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: 10684112
• 负责人: Renee A. Heffron
• 金额: $ 49.96万
• 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/10684112
• 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; Empathy; Ensure; Epidemic; Equipment; Funding; Guidelines; HIV; HIV Seronegativity; Harm Reduction; Health; Hepatitis C; Heroin; Human immunodeficiency virus test; Injectable; Injecting drug user; Injections; Intervention; Interview; Knowledge; 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; Transact; Uganda; Update; Work; addiction; antiretroviral therapy; 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; 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 过去十年，乌干达吸毒人数增加了 10 倍 (PWUD) 以及通过共用注射设备传播艾滋病毒的风险，这是这种情况下的常见做法 据估计，残疾人获得清洁设备的机会很少，艾滋病毒感染率高达 45%，强调残疾人士广泛获得艾滋病毒治疗和预防的重要性， 包括口服暴露前预防 (PrEP) 已纳入 HIV 预防指南。 2016 年乌干达和总统防治艾滋病紧急救援计划 (PEPFAR) 提供的资金一直支持对包括残疾人士在内的重点人群进行有针对性的推广。 然而，目前接受 PrEP 的人数不足 250 人，已被确定为 PWUD，这表明预防方面存在巨大差距 对于感染艾滋病毒的残疾人士来说，有机会优化 PrEP 的实施，并提供抗逆转录病毒治疗。 已纳入药物辅助治疗 (MAT) 计划以及针头和注射器交换计划 （NSP），通过利用那些对成瘾问题有同情心并具有抗击相关耻辱经验的提供者 我们努力通过整合 PrEP 递送来对 PrEP 采取类似的方法。 到 MAT 和 NSP 项目中，我们提出了一种分阶段的方法来进行形成性工作和完善 两个综合计划（PrEP + MAT 和 PrEP + NSP），以试点这些计划并评估 PrEP 的采用情况， 保留、遵守并进行成本研究，以直接为政策指导提供信息。 实施时将关注综合实施框架内的若干结构 研究并以最大的减少伤害网络、警察的成员参与的方式为基础 具体来说，我们的目标是：1）进行定性研究 探讨残疾人士和残疾人士对艾滋病毒预防服务的偏好以及使用/开具 PrEP 的意愿 a) 口服 PrEP 和 b) 乌干达坎帕拉残疾人士服务的提供者 2) 完善社区计划； 基于 NSP + PrEP 和基于设施的 MAT + PrEP 3) 比较 PrEP 的吸收、保留和依从性； PrEP 被纳入基于社区的 NSP 与基于设施的 MAT 到 PWUD；4) 估计 计划成本并进行预算影响分析，将 PrEP 纳入我们的 MAT 和 NSP 计划。 拟议的工作将为如何优化综合伤害减少和影响提供有力的证据。 在乌干达成员的直接参与下，向乌干达 PWUD 提供 PrEP。 卫生部在我们的调查小组中，我们的调查结果将立即用于政策指导和 这项工作将与美国和全球相关，作为同地办公的示范。 为残疾人士提供减少危害和艾滋病毒预防服务，并将提供一些关于 PrEP 的首批数据 PWUD 的依从性和保留率。