Reducing Stigma to Lower HIV Risk in People Who Inject Drugs

AI summary

From the trial's eligibility criteria. Machine-read from the registry text on this page, so it can be wrong. The registry text below and the trial team decide who can take part.

The trial is looking for adults in Bishkek who inject drugs or use drugs with someone who injects, and are HIV-negative. Staff at two methadone clinics can also join.

Age

18 years or older

Sex

All sexes can join

Disease stage

People who inject drugs or use drugs with someone who injects, and who currently use illicit drugs (salts, synthetics, pharmaceuticals or opioids). Clinic staff of any role at the two methadone sites.

Biomarker or test result

A rapid HIV test at the start must show HIV-negative status (for people who use drugs).

Main reasons for not taking part

• Started injecting drugs in the past 6 months
• Not currently using illicit drugs
• Lives outside the two eligible districts
• Plans to move away from Bishkek in the next 18 months
• Does not agree to all study sessions and surveys

The registry criteria, word for word

What the trial wants to find out

The purpose of this study is to reduce HIV transmission risk among people who inject drugs (PWID) through a multilevel intervention known as LIFT. LIFT intervenes to build intragroup PWID support at the community-level to reduce overall drug use and stigma. LIFT also increases efficacy in navigating HIV services in the presence of structural stigma. Additionally, LIFT intervenes on abstinence-based drug use stigma at the health facility-level to improve clinic policy and staff interactions with clients.

The 4 groups in the trial

• LIFT Intervention for People Who Use DrugsTreatment being tested

  LIFT intervention will include 5 peer-led participatory group sessions to reduce stigma and cultivate intragroup cohesion and support to increase HIV prevention efficacy. The intervention content will focus on 1) Naming the Problem (how intersectional stigma manifests and affects health outcomes), challenging myths that drive intersectional stigma and replacing myths with facts related to 2) Fears about drug use and internalized stigma (understanding drug dependence as a health condition), 3) Fears about MMT (understanding methadone treatment as a process, not a last resort), 4) Frears about HIV (understanding the health benefits of knowing ones HIV status and PrEP as a treatment to prevent HIV), and 5) Responding to intersectional stigma (challenging stigma and recognizing human rights and other protections for people who use drugs).

  Treatment: LIFT for People Who Use Drugs

• Waitlist Control for People Who Use DrugsExisting treatment, for comparison

  In the control district, all evidence-based HIV services will be delivered as standard of care. PWID living in the control district will have access to SSP outreach services, and MMT care can be accessed at the clinic located in the control district. Outreach workers and MMT clinic staff will not take additional steps to promote HIV testing or PrEP care referrals outside the clinic's standard practice. Once the active intervention phase is complete and the LIFT intervention group completes all study activities, PWID in the control district will be invited to participate in the same LIFT intervention activities described in the intervention arm.

  Treatment: LIFT for People Who Use Drugs

• LIFT Intervention for MMT StaffTreatment being tested

  The LIFT intervention will be comprised of 2-day participatory trainings focused on reducing the drivers of stigma within healthcare settings and will cover the following topics: 1) Building awareness and knowledge of what drug use stigma looks like in maintenance vs. abstinence-focused MMT services, 2) Reducing HIV transmission and promoting healthier options with clients via PrEP and SSP health promotion service referrals, 3) Building stress management, empathy, and reducing social distancing in the clinic setting, and 4) Understanding institutional maintenance of stigma reduction practices and focusing on developing internal clinic policies and practices.

  Treatment: LIFT for MMT Providers

• Waitlist Control for MMT StaffExisting treatment, for comparison

  In the control district, all evidence-based HIV services will be delivered as standard of care. The MMT clinic in the control district will still provide MMT care and SSP outreach services can be accessed at the clinic located in the intervention district. Outreach workers and MMT clinic staff will not take additional steps to promote HIV testing or PrEP care referrals outside the clinic's standard practice. Once the active intervention phase is complete and the LIFT intervention group completes all study activities, MMT providers in the control district will be invited to participate in the same LIFT intervention activities described in the intervention arm.

  Treatment: LIFT for MMT Providers