Improving HIV service delivery for people who inject drugs in Kazakhstan: study protocol for the Bridge stepped-wedge trial

Tara Mccrimmon,Baurzhan Baiserkin,Daniel J Feaster,Timothy Hunt,Lisa R Metsch,Assel Terlikbayeva,Nabila El-Bassel,Elwin Wu,Louisa Gilbert,Meruyert Darisheva,Anindita Dasgupta,Sholpan Primbetova,Alissa Davis,Azamat Kuskulov,Bruce R Schackman

doi:10.1186/s13012-019-0909-z

Abstract

BackgroundPeople who inject drugs (PWID) in Kazakhstan face many barriers to HIV testing as well as to accessing HIV care, to retention in HIV care, and to initiating and adhering to anti-retroviral treatment (ART). Needle and syringe programs (NSPs) are an opportune setting for integrated interventions to link PWID to HIV care.MethodsThis Hybrid Type II study employs a stepped-wedge design to evaluate both effectiveness and implementation outcomes of Bridge, an intervention to identify, test, and link HIV-positive PWID to HIV care. The study is conducted at 24 NSPs in three different regions of Kazakhstan, to assess outcomes on the individual, organizational, and policy levels.DiscussionThis trial responds to an identified need for new models of HIV service delivery for PWID through harm reduction settings.Trial registrationNCT02796027 on June 10, 2016.

Highlights

People who inject drugs (PWID) in Kazakhstan face many barriers to HIV testing as well as to accessing HIV care, to retention in HIV care, and to initiating and adhering to anti-retroviral treatment (ART)
The design of Bridge responds to calls for differentiated approaches to HIV care and integration of services into harm reduction programs, with implementation strategies tailored to challenges faced by regional Needle and syringe program (NSP)
This paper describes the protocols for an implementation study to identify hard-to-reach and stigmatized populations of PWID, test them for HIV, and link them to HIV care, all of which is implemented at existing NSPs in Kazakhstan

Summary

Background

Injection drug use remains a large contributor to the HIV epidemic in Kazakhstan, a country with an estimated 127,800 people who inject drugs (PWID) [1]. Additional organizational challenges include a lack of evidence-based methods for recruiting new clients and a lack of coordination of care linking NSPs to the AIDS Center and other services Despite these challenges, Kazakhstan’s NSPs, with community-based locations, outreach staff with strong connections to PWID communities, and ready access to primary care clinics and NGO services, may be an optimal setting to close the gaps in the HIV care continuum for PWID. Despite these proven successes, integrated programs are underused because of a lack of resources, staff training, and client motivation, and implementation of this strategy remains limited both globally and in Kazakhstan [20, 29] This highlights the need for interventions that strengthen the capacity of Kazakhstan’s NSPs to recruit and test at-risk PWID for HIV, and strengthen their protocols to link or re-link HIV-positive PWID to care. The design of Bridge responds to calls for differentiated approaches to HIV care and integration of services into harm reduction programs, with implementation strategies tailored to challenges faced by regional NSPs

Methods

Findings

Discussion