Russia and Eastern Europe have one of the fastest growing HIV epidemics in the world, with transmission risk primarily from injection drug use. Russia and other countries in the region have implemented routine HIV testing within established addiction treatment systems (i.e. narcology hospitals). The narcology system, however, works largely independent of other medical care systems and has not adopted strategies to link HIV- infected patients to HIV care. This is a missed opportunity: up to 45% of Russian injection drug users (IDUs) in narcology treatment have HIV, yet as few as 20% of those infected are in care. To retain those in HIV care the Russian AIDS treatment system has begun using case managers;however these efforts do not consider the unique challenges faced by IDUs that can impact retention nor do they address care initiation. The objective of this study """"""""Linking Infectious and Narcology Care (LINC)"""""""" is to improve upon the treat and retain dimensions of the """"""""seek, test, treat, and retain"""""""" paradigm in Eastern Europe. We will implement and assess a behavioral and structural intervention in Russia designed to support and motivate HIV-infected narcology heroin dependent patients (i.e., IDUs) to engage (i.e., initiate and retain) in HIV medical care and ultimately improve their HIV outcomes. LINC is a clinical model designed to coordinate narcology and HIV systems of care using elements shown to facilitate engagement in medical care: HIV case management and nurse home visits. The central hypothesis is that an intervention that involves coordination between the narcology and HIV systems via a) HIV case management delivered by a peer to help motivate and reduce barriers to HIV care, b) enhanced outpatient narcology treatment by addiction nurses and c) communication between these providers will lead to engagement in HIV care. Implementation research recognizes that effective interventions may not translate successfully across different contexts and systems. Hence, we will assess the organizational and operational issues that drive engagement in HIV care in Russia as well as a comparable setting in another former Soviet Union country, Ukraine. The project will be undertaken by an international research team experienced in addressing HIV, substance use, and clinical interventions in Russia. This proposal's Specific Aims are to assess the effectiveness of the LINC intervention compared to standard of care on 4 distinct outcomes:1) initiation of HIV care (>1 visit to HIV medical care) within 6 months of enrollment;2) retention in HIV care (>1 visit to medical care in 2 consecutive 6 month periods) within 12 months;3) appropriate HIV care (prescribed ART if CD4 cell count is <350 or having a second CD4 count if CD4 >350 within 12 months;and 4) improved HIV health outcomes (CD4 cell count at 12 months). The final Specific Aim is to establish the contextual factors that influence adoption and sustainability of the LINC intervention in Russia and another Eastern European country. If LINC can embed effectively within Eastern European medical systems, then it has the potential to be widely implemented in this region of the world and have a major impact on the HIV epidemic among IDUs.

Public Health Relevance

The LINC study will test an intervention to coordinate care between the addiction (i.e., narcology) and HIV/AIDS treatment systems in Russia and establish the contextual factors that might influence its adoption and sustainability in Eastern Europe. The LINC intervention is designed to support and motivate HIV-infected heroin dependent narcology patients (i.e., IDUs) to engage (i.e., initiate and retain) in HIV medical care to improve HIV outcomes. If effective, its impact would be substantial as the intervention has the potential to be widely implemented in this region with an IDU-driven HIV epidemic, reducing HIV/AIDS spread and complications.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA032082-04
Application #
8653953
Study Section
Special Emphasis Panel (ZDA1)
Program Officer
Jones, Dionne
Project Start
2011-07-15
Project End
2016-04-30
Budget Start
2014-05-01
Budget End
2015-04-30
Support Year
4
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Boston Medical Center
Department
Type
DUNS #
City
Boston
State
MA
Country
United States
Zip Code
02118
West, Brooke S; Cheng, Debbie M; Toussova, Olga et al. (2018) Contraceptive Use Among HIV-Infected Females with History of Injection Drug Use in St. Petersburg, Russia. AIDS Behav 22:1787-1791
Lasser, Karen E; Lunze, Karsten; Cheng, Debbie M et al. (2018) Depression and smoking characteristics among HIV-positive smokers in Russia: A cross-sectional study. PLoS One 13:e0189207
Chandler, Redonna; Gordon, Michael S; Kruszka, Bridget et al. (2017) Cohort profile: seek, test, treat and retain United States criminal justice cohort. Subst Abuse Treat Prev Policy 12:24
Nance, Robin M; Delaney, J A Chris; Golin, Carol E et al. (2017) Co-calibration of two self-reported measures of adherence to antiretroviral therapy. AIDS Care 29:464-468
Walley, Alexander Y; Cheng, Debbie M; Quinn, Emily K et al. (2017) Fatal and non-fatal overdose after narcology hospital discharge among Russians living with HIV/AIDS who inject drugs. Int J Drug Policy 39:114-120
Kiriazova, Tetiana; Lunze, Karsten; Raj, Anita et al. (2017) ""It is easier for me to shoot up"": stigma, abandonment, and why HIV-positive drug users in Russia fail to link to HIV care. AIDS Care 29:559-563
Idrisov, Bulat; Lunze, Karsten; Cheng, Debbie M et al. (2017) Role of substance use in HIV care cascade outcomes among people who inject drugs in Russia. Addict Sci Clin Pract 12:30
Tsui, Judith I; Ko, Stephen C; Krupitsky, Evgeny et al. (2016) Insights on the Russian HCV Care Cascade: Minimal HCV Treatment for HIV/HCV Co-infected PWID in St. Petersburg. Hepatol Med Policy 1:
Gnatienko, Natalia; Han, Steve C; Krupitsky, Evgeny et al. (2016) Linking Infectious and Narcology Care (LINC) in Russia: design, intervention and implementation protocol. Addict Sci Clin Pract 11:10
Beletsky, Leo; Rich, Josiah D; Walley, Alexander Y (2012) Prevention of fatal opioid overdose. JAMA 308:1863-4