Ending HIV and Taming HCV and Overdose Among Puerto Rican PWID in New York City: The Ganchero Intervention

纽约市波多黎各吸毒者中消灭艾滋病毒、控制丙型肝炎和吸毒过量：Ganchero 干预措施

• 批准号: 10699316
• 负责人: HONORIA M GUARINO
• 金额: $ 16.52万
• 依托单位: NORTH JERSEY AIDS ALLIANCE ,INC. (NJCRI)
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10699316
• 关键词: AIDS prevention; Air; Behavioral; Boston; Client; Clinical Trials; Consultations; County; Data; Diffusion; Disease Outbreaks; Drug Residues; Educational Curriculum; Effectiveness; Ethnic Population; Ethnography; Evaluation; Feedback; Focus Groups; Future; Goals; Grant; HIV; HIV/HCV; Health; Health behavior change; Hepatitis C; Hepatitis C Prevalence; High Prevalence; Indiana; Injecting drug user; Injections; Intervention; Interview; Knowledge; Learning; Massachusetts; Measures; Methods; Migrant; Modeling; Naloxone; Needle Sharing; Neighborhoods; New York City; Nonmigrant; Not Hispanic or Latino; Outcome Measure; Overdose; Pharmaceutical Preparations; Positioning Attribute; Process; Protocols documentation; Puerto Rican; Puerto Rico; Recommendation; Reporting; Research; Resources; Risk; Risk Behaviors; Risk Reduction; Role; Rural; Series; Services; Social Network; Sterility; Structure; Syringes; Time; Training; United States; Veins; Visual; Waiting Lists; Water; analog; design; drug use behavior; effectiveness outcome; effectiveness/implementation trial; empowerment; ethnic minority; evidence base; implementation fidelity; implementation intervention; implementation strategy; innovation; intervention refinement; meetings; member; migration; mortality; opioid overdose; outreach; overdose death; overdose prevention; overdose risk; peer; peer influence; prevent; preventive intervention; racial minority; response; rural area; surveillance study; syndemic; theories; urban area

Project Summary/Abstract The threat of HIV among people who inject drugs (PWID) in the United States (US) is not over. Multiple HIV outbreaks among PWID in rural and urban areas of the US have occurred recently, from 2015 in rural Indiana to 2018 in Boston, Massachusetts. PWID who are racial/ethnic minorities continue to be disproportionately infected with HIV. Among these, Puerto Rican (PR) PWID who started injecting drugs in Puerto Rico (PR) and continue to inject drugs in New York City (NYC) remain vulnerable not only to HIV, but also to hepatitis C (HCV) and fatal opioid overdose. Analyses conducted in NYC found PR PWID, especially those who migrated from PR, are the most HIV-vulnerable ethnic group. In 2017, the US overdose mortality rate for US-born and PR-born Puerto Rican PWID exceeded the rate for Non-Hispanic Whites, and the same holds true in NYC. Recent research showed that PR PWID have significantly higher prevalence of HCV than non-PR-PWID, and that PR-born migrant PWID have the highest HCV prevalence (86%) of all three groups. Helping PR-born PWID avoid HIV will help prevent HIV outbreaks in NYC. Lowering their HCV and overdose risk will help reduce overall HCV prevalence (67%) and overdose mortality rates (21.2 per 100,000) in NYC’s PWID. In this 3-year study, we will develop an innovative and culturally tailored HIV, HCV, and overdose risk- reduction intervention for migrant PR PWID in NYC that leverages the key migrant PWID role of the Ganchero, frequently used “injection doctors,” and migrants’ strong social network ties. The intervention will be twofold: 1) it will train Gancheros on the foundational HIV, HCV, and overdose knowledge required to, 2) deploy Gancheros to disseminate evidence-based risk-reduction messages and resources and to implement safer injection practices as they deliver their regular services to migrant PWID clients. The intervention will use a wait-list control design with 10 Gancheros and 60 clients in two Bronx neighborhoods. Across two time-lagged intervention implementation cycles (one per neighborhood, each consisting of a 6-session, small-group Ganchero training and a 4-month deployment period) and five assessment time points, we will measure the intervention’s feasibility (via Ganchero and client participation rates), acceptability (via Ganchero and client Visual Analog Scale [VAS] ratings and qualitative feedback) and preliminary effectiveness in increasing migrant clients’ rates of sterile syringe use (primary effectiveness outcome) and naloxone carriage (secondary effectiveness outcome). Changes in Gancheros’ HIV, HCV, and overdose knowledge and personal drug use behaviors will also be assessed before and after the training component. Ethnographic observations of Gancheros deploying intervention strategies will assess fidelity of implementation, barriers, and Gancheros’ responses to barriers, to inform refinements of the intervention and its implementation strategy. If successful, this intervention will reduce the high rates of HCV and overdose, and the significant potential for an HIV outbreak. We will then evaluate the Ganchero intervention in a hybrid effectiveness-implementation trial (R01).

项目概要/摘要 在美国，艾滋病毒对注射吸毒者 (PWID) 的威胁尚未结束。 最近，美国农村和城市地区吸毒者群体中的疫情爆发，从2015年起在印第安纳州农村地区 到 2018 年，马萨诸塞州波士顿的吸毒者中少数族裔/族裔比例仍然不成比例。 其中，波多黎各吸毒者（PR）开始在波多黎各（PR）注射毒品， 纽约市 (NYC) 继续注射吸毒者不仅容易感染艾滋病毒，而且容易感染丙型肝炎 (HCV) 和致命的阿片类药物过量 在纽约进行的分析发现 PR 吸毒者，尤其是那些移民的人。 2017 年，美国出生的美国人和美国人中的艾滋病毒过量死亡率。 出生于公关的波多黎各吸毒者的比例超过了非西班牙裔白人的比例，纽约市也是如此。 最近的研究表明，PR 注射吸毒者的 HCV 患病率明显高于非 PR 注射吸毒者，并且 在所有三个群体中，公关出生的移民吸毒者的丙肝病毒感染率最高（86%）。 注射吸毒者避免感染艾滋病毒将有助于预防纽约市的艾滋病毒爆发，降低他们的丙型肝炎病毒和服药过量的风险将有所帮助。 降低纽约市注射吸毒者的 HCV 总体患病率 (67%) 和服药过量死亡率 (每 100,000 人 21.2 人)。 在这项为期 3 年的研究中，我们将开发一种创新的、根据文化定制的 HIV、HCV 和用药过量风险 - 针对纽约市移民 PR PWID 的减少干预措施，利用 Ganchero 的关键移民 PWID 角色， 频繁使用的“注射医生”以及移民强大的社交网络联系将是双重干预：1） 它将对 Gancheros 进行有关部署所需的基本 HIV、HCV 和用药过量知识的培训 Gancheros 传播基于证据的降低风险信息和资源，并实施更安全的措施 他们向移民吸毒者提供常规服务时的注射做法。干预措施将使用注射剂。 等候名单控制设计，涉及两个布朗克斯社区的 10 个 Gancheros 和 60 个客户。 干预实施周期（每个社区一个，每个周期由 6 次小组组成） Ganchero 培训和 4 个月的部署期）和五个评估时间点，我们将测量 干预的可行性（通过 Ganchero 和客户参与率）、可接受性（通过 Ganchero 和客户参与率） 视觉模拟量表 [VAS] 评级和定性反馈）以及增加的初步有效性 移民客户的无菌注射器使用率（主要有效性结果）和纳洛酮携带率（次要结果） 有效性结果）。 Gancheros 的 HIV、HCV 和用药过量知识以及个人药物使用情况的变化。 还将在培训部分之前和之后对行为进行评估。 Gancheros 部署干预策略将评估实施的保真度、障碍和 Gancheros 对障碍的反应，为干预措施及其实施策略的改进提供信息。 这种干预措施将降低丙肝病毒和药物过量的高发病率，以及艾滋病毒感染的巨大潜力 然后，我们将在混合有效性实施试验（R01）中评估 Ganchero 的干预措施。