Improving HIV service delivery for people who inject drugs in Kazakhstan: study protocol for the Bridge stepped-wedge tr
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(2019) 14:62
STUDY PROTOCOL
Open Access
Improving HIV service delivery for people who inject drugs in Kazakhstan: study protocol for the Bridge stepped-wedge trial Tara McCrimmon1,2, Louisa Gilbert1,2, Timothy Hunt1,2, Assel Terlikbayeva1, Elwin Wu1,2, Meruyert Darisheva1, Sholpan Primbetova1, Azamat Kuskulov1, Alissa Davis1,2, Anindita Dasgupta1,2, Bruce R. Schackman3, Lisa R. Metsch4, Daniel J. Feaster5, Baurzhan Baiserkin6 and Nabila El-Bassel1,2*
Abstract Background: People who inject drugs (PWID) in Kazakhstan face many barriers to HIV testing as well as to accessing HIV care, to retention in HIV care, and to initiating and adhering to anti-retroviral treatment (ART). Needle and syringe programs (NSPs) are an opportune setting for integrated interventions to link PWID to HIV care. Methods: This Hybrid Type II study employs a stepped-wedge design to evaluate both effectiveness and implementation outcomes of Bridge, an intervention to identify, test, and link HIV-positive PWID to HIV care. The study is conducted at 24 NSPs in three different regions of Kazakhstan, to assess outcomes on the individual, organizational, and policy levels. Discussion: This trial responds to an identified need for new models of HIV service delivery for PWID through harm reduction settings. Trial registration: NCT02796027 on June 10, 2016. Keywords: HIV, Harm reduction, People who inject drugs (PWID)
Contributions to the literature This paper describes the Bridge study, an implementation study to improve access to HIV testing and linkage to care among people who inject drugs (PWID) in Kazakhstan. This is the first HIV implementation study among PWID conducted in Central Asia.
Provides an example of a stepped-wedge design and robust multi-level assessments to evaluate effectiveness and implementation outcomes of Bridge.
Can serve as a model of a differentiation of care approach that utilizes harm reduction settings for HIV testing, linkage, and retention in care.
* Correspondence: [email protected] 1 Global Health Research Center of Central Asia, Almaty, Kazakhstan 2 Columbia University School of Social Work, 1255 Amsterdam Ave., New York, NY 10027, USA Full list of author information is available at the end of the article
Background Injection drug use remains a large contributor to the HIV epidemic in Kazakhstan, a country with an estimated 127,800 people who inject drugs (PWID) [1]. The prevalence of HIV among Kazakhstan’s PWID is higher than any other key population at 9.2% (compared to 1.9% for sex workers, 6.1% for men who have sex with men, and 3.5% for prisoners) [2]. Parenteral transmission of HIV through injection drug use accounts for 54% of the approximately 26,887 registered cases of HIV in Kazakhstan’s history [3]. Furthermore, sexual transmission of HIV often occurs among the sexual partners of injection drug users [3], and one study in Kazakhstan found an HIV prevalence of 10.4% among non-PWID partners of PWID [4]. Large gaps in the continuum of HIV care for PWID have intensified the epidemic among this com
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