Peer-based HIV Self-testing among High Risk Women Who Inject or Use Drugs in Kazakhstan, Central Asia

哈萨克斯坦、中亚地区注射或吸毒高危女性中基于同伴的艾滋病毒自我检测

基本信息

批准号：
10082944
负责人：
Nabila El-Bassel
金额：
$ 25.2万
依托单位：
CITY COLLEGE OF NEW YORK
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 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10082944
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Advocacy Africa Alcohol or Other Drugs use Amelia Attention Awareness Behavioral Biological Caring Central Asia Cessation of life Client Communicable Diseases Communities Counseling Country Data Dermatology Development Drug usage Drug user Early Diagnosis Epidemic Focus Groups Goals HIV HIV Infections HIV Seronegativity HIV/STD Health Personnel High Risk Woman Human immunodeficiency virus test Incidence Individual Infection Injecting drug user Intention Intervention Interview Kazakhstan Knowledge Link Persons Pharmaceutical Preparations Phase Play Population Population Intervention Prevalence Prevention Prevention strategy Privatization Public Health Randomized Research Research Infrastructure Risk Risk Reduction Role Services Sexual Partners Site Technology Testing Text Thinking Time Training Treatment Efficacy United States Validation Viral Vulnerable Populations Woman Work advocacy organizations antiretroviral therapy arm base behavior change case finding coping cost design empowerment evidence base experience experimental arm female sex worker follow-up improved injection drug use innovation knowledge base novel peer peer support pre-exposure prophylaxis preference primary outcome response secondary outcome sex social stigma success theories tool uptake

项目摘要

ABSTRACT Central Asia (CA) has one of the world’s fastest growing HIV epidemics, increasing 30% since 2010. By 2017, key populations and their sex partners made up 95% of new HIV infections, including 9% among female sex workers (FSW), 39% among people who inject drugs (PWID), and 28% among clients/sex partners of sex workers/other key populations. In Kazakhstan, a major CA regional economy, there was a 106% increase in new HIV infections from 2010 to 2017. FSW who also inject drugs (FSWID) are at significantly increased risk of HIV infection, but are less likely to engage in HIV testing and receive care. HIV testing is the key point of entry to HIV care and ART, and, for HIV-negative individuals, to PrEP/PEP. In Kazakhstan, barriers to HIV testing for FSWID, include stigma, inconvenience, and health care provider bias against women who are FSW and/or drug users. Although HST is recommended by the WHO, very limited research on FSW and PWID exists. Reviews of interventions to increase testing suggest that HST can increase consistent or frequent testing, but that linkage to care rates can be lower with HST. Importantly, no studies have been conducted in CA or, to our knowledge, among FSWID, a vital population to target given their elevated risk for HIV, low uptake of HIV testing, and experiences of dual stigma. The primary goal of this study is to assess acceptability, feasibility, preliminary efficacy and cost of a peer-based HIV self-testing intervention to increase consistent HIV testing and linkage to care or prevention among women who exchange sex and inject drugs in Kazakhstan using the R34 mechanism. In Phase 1, we will conduct in-depth interviews and focus groups with 40 FSWID to identify responses to HST components from efficacious HST and linkage to care interventions with FSW. In Phase 2, we will engage design thinking approaches and intervention adaptation to optimize fidelity and fit of existing components and develop novel components reflecting our theoretical approaches; we will component test (N=20) and pre-pilot components (N=20). In Phase 3, we will randomize 90 HIV-uninfected FSWID to either the adapted experimental condition (4 sessions) or a time- and attention-controlled standard HIV test-counseling condition and follow for 18 months for impacts on consistent HIV testing, HST and linkage to care/prevention. The RCT will be conducted in partnership with Amelia, a non-profit, FSW advocacy organization, and KSCDID, which leads national HIV treatment/prevention strategy. Results will fill key gaps in the knowledge base around optimal HST implementation among FSWID in CA, through analysis of an innovative intervention with an explicit focus on stigma reduction and peer support with substance using populations. Results will have relevance for HST and linkage programming in other CA countries, as well as the 120 countries that have HIV epidemics where FSW and PWID play important roles, including the United States.

抽象的中亚 (CA) 是世界上艾滋病毒流行增长最快的地区之一，自 2010 年以来增长了 30%。到 2017 年，重点人群及其性伴侣占新增艾滋病毒感染者的 95%，其中女性占 9% 工作者 (FSW)、注射吸毒者 (PWID) 中的 39%、以及嫖客/性伴侣中的 28% 在哈萨克斯坦这个主要的 CA 地区经济体中，新增人口增长了 106%。 2010 年至 2017 年 HIV 感染情况。同时注射吸毒的 FSW (FSWID) 感染 HIV 的风险显着增加感染，但不太可能进行艾滋病毒检测并接受艾滋病毒检测是艾滋病毒进入的关键点。在哈萨克斯坦，FSWID 的艾滋病毒检测面临障碍，包括对 FSW 和/或吸毒妇女的耻辱、不便和医疗保健提供者的偏见。尽管世界卫生组织推荐 HST，但对 FSW 和 PWID 的研究非常有限。增加检测的干预措施表明 HST 可以增加一致或频繁的检测，但这种联系 HST 的护理率可能会降低重要的是，尚未在 CA 进行任何研究，或者据我们所知， FSWID 是一个重要的目标人群，因为他们感染艾滋病毒的风险较高，艾滋病毒检测率较低，并且本研究的主要目的是评估双重耻辱的可接受性、可行性、初步性。基于同伴的艾滋病毒自我检测干预措施的功效和成本，以提高艾滋病毒检测的一致性和与使用 R34 机制对哈萨克斯坦发生性行为和注射毒品的妇女进行护理或预防。在第一阶段，我们将与 40 名 FSWID 进行深入访谈和焦点小组讨论，以确定对 HST 的回应有效的 HST 以及与 FSW 的护理干预措施的联系在第二阶段，我们将进行设计。思维方法和干预适应，以优化现有组件的保真度和契合度，并开发反映我们理论方法的新颖组件；我们将进行组件测试（N=20）和预试点在第 3 阶段，我们将 90 名未感染 HIV 的 FSWID 随机分配到适应的实验组中。条件（4 次）或时间和注意力控制的标准 HIV 检测咨询条件，并遵循将进行 18 个月的随机对照试验，以了解对持续艾滋病毒检测、HST 以及与护理/预防的联系的影响。与非营利性 FSW 倡导组织 Amelia 以及领导国家艾滋病毒的 KSCDID 合作治疗/预防策略的结果将填补最佳 HST 知识库的关键空白。通过分析创新干预措施，明确关注以下方面，在加利福尼亚州 FSWID 中实施药物滥用人群的耻辱减少和同伴支持的结果将与 HST 和相关。与其他 CA 国家以及 120 个艾滋病毒流行国家的联系规划注射吸毒者和注射吸毒者发挥着重要作用，其中包括美国。