Dushanbe

Central Asia is experiencing the fastest growing HIV epidemic globally, mainly affecting people who inject drugs PWID and their sexual partners. This research focuses on expanding opioid agonist therapies OAT in Kazakhstan, Kyrgyzstan, and Tajikistan, as scaling up OAT combined with antiretroviral therapy ART is considered the most cost-effective way to prevent new HIV infections. The study uses the NIATx implementation strategy guided by the Exploration-Planning-Implementation-Sustainment EPIS framework to understand and improve OAT delivery in this challenging healthcare context. The study involves training and coaching national experts and Chief Narcologists in these countries using NIATx tools and quality improvement techniques. This includes initial training sessions, ongoing coaching, and collaborative learning to overcome barriers and improve OAT entry and retention. The researchers will also conduct formative research to assess facilitators and barriers at client, program, and structural levels, aiming to create sustainable and locally adapted OAT models integrated with primary and HIV care. Participants include PWID meeting opioid dependence criteria, OAT delivery staff, and Chief Narcologists involved in OAT programs. Assessments include surveys, organizational evaluations, and focus groups, with ongoing monitoring of OAT census, new patient numbers, and dropout rates over 36 months. Stakeholder meetings will help guide implementation and policy changes to support sustainability. The total study duration includes long-term follow-up to assess implementation trajectories and outcomes.

Researchers are investigating how to increase the use of Opioid Agonist Therapy OAT in justice systems such as prisons and probation in Tajikistan, Kyrgyzstan, Moldova, and Georgia. The study aims to identify barriers to expanding OAT, which is used to help prevent HIV in people who inject drugs PWID. This project includes establishing a NIATx learning collaborative to support the scale-up of OAT and analyzing its growth using advanced data methods. The study involves two main parts Aim 1 focuses on creating NIATx learning collaboratives with prison OAT providers, including addiction specialists and primary care doctors. Data on OAT scale-up will be collected every six months from each countrys national OAT database, alongside surveys completed by prison narcologists. Aim 2 develops similar collaboratives with probation and prison officers, collecting data from national databases and surveying probation officers every six months. Researchers will also use observation and interviews for deeper understanding. Participants include prison OAT providers, probation officers, and people currently in probation who inject opioids. Data collection includes surveys, focus groups, and ethnographic observations over up to four years. The primary outcome is the number of participants receiving OAT, while secondary outcomes assess adherence to the NIATx protocol. The study is non-randomized and open-label, running from late 2024 through 2028 to evaluate how best to expand OAT services in these justice settings.