Dushanbe

Central Asia is experiencing the fastest-growing HIV epidemic globally, mainly affecting people who inject drugs and their sexual partners. The trial focuses on expanding opioid agonist therapies (OAT) in Kazakhstan, Kyrgyzstan, and Tajikistan, using the Network for the Improvement of Addiction Treatment (NIATx) strategy guided by the Exploration-Planning-Implementation-Sustainment (EPIS) framework. This approach aims to overcome barriers in healthcare delivery systems and improve prevention and treatment of HIV and opioid use disorder in the region. The study involves training Chief Narcologists and other professionals in OAT delivery through NIATx tools and quality improvement techniques. This includes a 2-3 day training for coaches and ongoing support from a US-based super coach. Participants will identify targets for improving OAT entry and retention using Plan-Do-Study-Act cycles and collaborative learning. The program will adapt to local cultural and healthcare contexts to promote sustainable OAT scale-up. Participants will be assessed through surveys, focus groups, and organizational evaluations involving people who inject drugs and OAT delivery staff. Researchers will measure OAT coverage and retention over 36 months to understand implementation trajectories and program effectiveness. Stakeholder meetings will inform policy changes to support sustainable OAT integration into primary and HIV care settings, aiming to reduce new HIV infections and improve treatment outcomes.

Researchers are studying barriers to expanding Opioid Agonist Therapy (OAT) within justice systems, specifically prisons and probation sites in Tajikistan, Kyrgyzstan, Moldova, and Georgia. The goal is to improve access to OAT for people who inject drugs (PWID) and reduce HIV transmission. This project uses a collaborative learning model called NIATx to support OAT scale-up, with data analyzed using specialized growth analyses. The study involves creating NIATx learning collaboratives with prison OAT providers, including addiction care specialists and primary care doctors, and with probation and prison officers across the four countries. Data on OAT scale-up is collected from national databases every six months, along with surveys of prison narcologists and probation officers. Researchers also use ethnographic methods like observation and interviews with probation clients and staff to understand challenges and opportunities. Participants in this research complete surveys and may take part in focus groups. The study collects data over several years, measuring how many participants receive OAT during this time. Surveys are repeated every six months to track progress. The study also monitors implementation and gathers qualitative insights from staff and clients to support ongoing improvement of OAT programs within justice settings.