A novel, bottom-up approach to promote evidence-based HIV prevention for people who inject drugs in Ukraine: protocol for the MICT (‘Bridge’) HIV prevention exchange project

Owczarzak, Jill; Filippova, Olga; Phillips, Sarah D.

doi:10.1186/1748-5908-9-18

Cited by 6 publications

(4 citation statements)

References 65 publications

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“…Our paper draws on data collected during a five-year HIV prevention project that included site visits, in-depth interviews, structured interviews, focus groups and conversations with staff from eight HIV-focused NGOs in the central, southern and eastern regions of Ukraine, areas with the highest HIV rates and epidemics concentrated among people who inject drugs (PWID). Agencies were recruited as part of a larger study investigating the ability of NGOs to develop and implement behaviour change HIV prevention interventions (Owczarzak, Filippova, and Phillips 2014; Owczarzak et al 2016). We announced the study to HIV prevention organisations throughout Ukraine and invited interested agencies to complete an application.…”

Section: Methodsmentioning

confidence: 99%

“…In September 2014, members of a US and Ukraine-based research team and eight representatives from Ukrainian HIV prevention agencies met in Vilnius, Lithuania to finalise a survey to assess the effectiveness of HIV prevention programmes developed by the agencies (Owczarzak, Filippova, and Phillips 2014; Owczarzak et al 2016). Because one of the agencies planned to work with female clients exclusively and the others planned to include women in their work, we needed survey questions that captured the unique risks women face related to drug and condom use with sex partners.…”

Section: Introductionmentioning

confidence: 99%

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‘Pure’ drug users, commercial sex workers and ‘ordinary girls’: gendered narratives of HIV risk and prevention in post-Soviet Ukraine

Owczarzak

Phillips

Cho

2018

Culture, Health & Sexuality

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International best practices call for a gender-responsive approach to HIV prevention for women, including those who use drugs and those who engage in sex work. This paper draws on multiple qualitative data sources collected over five years in Ukraine to explore the notions of gender, women and family that buttress HIV-related programmes for women. Our analysis reveals that service providers often cast women as hapless victims of unfortunate family circumstances and troubled personal relationships that produce sudden poverty, or social strivers who seek access to wealth and privilege at the expense of their health. Women are portrayed as most vulnerable to HIV when they lack a male 'protector'. We argue that the programmes constituted around these stereotypes of women and their vulnerabilities reflect new forms of institutional power that deflect attention away from gendered socio-economic processes that contribute to women's HIV vulnerability, including job insecurity and unemployment, workplace discrimination, unreliable social benefits and power imbalances within their relationships. We explore how to transform HIV prevention efforts to better address the causes of women's increased vulnerability to HIV in Ukraine and in Eastern Europe more generally.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

‘Pure’ drug users, commercial sex workers and ‘ordinary girls’: gendered narratives of HIV risk and prevention in post-Soviet Ukraine

Owczarzak

Phillips

Cho

2018

Culture, Health & Sexuality

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“…As described in detail elsewhere (Owczarzak et al, 2016(Owczarzak et al, , 2014, in Phase I of the project we trained service providers from eight nongovernmental organizations (NGOs) that work in HIV prevention from regions with the highest rates of HIV and epidemics concentrated among PWID, to develop interventions based on a "common factors" approach that also reflected their local HIV and drug use contexts, organizational resources, and clients. All study agencies worked in urban areas from a harm reduction perspective and provided a range of services that included HIV and hepatitis C testing, psychosocial support, case management, and community centers.…”

Section: Study Sitesmentioning

confidence: 99%

Outcome evaluation of a “common factors” approach to develop culturally tailored HIV prevention interventions for people who inject drugs

Owczarzak

Nguyen

Mazhnaya

et al. 2019

Drug and Alcohol Dependence

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Background: Current models of HIV prevention intervention dissemination involve packaging interventions developed in one context and training providers to implement that specific intervention with fidelity. Providers rarely implement these programs with fidelity due to perceived incompatibility, resource constraints, and preference for locally-generated solutions. Moreover, such interventions may not reflect local drug markets and drug use practices that contribute to HIV risk. Purpose: This paper examines whether provider-developed interventions based on common factors of effective, evidence-based behavioral interventions led to reduction in drug-related HIV risk behaviors at four study sites in Ukraine. Methods: We trained staff from eight nongovernmental organizations (NGOs) to develop HIV prevention interventions based on a common factors approach. We then selected four NGOs to participate in an outcome evaluation. Each NGO conducted its intervention for at least N=130 participants, with baseline and 3-month follow-up assessments. Results: At three sites, we observed reductions in the prevalence of both any risk in drug acquisition and any risk in drug injection. At the fourth site, prevalence of any risk in drug injection decreased substantially, but the prevalence of any risk in drug acquisition essentially stayed unchanged. Conclusions: The common factors approach has some evidence of efficacy in implementation, but further research is needed to assess its effectiveness in reducing HIV risk behaviors and transmission. Behavioral interventions to reduce HIV risk developed using the common factors approach could become an important part of the HIV response in low resource settings where capacity building remains a high priority.

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“…Increasingly, implementation science (IS) is being used to aid in the planning and successful delivery of complex evidence-based interventions and their adoption among PWID in the US and abroad. Prior MOUD and harm reduction research has examined implementation facilitators and barriers within the organizational healthcare and social service systems [24][25][26][27][28][29][30][31][32], workforce capacity [33], financing, and policy contexts [34,35]. In the context of HIV and substance use, IS frameworks and methods have been leveraged in the US to articulate organization and patient perspectives of harm reduction interventions for PWID with HIV [36], improve the success of HIV prevention interventions by accounting for the unique injection contexts on HIV risk behaviors among PWID [37], and help to expand harm reduction interventions via pharmacy services directed to PWID [38].…”

Section: Introductionmentioning

confidence: 99%

A data-driven approach to implementing the HPTN 094 complex intervention INTEGRA in local communities

Smith,

Perez-Brumer,

Nicholls

et al. 2024

Implementation Sci

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Background HIV burden in the US among people who inject drugs (PWID) is driven by overlapping syndemic factors such as co-occurring health needs and environmental factors that synergize to produce worse health outcomes among PWID. This includes stigma, poverty, and limited healthcare access (e.g. medication to treat/prevent HIV and for opioid use disorder [MOUD]). Health services to address these complex needs, when they exist, are rarely located in proximity to each other or to the PWID who need them. Given the shifting drug use landscapes and geographic heterogeneity in the US, we evaluate a data-driven approach to guide the delivery of such services to PWID in local communities. Methods We used a hybrid, type I, embedded, mixed method, data-driven approach to identify and characterize viable implementation neighborhoods for the HPTN 094 complex intervention, delivering integrated MOUD and HIV treatment/prevention through a mobile unit to PWID across five US cities. Applying the PRISM framework, we triangulated geographic and observational pre-implementation phase data (epidemiological overdose and HIV surveillance data) with two years of implementation phase data (weekly ecological assessments, study protocol meetings) to characterize environmental factors that affected the viability of implementation neighborhoods over time and across diverse settings. Results Neighborhood-level drug use and geographic diversity alongside shifting socio-political factors (policing, surveillance, gentrification) differentially affected the utility of epidemiological data in identifying viable implementation neighborhoods across sites. In sites where PWID are more geographically dispersed, proximity to structural factors such as public transportation and spaces where PWID reside played a role in determining suitable implementation sites. The utility of leveraging additional data from local overdose and housing response systems to identify viable implementation neighborhoods was mixed. Conclusions Our findings suggest that data-driven approaches provide a contextually relevant pragmatic strategy to guide the real-time implementation of integrated care models to better meet the needs of PWID and help inform the scale-up of such complex interventions. This work highlights the utility of implementation science methods that attend to the impact of local community environmental factors on the implementation of complex interventions to PWID across diverse drug use, sociopolitical, and geographic landscapes in the US. Trial registration ClincalTrials.gov, Registration Number: NCT04804072. Registered 18 February 2021.

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A novel, bottom-up approach to promote evidence-based HIV prevention for people who inject drugs in Ukraine: protocol for the MICT (‘Bridge’) HIV prevention exchange project

Cited by 6 publications

References 65 publications

‘Pure’ drug users, commercial sex workers and ‘ordinary girls’: gendered narratives of HIV risk and prevention in post-Soviet Ukraine

‘Pure’ drug users, commercial sex workers and ‘ordinary girls’: gendered narratives of HIV risk and prevention in post-Soviet Ukraine

Outcome evaluation of a “common factors” approach to develop culturally tailored HIV prevention interventions for people who inject drugs

A data-driven approach to implementing the HPTN 094 complex intervention INTEGRA in local communities

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