syringe sharing, condomless sex); and (3) to determine the incremental cost-effectiveness of the intervention in terms of HIV cases averted among PWID (N=600) over the course of 18 months. The intervention (on-site PrEP, peer navigation, SMS reminders, DCS and associated risk reduction counseling, standard-of-care services) will be compared to the standard-of-care only (HIV testing, PrEP referrals, fentanyl test strips, naloxone) condition. The proposal is directly responsive to PAR-18-915’s aim to leverage implementation science to improve each step of the Seek, Test, Treat, and Retain (STTR) continuum for PWUD as well broader NIH priorities to reduce HIV incidence and develop, test, and implement strategies to improve HIV testing and entry into prevention and care. The study is innovative as it attends to multiple comorbidities, it is inclusive of the expertise of PWID in all components of the study and builds on our experience in delivering outreach services during COVID-19.

项目摘要 与普通人群相比，注射毒品（PWID）的艾滋病毒风险极高 在美国针对它们的预防前预防（PREP）计划很少，因此 该人群的吸收仍然很低。近年来，已经对药物使用服务进行了扩展以解决 但是，在PWID中过量服用，它们仍然是未充分利用的入口点。关键收益 归因于持续的Ooid的PWID人群的扩大人群可以迅速发出艾滋病毒 流行病，新喷油器中的新艾滋病毒爆发以及出现的COVID-19大流行病 破坏了关键的HIV预防服务，包括注射器服务计划，治疗和避孕套分配。 雷达的总体目的（通过药物分析和反应快速警报）是设计， 实施和评估一辆移动健康货车，该货车提供现场准备，同行导航和共同确定的药物 检查服务（DCS）。这项研究将通过提供新颖的干预措施来扩大准备服务的影响 旨在提高准备意识和参与。 DCS使PWID能够理解精度 其药物的化学含量以告知更安全的药物实践，并且在非法芬太尼的地方至关重要 驱动过量死亡率。同行导航的集成将有助于满足多重的紧迫需求 PWID并随后增强了他们参与预备连续体。我们的具体目的是：（1） 开发社区级，移动，集成的准备干预措施，旨在增加PWID参与 准备继续前进； （2）通过阶梯楔形群集随机试验实施干预措施， 评估其对PREP的影响或在过去六个月中见过预备提供者的影响 （n = 600）在18个月的时间里； （2a）衡量干预对艾滋病毒风险行为的影响（例如， 注射器共享，无避孕套性）； （3）确定干预的增量成本效益 在18个月的时间里，PWID（n = 600）之间避免了艾滋病毒案件的条款。干预（现场 准备，同行导航，SMS提醒，DC和相关的降低风险咨询，护理标准 服务）将与仅保健标准（HIV测试，PrEP推荐，芬太尼测试条， 纳洛酮）条件。该提案直接响应Par-18-915的目标，以利用实施 科学以改善寻求，测试，治疗和保留（STTR）连续体的科学 更广泛的NIH优先事项，以减少艾滋病毒的发病率和发展，测试和实施改善艾滋病毒的策略 测试和进入预防和护理。这项研究具有创新性，因为它涉及多种合并症，这是 包括PWID在研究的所有组成部分中的专业知识，并以我们提供的经验为基础 Covid-19期间的外展服务。