Advancing An Evidence-Based, Integrated HIV and Overdose Prevention Intervention for Injecting Drug-Involved Couples in Kazakhstan

BACKGROUND & PURPOSE: The widespread patterns of drug-related and sexual risk behaviors and the sharply rising rates of HIV and sexually transmitted infections among injecting drug users (IDUs) and their sexual partners in Kazakhstan all underscore the need for effective behavioral interventions. Moreover, opiate overdose has been reported as the most frequent cause of death among IDUs in Kazakhstan, highlighting the need for HIV interventions to address overdose prevention. Training IDUs to use prescription Naloxone to reverse overdose has been established as an effective intervention in several countries. The aim of Project Renaissance is to advance an evidence-based intervention that integrates HIV prevention and Naloxone-based opiate overdose prevention for injecting drug-involved heterosexual couples. This presentation will describe the process of advancing this evidence-based intervention from adapting and pilot-testing a couples-based prevention intervention in a Stage 1 developmental study to rigorously testing the efficacy of the intervention in a Stage 2 randomized controlled trial (RCT).

METHODS: Project Renaissance began with a pilot study to adapt and test the feasibility, safety and preliminary effects of a couple-based HIV prevention intervention for IDUS in Shu, Kazakhstan. Of the 40 IDU couples enrolled in a pilot RCT, 20 couples were randomized to a 4 -session Couple-Based HIV/STI Risk Reduction intervention (CHSR), and 20 couples were randomized to a 4-session Wellness Promotion comparison condition (WP). Outcomes were assessed at 3-month follow-up with a 95% retention rate.

RESULTS: Compared to WP participants, CHSR participants were significantly more likely to report a higher proportion of condom use during vaginal sex and fewer number of acts of unprotected vaginal sex, lower number and proportion of injection acts in which syringes were shared and fewer people with whom participant shared needles from baseline to 3-month follow-up. No adverse events were detected. However, within a year after completing the intervention 4 participants died from overdose.

CONCLUSION & IMPLICATIONS: This pilot trial demonstrated the feasibility and safety of the CHSR and showed preliminary effects of the CHSR in reducing both drug-related and sexual HIV risks among this sample of IDUs in Kazakhstan, but underscored the need for opiate prevention. Building on the results of this pilot trial, Project Renaissance formed a community advisory board of key stakeholders from NGOs, Ministry of Health, local and international NGOs to advance integrated OD/HIV prevention strategies with IDUs in Almaty, Kazakhstan. Project Renaissance also obtained funding from NIDA to test the efficacy of an integrated 5-session HIV/STI risk reduction and overdose management intervention in a Stage 2 efficacy RCT with 400 injecting drug-involved couples in Almaty, Kazakhstan. Project Renaissance in collaboration with the Republican AIDS Center of Kazakhstan is pilot testing a Naloxone distribution program among participants enrolled in this RCT. Since enrollment began for this trial in May 2009, 21 participants have reported that they successfully used Naloxone to reverse an opiate overdose. Based on the initial success of this pilot distribution, the community advisory board for Project Renaissance is advancing efforts to scale up Naloxone distribution with IDUs in Kazakhstan.