Exploring the Feasibility of a Peer-Driven Intervention to Improve HIV Prevention among Prisoners Who Inject Drugs

探索同伴驱动干预措施的可行性，以改善注射吸毒囚犯的艾滋病毒预防

• 批准号: 10597208
• 负责人: Julia Rozanova
• 金额: $ 13.76万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-15 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10597208
• 关键词: AIDS prevention; Address; Advocate; Applied Skills; Attitude to Health; Behavior; Behavioral; Biometry; Career Choice; Career Mobility; Caring; Central Asia; Characteristics; Collaborations; Communities; Country; Criminal Justice; Data; Drug abuse; Drug usage; Eastern Europe; Economics; Education; Educational process of instructing; Elements; Enrollment; Ensure; Environment; Epidemic; Epidemiology; Ethnography; Evaluation; Evidence based intervention; Funding; Future; Goals; HIV; HIV Infections; HIV Seronegativity; HIV risk; Health; Health Personnel; Health Policy; Health behavior; Imprisonment; Incentives; Incidence; Individual; Infection; Injecting drug user; Injections; Intervention; Interview; Kyrgyzstan; Learning; Life; Link; Manuals; Mediating; Medical Sociology; Medical Staff; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Needle-Exchange Programs; Outcome; Participant; Peer Pressure; Persons; Pharmaceutical Preparations; Policies; Positioning Attribute; Preparation; Prevalence; Prevention; Prevention program; Prisoner; Prisons; Privacy; Procedures; Protocols documentation; Public Health; Quasi-experiment; Recommendation; Recording of previous events; Research; Research Activity; Research Personnel; Research Project Grants; Resources; Risk; Risk Behaviors; Risk Reduction; Role; Shapes; Social Controls; Social Interaction; Social stratification; Stigmatization; Structure; System; Testing; Training; Universities; Violence; Volatilization; Vulnerable Populations; Work; addiction; arm; biobehavior; career; career development; community setting; cost; cost effective; efficacious intervention; experience; experimental study; global health; health care delivery; health care service; improved; injection drug use; medical outreach; methadone treatment; mortality; opioid epidemic; opioid injection; outreach; patient oriented research; peer; peer influence; peer support; prevention service; prison population; programs; recruit; role model; scale up; skills; social; social stigma; stakeholder perspectives; structured data; success; theories; therapy development; transmission process; treatment as usual; treatment program; two-arm study; uptake

Abstract Summary: Eastern Europe and Central Asia (EECA) is the only region where HIV incidence and mortality has increased, primarily fueled by people who inject drugs (PWID) who interface regularly with prisons. In Kyrgyzstan’s (KYR) prisons, HIV prevalence among opioid injectors exceeds 30%, and within prison drug injection is associated with being HIV+. KYR presents a unique opportunity to develop an HIV prevention program for prison settings because all the 15 HIV prevention programs recommended for prisons are available there. Based on many commonalities shared by prisons globally, lessons learned in the KYR prisons can inform HIV prevention efforts in other countries, including the US that is experiencing an explosive opioid epidemic. Data suggests that prisoners who inject drugs may join addiction treatment programs, and influenced by peers. Harnessing these peer influences on prisoners to incorporate more effective use of formal healthcare services, especially of addiction treatment programs and syringe exchange within prison, is a WHO priority. Compared to professional outreach workers, peer-driven interventions (PDIs) are more efficient and cost-effective in recruiting and engaging PWID in HIV prevention, yet aside from scant peer education prison programs, PDIs have not involved prisoners or directly focused on reducing HIV risk through promoting engagement with addiction treatment or syringe exchange. To address these critical gaps, the mentored K01 Award will provide the candidate with training and mentoring, including a real-world two-arm study that focuses on primary HIV prevention among PWID in prisons. The first arm of the study (Project 1.1) develops, pilots, and assesses the feasibility of a 12-week in-prison PDI to reduce HIV risk among prisoners who inject drugs by increasing uptake of available prison addiction treatment programs. The study’s second arm (Project 1.2) uses ethnographic observation of the 12-week PDI, and qualitative interviews with study participants and prison staff after the PDI in both Experiment and Control prisons, to explore why the PDI is successful (or not), refine the PDI manual, and develop hypotheses attributing changes in outcomes to the PDI that will be tested within a future R01 to conduct a RCT. The candidate, Dr. Rozanova, is well-positioned to perform this work because of her strong medical sociology and qualitative skills that will be extended by further training in mixed-methods and biostatistics, and her commitment to more advanced training in HIV, addiction, and prison health after transitioning her career to the new field 2 years ago. Over 5 years, she will achieve her career goals to: 1) Gain experience in PDI development and implementation to address stigma-specific barriers to HIV prevention services in prison; 2) Master using ethnography and qualitative interviews combined with new quantitative skills to evaluate the success of an experiment from its stakeholders’ perspective, and ultimately 3) develop an independent career path in patient-oriented research focused on HIV prevention, prison and global health, and addiction treatment. She will achieve her goals from an interdisciplinary team of mentors with expertise in HIV, addiction, prison health, experiments in criminal justice settings, and biostatistics and epidemiology, and through completion of relevant didactic work and seminars and conduct related research to apply the skills needed to become an independent researcher within the rich intellectual environment available at Yale University.

摘要摘要： 东欧和中亚 (EECA) 是唯一一个艾滋病毒发病率和死亡率上升的地区，这主要是由于 在吉尔吉斯斯坦 (KYR) 监狱中，阿片类药物注射者的艾滋病毒感染率超过 30%，而在监狱内注射毒品与艾滋病毒呈阳性有关。 为监狱环境制定艾滋病毒预防计划的机会，因为所有 15 项艾滋病毒预防计划 根据全球监狱的许多共同点，KYR 监狱的经验教训可以为其他国家（包括正在经历爆炸性阿片类药物预防的美国）的艾滋病毒工作提供参考。 数据表明，注射毒品的囚犯可能会参加成瘾治疗计划，并受到同龄人的影响。 利用这些同伴对囚犯的影响，更有效地利用正规医疗服务，尤其是 与专业外展相比，监狱内的成瘾治疗计划和注射器交换是世卫组织的优先事项。 工作人员、同伴驱动的干预措施 (PDI) 在招募和吸引吸毒者参与艾滋病毒治疗方面更加高效且更具成本效益 预防，但除了很少的同伴教育监狱计划外，监狱发展机构没有涉及囚犯或直接关注 通过促进成瘾治疗或注射器交换来降低艾滋病毒风险 为了解决这些关键差距，受指导的 K01 奖将为候选人提供培训和指导，包括一项侧重于吸毒者初级艾滋病毒预防的现实世界双臂研究。该研究的第一部分（项目 1.1）负责开发、试点和实施。 评估为期 12 周的监狱内 PDI 通过提高吸毒率来降低注射吸毒囚犯的艾滋病毒风险的可行性 该研究的第二部分（项目 1.2）使用了 12 周 PDI 的人种学观察，以及 PDI 后在实验和对照中对研究参与者和监狱工作人员的定性访谈。 监狱，探索 PDI 成功（或失败）的原因，完善 PDI 手册，并提出归因变化的假设 PDI 的结果将在未来的 R01 中进行测试，以进行 RCT 候选人 Rozanova 博士处于有利位置。 能够完成这项工作是因为她拥有强大的医学社会学和定性技能，这些技能将通过进一步的培训得到扩展 混合方法和生物统计学，以及她在艾滋病毒、成瘾和监狱卫生方面的更高级培训的承诺 两年前，她将职业生涯转向新领域，五年多来，她将实现自己的职业目标：1) 获得 PDI 开发和实施的经验，以解决监狱中艾滋病毒预防服务的耻辱特定障碍；2) 掌握民族志的使用；定性访谈与新的定量技能相结合，从利益相关者的角度评估实验的成功，最终 3) 在以患者为中心的研究中开发一条独立的职业道路，重点关注艾滋病毒预防、监狱和全球健康以及成瘾治疗。通过跨学科团队实现她的目标拥有艾滋病毒、成瘾、监狱卫生、刑事司法环境实验和生物统计学专业知识的导师 流行病学，并通过完成相关的教学工作和研讨会并进行相关研究来应用技能 需要在耶鲁大学丰富的知识环境中成为一名独立研究员。

项目成果

Social Support is Key to Retention in Care during Covid-19 Pandemic among Older People with HIV and Substance Use Disorders in Ukraine.

在乌克兰，Covid-19 疫情期间，社会支持是感染艾滋病毒和药物滥用障碍的老年人继续接受护理的关键。

• 发表时间: 2020
• 影响因子: 2
• 作者: Rozanova, Julia;Shenoi, Sheela;Zaviryukha, Irina;Zeziulin, Oleksandr;Kiriazova, Tetiana;Rich, Katherine;Mamedova, Elmira;Yariy, Volodymyr
• 通讯作者: Yariy, Volodymyr

An expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care.

乌克兰老年人中艾滋病毒流行不断扩大：对以患者为中心的护理的影响。

• 发表时间: 2021
• 影响因子: 3.7
• 作者: Rozanova, Julia;Zeziulin, Oleksandr;Rich, Katherine M;Altice, Frederick L;Kiriazova, Tetiana;Zaviryukha, Irina;Sosidko, Tetiana;Gulati, Komal;Carroll, Constance;Shenoi, Sheela V
• 通讯作者: Shenoi, Sheela V