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.

Public Health Relevance

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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA029910-05
Application #
8699734
Study Section
Special Emphasis Panel (ZDA1-SXC-E (07))
Program Officer
Jones, Dionne
Project Start
2010-09-01
Project End
2015-07-31
Budget Start
2014-08-01
Budget End
2015-07-31
Support Year
5
Fiscal Year
2014
Total Cost
$394,709
Indirect Cost
$105,348
Name
Yale University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
Makarenko, Iuliia; Mazhnaya, Alyona; Polonsky, Maxim et al. (2016) Determinants of willingness to enroll in opioid agonist treatment among opioid dependent people who inject drugs in Ukraine. Drug Alcohol Depend 165:213-20
Mazhnaya, Alyona; Bojko, Martha J; Marcus, Ruthanne et al. (2016) In Their Own Voices: Breaking the Vicious Cycle of Addiction, Treatment and Criminal Justice Among People who Inject Drugs in Ukraine. Drugs (Abingdon Engl) 23:163-175
Azbel, Lyuba; Polonsky, Maxim; Wegman, Martin et al. (2016) Intersecting epidemics of HIV, HCV, and syphilis among soon-to-be released prisoners in Kyrgyzstan: Implications for prevention and treatment. Int J Drug Policy 37:9-20
Bojko, Martha J; Mazhnaya, Alyona; Marcus, Ruthanne et al. (2016) The Future of Opioid Agonist Therapies in Ukraine: A Qualitative Assessment of Multilevel Barriers and Ways Forward to Promote Retention in Treatment. J Subst Abuse Treat 66:37-47
Polonsky, Maxim; Azbel, Lyuba; Wickersham, Jeffrey A et al. (2016) Accessing methadone within Moldovan prisons: Prejudice and myths amplified by peers. Int J Drug Policy 29:91-5
Altice, Frederick L; Azbel, Lyuba; Stone, Jack et al. (2016) The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia. Lancet 388:1228-48
Polonsky, Maxim; Rozanova, Julia; Azbel, Lyuba et al. (2016) Attitudes Toward Addiction, Methadone Treatment, and Recovery Among HIV-Infected Ukrainian Prisoners Who Inject Drugs: Incarceration Effects and Exploration of Mediators. AIDS Behav 20:2950-2960
Polonsky, Maxim; Azbel, Lyuba; Wickersham, Jeffrey A et al. (2015) Challenges to implementing opioid substitution therapy in Ukrainian prisons: Personnel attitudes toward addiction, treatment, and people with HIV/AIDS. Drug Alcohol Depend 148:47-55
Kamarulzaman, Adeeba; Altice, Frederick L (2015) Challenges in managing HIV in people who use drugs. Curr Opin Infect Dis 28:10-6
Bojko, Martha J; Mazhnaya, Alyona; Makarenko, Iuliia et al. (2015) ""Bureaucracy & Beliefs"": Assessing the Barriers to Accessing Opioid Substitution Therapy by People Who Inject Drugs in Ukraine. Drugs (Abingdon Engl) 22:255-262

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