Injection drug use (IDU) has greatly contributed to an explosive and volatile HIV epidemic in states of the former Soviet Union (FSU) - especially in Ukraine. This region, for reasons similar in North America, incarceration of drug users is among the highest in the world. As a result, there is a concentration of HIV/AIDS and other infectious diseases (HBV, HCV, TB, STIs) within the criminal justice system (CJS). In many FSU countries, high-risk sexual and injection behaviors within prisons have resulted in significant intra-prison HIV transmission. The CJS is therefore a sentinel place not only to detect and treat HIV among drug users and their sexual partners, but to adapt and implement evidence-based interventions that are effective in decreasing HIV-related morbidity and mortality. In this application, we propose to create an innovative and new collaborative research program in Ukraine called PRIDE (Prison-related Research, Intervention Development and Evaluation), which addresses research and implementation issues in the FSU region associated with HIV, substance abuse and the CJS. PRIDE creates an infrastructure for research that involves both researchers and the CJS partners and includes collaborators from Ukraine, Kazakhstan and Georgia. The synergy between researchers and CJS partners allows an open dialogue and opportunity to incorporate implementation research using the Plan-Do-Study-Act (PDSA) that is likely to yield the most effective outcomes. Phase I provides a menu of surveillance activities that can be selected for research activities within the Ukraine CJS. Differing methodological strategies are available to answer different questions, including burden of infectious diseases and co-morbidity among prisoners, HIV risk behaviors and HIV transmission within prison, pre-release needs of prisoners with HIV, drug dependence and/or TB. Phase II reviews all surveillance and needs assessment activities and to select from a number of evidence-based interventions that should be adapted and pilot-tested among prisoners. Though not known a priori, the menu of options includes alternatives to incarceration, behavioral interventions such as the Holistic Health Recovery Program (HHRP), opioid substitution therapy (OST) administered either during incarceration or as a pre- or post-release intervention, prison-release interventions adapted from nationally-recognized models created by Yale investigators or others worthy of exploration and agreed upon through PRIDE. Phase III involves adaptation and pilot testing of selected interventions. Results from these pilots are to be used for further research, including application for new grants. The likelihood of success for PRIDE is based upon: 1) over 20 years of innovative research at the interface of substance abuse, HIV/AIDS and the CJS;2) an extensive research history between Yale and Ukraine;and 3) conducting research in Ukraine where the burden of disease is great and its central role in FSU activities is considerable.
Criminal justice systems (CJS) are sentinels sites for the detection and treatment of HIV among IDUs and require effective transition to the community. This application seeks to innovatively promote and facilitate research in countries of the former Soviet Union through partnerships between researchers and the CJS and the conduct of evidence-based research to impede the HIV epidemic among IDUs in Ukraine.
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