Linking Infectious and Narcology Care in Russia
Condition: HIV Infection; Drug Use
MeSH terms: HIV Infections
Study type: Interventional

Summary: 
      The purpose of this study is to implement and assess a behavioral and structural intervention
      in Russia designed to support and motivate HIV-infected narcology heroin dependent patients
      (i.e., IDUs) to engage (i.e., initiate and retain) in HIV medical care and ultimately improve
      their HIV outcomes. The central hypothesis is that an intervention that involves coordination
      between the narcology and HIV systems via HIV case management delivered by a peer to help
      motivate and reduce barriers to HIV care will lead to engagement in HIV care.
    

Detailed description: 
      The objective of this study "Linking Infectious and Narcology Care (LINC)" is to improve upon
      the treat and retain dimensions of the "seek, test, treat, and retain" paradigm in Eastern
      Europe. We will implement and assess a behavioral and structural intervention in Russia
      designed to support and motivate HIV-infected narcology heroin dependent patients (i.e.,
      IDUs) to engage (i.e., initiate and retain) in HIV medical care and ultimately improve their
      HIV outcomes.

      LINC is a clinical model designed to coordinate narcology and HIV systems of care using
      elements shown to facilitate engagement in medical care: HIV case management and
      point-of-care CD4 testing. The central hypothesis is that an intervention that involves
      coordination between the narcology and HIV systems via HIV case management delivered by a
      peer to help motivate and reduce barriers to HIV care will lead to engagement in HIV care.

      Implementation research recognizes that effective interventions may not translate
      successfully across different contexts and systems. Hence, we will assess the organizational
      and operational issues that drive engagement in HIV care in Russia.

      The project will be undertaken by an international research team experienced in addressing
      HIV, substance use, and clinical interventions in Russia. This proposal's Specific Aims are
      to assess the effectiveness of the LINC intervention compared to standard of care on 4
      distinct outcomes: 1) initiation of HIV care (> 1 visit to HIV medical care) within 6 months
      of enrollment; 2) retention in HIV care (> 1 visit to medical care in 2 consecutive 6 month
      periods) within 12 months; 3) appropriate HIV care (prescribed ART if CD4 cell count is <350
      or having a second CD4 count if CD4 ≥350 within 12 months; and 4) improved HIV health
      outcomes (CD4 cell count at 12 months). The final Specific Aim is to establish the contextual
      factors that influence adoption and sustainability of the LINC intervention in Russia. If
      LINC can embed effectively within Eastern European medical systems, then it has the potential
      to be widely implemented in this region of the world and have a major impact on the HIV
      epidemic among IDUs.
    

Intervention name(s): LINC Case Management
Intervention type(s): Behavioral
Intervention description(s): The 1st case management (CM) session will be at the Narcology Hospital and will follow a modified strengths-based case management curriculum. As part of this first session, the CM will show a 10 minute video clip produced by a Russian NGO of HIV-infected patients talking about accessing HIV care. The CM will also tell the patient what his/her CD4 cell count is and discuss what it means with the patient. The case manager will help the client identify the outpatient HIV clinic on a map and will discuss basic drug harm reduction ideas with the client. The remaining 4 CM sessions will happen over the following 6 months. Sessions may happen at the HIV clinic, NGOs, or in the community. The HIV CM helps the client understand the importance of HIV care, identify barriers to care acquisition and recognize one's own strengths, abilities and assets to reduce self-identified barriers to care. The HIV CM's primary aim is to have the client attend an appointment at the HIV outpatient clinic.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: HIV; drug addiction; Russia; case management