About this trial
Central Asia (CA) represents the most rapidly growing HIV epidemic region worldwide, concentrated in people who inject drugs (PWID) and their sexual partners, and scaling up opioid agonist therapies (OAT) in this region is the most cost-effective strategy to prevent new HIV infections, and more effective when combined with antiretroviral therapy (ART). The investigators propose to use the Network for the Improvement of Addiction Treatment (NIATx) implementation strategy to scale-up OAT in three diverse Central Asian countries (Kazakhstan, Kyrgyzstan, Tajikistan) and guided by the Exploration-Planning-Implementation-Sustainment (EPIS) framework. Understanding the trajectories of implementation and scale-up in this context may emerge through creating communities of practice, especially when cohesion and competence evolves, and may guide other healthcare delivery challenges in the region (e.g., HIV, TB); as well as build important regional expertise and understanding implementation trajectories should help support OAT program sustainability.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Quantitative surveys for PWID
18 years or older
Meeting DSM-V criteria for opioid dependence
Be either treatment naïve and seeking OAT or be on OAT for < 90 days
Disqualifiers
Not willing to provide consent
Trial design
Single group
Treatments tested in this trial
NIATx
BehavioralFor each country, the learning collaborative will be comprised of a Chief Narcologist from each region where the investigators will initially train them and the coaches using all the tools from the NIATx Academy (2-3-day training). The national coach for each country will receive ongoing and in-depth coaching from a US-based super coach. A nationwide Nominal Group Technique (NGT) will be conducted to assess barriers and potential targets to guide decision-making about changes. At the end of the initial meeting, each Chief Narcologist (CN) will be able to identify a change target for Plan, Do, Study, Act (PDSA) (entry, retention) and create a Change Project Form to state what will be done (e.g. flowcharting), who is involved (team), what are the measures and timeframe (\<4 weeks).
Treatment groups
Trial outcomes
Primary outcomes
OAT Census
Absolute number of patients on OAT per country
OAT Census per Oblast
Absolute number of patients on OAT per oblast
Secondary outcomes
New Patients
Total number of newly enrolled patients into OAT services, per country
New Patients per Oblast
Total number of newly enrolled patients into OAT services, per oblast
Dropout
Total number of patients dropping out of OAT services, per country
Dropout per Oblast
Total number of patients dropping out of OAT services, per oblast
Sponsors and contacts
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Yale University
Lead sponsor
Den Sooluk Nuru
Collaborator
Institute for International Health and Education
Collaborator
Global Health Research Center of Central Asia
Collaborator
National Institute on Drug Abuse (NIDA)
Collaborator