Implementation science research on PrEP delivery and costing within MAT andNSP services for PWUD in Uganda

乌干达残疾人士 MAT 和 NSP 服务中 PrEP 交付和成本计算的实施科学研究

• 批准号: 10631694
• 负责人: Renee A. Heffron
• 金额: $ 54.14万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10631694
• 关键词: AIDS prevention; Adherence; Advocate; Africa; Attention; Buprenorphine; Capital; Cities; Cocaine; Communicable Diseases; Communities; Consensus; Consolidated Framework for Implementation Research; Consultations; Data; Drug usage; Drug user; Educational workshop; Ensure; Epidemic; Equipment; Funding; Guidelines; HIV; HIV Seronegativity; HIV antiretroviral; Harm Reduction; Health; Hepatitis C; Heroin; Human immunodeficiency virus test; Injectable; Injecting drug user; Injections; Institutes; Intervention; Interview; Knowledge; Location; Measures; Methods; Modeling; Needle-Exchange Programs; Needles; Oral; Persons; Pharmaceutical Preparations; Plasma; Police Forces; Policies; Population; Prevalence; Prevention; Prevention Guidelines; Provider; Qualitative Research; Reporting; Research; Risk; Scientist; Service delivery model; Service provision; Services; Site; Surveys; Syringes; Tenofovir; Uganda; Update; Work; addiction; antiretroviral therapy; base; budget impact; community based participatory research; cost; cost estimate; evidence base; experience; follow-up; implementation science; improved; infancy; medication-assisted treatment; member; multidisciplinary; novel; pathogen; pre-exposure prophylaxis; preference; prescription pain reliever; prevention service; programs; recruit; scale up; service delivery; sex; social; social stigma; trafficking; transmission process; treatment program; uptake; willingness

ABSTRACT In the past decade, Uganda seen increases – as large as 10-fold – in the number of people who use drugs (PWUD) and the risk for HIV transmission through shared injection equipment, a common practice in this setting with low access to clean equipment. HIV prevalence among PWUD has been estimated to be as high as 45%, highlighting the importance of widescale access to HIV treatment and prevention for PWUD, including oral pre-exposure prophylaxis (PrEP). PrEP was integrated into HIV prevention guidelines in Uganda in 2016 and PEPFAR funding has been supporting targeted rollout to key populations, including PWUD. However, <250 people currently accessing PrEP have identified as PWUD, indicating a large gap in prevention and an opportunity to optimize PrEP delivery for PWUD. For PWUD living with HIV, antiretroviral treatment has been integrated into medication assisted treatment (MAT) programs and needle and syringe exchange programs (NSP), by leveraging providers who empathize with addiction and have experience combating stigma associated with drug use. We hypothesize that a similar approach can be done for PrEP by integrating PrEP delivery into MAT and NSP programs and we proposed a staged approach to conduct formative work and refine two integrated programs (PrEP + MAT and PrEP + NSP), to pilot these programs and assess PrEP uptake, retention, and adherence and to conduct costing research to directly inform policy guidance. Our work will be conducted with attention to several constructs within the Consolidated Framework for Implementation Research and grounded in a participatory approach with members of the largest harm reduction network, police force, and PWUD in Uganda as project advisors. Specifically, we aim to: 1) conduct qualitative research to explore preferences for HIV prevention services and willingness to use/prescribe PrEP among PWUD and providers of a) oral PrEP and b) services for PWUD in Kampala, Uganda; 2) refine programs for community- based NSP + PrEP and facility-based MAT + PrEP; 3) compare PrEP uptake, retention, and adherence when PrEP is integrated into community-based NSP versus facility-based MAT to PWUD; and 4) estimate the programmatic costs and conduct budget impact analysis for integrating PrEP into our MAT and NSP programs. Impact. The proposed work will provide robust evidence about how to optimize integrated harm reduction and PrEP delivery to PWUD in Uganda and similar settings. With direct engagement from members of the Ugandan Ministry of Health on our investigative team, our findings will be immediately useful for policy guidelines and to guide programmatic scale-up. This work will be relevant to the US and globally as a demonstration of co-located harm reduction and HIV prevention services for PWUD and it will provide some of the first data on PrEP adherence and retention among PWUD.

抽象的 在过去的十年中，乌干达在使用毒品的人数中看到了增长（多达10倍） （PWUD）和通过共享注射设备传播HIV的风险，这是在这种情况下的常见做法 使用清洁设备的途径较低。据估计，PWUD中的艾滋病毒患病率与 45％的人强调了宽阔的艾滋病毒治疗和预防范围的重要性， 包括口服预防前预防（PREP）。 PREP已纳入HIV预防指南 2016年的乌干达和PEPFAR资金一直支持针对关键人口的有针对性的推出，包括PWUD。 但是，目前访问Prep的250人已确定为PWUD，这表明预防差距很大 并有机会优化PWUD的预备交付。对于患有艾滋病毒的pWud，抗逆转录病毒治疗已有 被整合到药物辅助治疗（MAT）计划以及针和注射器交换计划中 （NSP），通过利用同情成瘾并具有与污名相关的经验的提供者 使用毒品。我们假设可以通过集成准备交付来做类似的方法 进入MAT和NSP程序，我们提出了一种分阶段的方法来进行形成性工作和完善 两个集成程序（PREP + MAT和PREP + NSP），以试行这些程序并评估PREP吸收， 保留，依从性并进行成本研究以直接为政策指导提供信息。我们的工作 将在合并框架内的几种构造中注意实施 研究并以最大危害减少网络成员的参与方式为基础，警察 部队和乌干达的普瓦德（Pwud）担任项目顾问。具体而言，我们的目的是：1）进行定性研究 探索对艾滋病毒预防服务的偏好，并愿意在PWUD和 a）口服准备和b）在乌干达坎帕拉的PWUD服务的提供者； 2）完善社区的计划 - 基于NSP + PREP和基于设施的MAT + PREP; 3）比较何时的准备摄取，保留和依从性 PREP被整合到基于社区的NSP与基于设施的垫子到PWUD； 4）估计 编程成本并进行预算影响分析，以将PREP集成到我们的MAT和NSP程序中。 影响。拟议的工作将提供有关如何优化综合危害减少和 在乌干达和类似环境中向普瓦德进行准备。在乌干达成员的直接参与下 卫生部在我们的调查团队中，我们的调查结果将对政策指南立即有用，并 指南编程规模。这项工作将与美国和全球有关 PWUD的减少伤害和艾滋病毒预防服务，它将提供一些有关PREP的第一个数据 PWUD之间的依从性和保留。