Integration of buprenorphine into a multi-component harm reduction program fro people who inject drugs in Kampala, Uganda

将丁丙诺啡纳入针对乌干达坎帕拉注射吸毒者的多成分减害计划

基本信息

批准号：
10075523
负责人：
Julia B Dickson-Gomez
金额：
$ 19.8万
依托单位：
MEDICAL COLLEGE OF WISCONSIN
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-01 至 2023-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10075523
关键词：
AIDS prevention Adherence Africa Africa South of the Sahara African Alcohols Blood Buprenorphine Caring Clinic Cocaine Collaborations Computers Country Drops Education Ensure Epidemic Equipment Female Funding HIV HIV Infections HIV Seronegativity HIV Seropositivity HIV risk HIV/HCV Harm Reduction Hepatitis C Hepatitis C Prevalence Hepatitis C virus Heroin Heroin Users High Prevalence Human immunodeficiency virus test Incidence Infection Injecting drug user Injections Intervention Intervention Studies Interview Investments Kenya Link Measures Methods Modeling Naloxone Needle Sharing Needle-Exchange Programs Outcome Overdose Participant Pharmaceutical Preparations Pharmacotherapy Phase Population Prevalence Preventive Intervention Prophylactic treatment Psychosocial Assessment and Care Public Health Schools Qualitative Research Reporting Research Personnel Resources Risk Risk Behaviors Risk Reduction Self-Direction Services Social Network Sterility Surveys Swab Syringes Tanzania Testing Tourniquets Uganda Universities Viral Water Woman antiretroviral therapy base condoms cooking drug market illicit drug use implementation science injection drug use innovation methadone clinic/center peer pre-exposure prophylaxis programs recruit scale up sex sexual risk behavior transmission process treatment program uptake

项目摘要

ABSTRACT Since 2008, countries in Sub Saharan Africa have seen rapid increases in injection drug use including injection of heroin and cocaine [1-11] resulting in high prevalence of HIV and HCV infection, particularly in Tanzania and Kenya [1, 12, 13]. Uganda also has seen an increase in people who inject drugs [14-16] with recent estimates at approximately 4000 in Kampala [17]. HIV prevalence among PWID in Uganda is estimated to be around 17% in multiple studies [14, 17], with heroin being the most commonly injected drug. Despite the serious risk, interventions to reduce the harms associated with injection drug use and drug related sexual risk are just beginning to be developed and implemented in the region. Most researchers argue that a combination of approaches are needed to reduce HIV infection among PWID including: provision of clean syringes through syringe exchange programs (SEPs); frequent HIV testing and linkage to HIV care; antiretroviral therapy initiation after infection to reduce risk of onward transmission through viral suppression; medication assisted therapy; psychosocial support and pre- and post-exposure prophylaxis [22-24]. In the proposed application, we will collaborate with the Uganda Harm Reduction Network and Makerere University School of Public Health to develop, refine and pilot for feasibility and acceptability a combination HIV prevention intervention for PWID in two harm reduction Drop In Centers (DICs) in Kampala. We will use implementation science methods, the Consolidated Framework for Intervention Research (CFIR), to develop the intervention so that it can be feasibly implemented and sustained using the resources in DICs. The intervention will use social network HIV/HCV testing to bring PWID into the DICs. Participants will be given a small stipend for receiving HIV and HCV testing, and those who inject heroin will be offered naloxone, buprenorphine, a self-directed computer- based drug treatment program, CBT4CBT, and will complete a short interview to identify other PWID and receive coupons to recruit them for HIV/HCV testing. Participants will also be offered an array of services already offered in the DICs including syringes and other safe injection supplies, PrEP, and condoms. Finally, those who are HIV positive will be assigned a peer navigator who will link them into care and ensure continued attendance to HIV clinics and ART adherence. Specific aims of the proposed project include the following: 1) To develop a combination HIV prevention intervention for PWID in Kampala Uganda, using the Consolidated Framework for Intervention Research; 2) To refine the intervention through implementation cycles using the CFIR framework to identify barriers and find solutions to implementation and scale-up; 3) To assess feasibility, acceptability and initial promise of the intervention with a 6-month pilot test. We will collect quantitative implementation outcomes including the numbers of people tested for HIV/HCV, uptake of syringes and Naloxone, uptake and retention on buprenorphine, and uptake of CBT4CBT and conduct surveys at baseline and 3-months with pilot participants to measure changes in injection and sexual risk behaviors before and after receiving intervention components.

抽象的自2008年以来，撒哈拉以南非洲国家的注射毒品使用量迅速增加，其中包括注射毒品海洛因和可卡因 [1-11] 导致艾滋病毒和丙型肝炎病毒感染率高，特别是在坦桑尼亚和肯尼亚 [1,12,13]。根据最近的估计，乌干达注射毒品的人数也有所增加 [14-16] 坎帕拉大约 4000 [17]。乌干达注射吸毒者的艾滋病毒感染率估计约为多项研究显示该比例为 17% [14, 17]，其中海洛因是最常注射的药物。尽管存在严重的风险，减少与注射吸毒相关的危害和吸毒相关性风险的干预措施是正确的并开始在该地区开发和实施。大多数研究人员认为，结合需要采取措施减少吸毒者中的艾滋病毒感染，包括：通过以下方式提供干净的注射器注射器交换计划（SEP）；经常进行艾滋病毒检测并与艾滋病毒护理联系起来；抗逆转录病毒治疗感染后启动，通过病毒抑制降低继续传播的风险；药物辅助治疗;心理社会支持以及暴露前和暴露后预防[22-24]。在拟议的申请中，我们将与乌干达减害网络和麦克雷雷大学公共卫生学院合作开发、完善和试点针对注射吸毒者的艾滋病毒综合预防干预措施的可行性和可接受性坎帕拉的两个减害救助中心 (DIC)。我们将使用科学的实施方法，干预研究综合框架（CFIR），制定干预措施，使其能够利用 DIC 的资源切实可行地实施和维持。干预将使用社交网络 HIV/HCV 检测将吸毒者纳入 DIC。参与者将因感染艾滋病毒而获得小额津贴 HCV 检测，注射海洛因的人将获得纳洛酮、丁丙诺啡、一种自动控制的计算机基于药物治疗计划，CBT4CBT，并将完成一个简短的访谈，以确定其他注射吸毒者和获得优惠券以招募他们进行 HIV/HCV 检测。参与者还将获得一系列服务 DIC 中已经提供了注射器和其他安全注射用品、PrEP 和避孕套。最后，艾滋病毒呈阳性的人将被指派一名同伴导航员，将他们与护理联系起来并确保持续到 HIV 诊所就诊和坚持 ART 治疗。拟议项目的具体目标包括：1) 为乌干达坎帕拉吸毒者制定艾滋病毒综合预防干预措施，利用综合干预研究框架； 2) 通过实施周期完善干预措施 CFIR 框架，用于识别障碍并找到实施和扩大解决方案； 3）评估可行性，通过 6 个月的试点测试干预措施的可接受性和初步承诺。我们将定量收集实施成果，包括艾滋病毒/丙型肝炎病毒检测人数、注射器使用率和纳洛酮、丁丙诺啡的摄取和保留，以及 CBT4CBT 的摄取并在基线进行调查与试点参与者一起为期 3 个月，测量注射前后的注射和性危险行为的变化接受干预成分。