UNI_

    UNI project – Increasing Involvement of MSM in the Continuum of Care in Kazakhstan (2016 – 2021)

    Funding: National Institute of Drug Abuse (NIDA)

    Grant amount: 3’431’964 USD

    The project goal: The study aimed to test the efficacy of a social network-based HIV intervention designed to increase the number of MSM who use drugs in Kazakhstan and engage them in the continuum of care.

    Project Description: The study involved a phased clinical trial in Almaty, Shymkent and Astana involving MSM who use drugs. As part of the intervention, MSM served as experts and used social networking processes to increase their engagement in the HIV treatment continuum. The study included 629 people, of whom 254 reported having had an HIV test in the past 6 months.

    The project results: The results of this clinical trial confirm that the PRIDE in HIV Care program is an effective behavioral intervention that can increase HIV testing rates among MSM in Kazakhstan, as well as encourage behavior change among people who have never received direct intervention.

    Publications:

    • Earlier Sexual Debut and Anti-Gay Victimization Among Men Who Have Sex With Men (MSM) in Kazakhstan (https://pubmed.ncbi.nlm.nih.gov/37272025/);
    • Compounding vulnerabilities: victimization and discrimination is associated with COVID-19 disruptions to HIV-related care among gay, bisexual, and other men and transgender and nonbinary people who have sex with men in Kazakhstan (https://pubmed.ncbi.nlm.nih.gov/36628449/);
    • HIV Stigma, Homophobia, Sexual and Gender Minority Community Connectedness and HIV Testing Among Gay, Bisexual, and Other Men and Transgender People Who Have Sex with Men in Kazakhstan  (https://pubmed.ncbi.nlm.nih.gov/33743115/);
    • Polydrug Use, Sexual Risk, and HIV Testing Among Cisgender Gay, Bisexual, and Other Men and Transgender and Nonbinary Individuals Who Have Sex With Men in Kazakhstan (https://pubmed.ncbi.nlm.nih.gov/36181500/).
    • Reeder KG, Lee YG, Sung J, Vinogradov V, Zhakupova G, Mergenova G, Davis A, Paine EA, Primbetova S, Terlikbayeva A, Kali S, Hunt T, Wu E. Trans Health is Public Health: The Prevalence of HIV Among Trans and Gender Expansive People in Kazakhstan. Res Sq [Preprint]. 2024 Sep 24:rs.3.rs-5124958. doi: 10.21203/rs.3.rs-5124958/v1. PMID: 39399678; PMCID: PMC11469378.
    • Laughney, C. I., Lee, Y. G., Mergenova, G., Vinogradov, V., Zhakupova, G., Paine, E. A., … & Wu, E. (2023). Earlier Sexual Debut as a Risk Factor for Substance Use Among Men Who Have Sex with Men (MSM) in Kazakhstan. Global Social Welfare, 1-8.
    • Laughney CI, Lee YG, Mergenova G, Vinogradov V, Zhakupova G, Paine EA, Primbetova S, Terlikbayeva A, Wu E. Earlier Sexual Debut and Exchange Sex among Men Who Have Sex with Men (MSM) in Kazakhstan. J Sex Res. 2023 Jul;60(6):919-924. doi: 10.1080/00224499.2023.2167064. Epub 2023 Jan 19. PMID: 36657067; PMCID: PMC10354213.
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    UNI eng

    UNI Project – At risk men’s involvement in HIV treatment continuum in the Republic of Kazakhstan (2017 – 2021)

    Kazakhstan has a significant need for renewed and innovative HIV prevention and treatment efforts. Kazakhstan is one of the only nine countries that saw >25% increase in HIV incidence in the first decade of this century. Besides, AIDS-related mortality has actually increased 21% between 2005-2011 in Central Asia.

    Several lines of evidence point to the value and urgent need for research on at-risk men who in Kazakhstan. Men who have sex with men (MSM) are one of the key at-risk populations that bear the disproportionate brunt of the pandemic. Likewise, drug use and drug injecting are the major factors in HIV infection transmission in Kazakhstan. The UNI project seeks to engage at-risk men who use drugs to get tested for HIV and subsequently link to friendly care and treatment services.

    The proposed study includes step-by-step clinical trial (intervention) in 4 cities of Kazakhstan involving 1,000-1,400 at-risk men. Intervention training program will be delivered for at-risk men on the issues of becoming experts and promoters of other at-risk men’s engagement in HIV testing, treatment and care through social networks.

    Study goals:

    1. Deliver and test/evaluate an intervention that will increase the number of at-risk men engaged in the HIV care continuum. This intervention will help Kazakhstan meet the UNAIDS strategy of “90-90-90” by:

      • Increasing the number of at-risk menwho get tested, and hence, detecting those who are HIV-infected (“living with HIV”)
      • Increasing the number of at risk men living with HIV on antiretroviral treatment
      • Increasing the number of at risk men living with HIV who achieve viral suppression

    2. The detection and “treatment as prevention” will reduce the overall incidence and prevalence of HIV among a key population in Kazakhstan
    3. Develop and evaluate resources, infrastructure, and procedures needed for intervention implementation and scale-up

    Innovative approach

    1. 4 weekly group sessions where participants are trained to become “peer health promoters”
    2. Disseminate/diffuse HIV and health literacy, as well as information on accessing services at AIDS centers
    3. Trained to become highly effective in reaching at-risk men both face-to-face  and via social media
    4. Designed to enhance an evidence-based intervention to have a “multiplier effect.” The impact is multiplied because:

      • Reaches individual at-risk men plus their larger social networks of hidden and at-risk men
      • Offering STI testing is not only an incentive for at-risk men participation, but has a preventive effect because treatment of STIs is known to reduce HIV transmission
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    Aegida

    Aegida Project – “Assessment of the intervention to develop HIV self-testing skills and reduce stigma among women at risk in Kazakhstan” (2021 – 2023)

    This project Aegida, funded by the U.S. National Institute on Drug Abuse (NIDA), is a pilot randomized control trial (RCT) of women engaged in commercial sex work and drug use in Kazakhstan. The project’s goal is to increase regular HIV testing, enable early detection of new HIV/STI cases, and reduce HIV stigma among at-risk women. The intervention aims to support HIV self-testing and stigma reduction, with a control arm focusing on HIV risk reduction and disease prevention. The project is being implemented in Almaty, supported by the Kazakh Scientific Center for Dermatology and Infectious Diseases, and the Center for AIDS Prevention and Control in Almaty.

    Publications:

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    Nova

    NOVA project – Evaluating a Microfinance Intervention for High Risk Women in Kazakhstan (2014 – 2019)

    Project NOVA was a randomized control trial (RCT) funded by the National Institute on Drug Abuse (NIDA), focusing on women engaged in commercial sex work in Kazakhstan. The study assessed the effectiveness of a comprehensive microfinance intervention, including financial literacy and vocational training, against a control group receiving only the HIV risk reduction component. The intervention aimed to reduce new cases of HIV, STIs, and hepatitis C, as well as risks associated with sexual behavior and drug use among women in Almaty and Karaganda regions.

    Publications:

    • Witte, S. S., Pala, A. N., Mukherjee, T. I., Yang, L. S., McCrimmon, T., Mergenova, G., … & El-Bassel, N. (2023). Reducing partner violence against women who exchange sex and use drugs through a combination microfinance and HIV risk reduction intervention: a cluster randomized trial. AIDS and behavior, 27(12), 4084-4093. (https://pubmed.ncbi.nlm.nih.gov/37389675/);
    • Vélez-Grau, C., El-Bassel, N., McCrimmon, T., Terlikbayeva, A., Primbetova, S., Mergenova, G., … & Witte, S. S. (2022). ‘I never hoped for anything… now I have other plans’: The role of microfinance in HIV intervention for women who use drugs and engage in sex work in Kazakhstan. International social work, 65(4), 663-677. (https://pubmed.ncbi.nlm.nih.gov/38031578/);
    • Mukherjee, T. I., Pala, A. N., Terlikbayeva, A., Davis, A., Howard, A. A., McCrimmon, T., … & El-Bassel, N. (2022). Social and structural determinants of health associated with police violence victimization: A latent class analysis of female sex workers who use drugs in Kazakhstan. International Journal of Drug Policy, 106, 103750. (https://pubmed.ncbi.nlm.nih.gov/35667193/);
    • Vélez-Grau, C., El-Bassel, N., McCrimmon, T., Chang, M., Terlikbayeva, A., Primbetova, S., … & Witte, S. S. (2021). Suicidal ideation among women who engage in sex work and have a history of drug use in Kazakhstan. Mental health & prevention, 23, 200208. (https://pubmed.ncbi.nlm.nih.gov/38031555/);
    • El‐Bassel, N., McCrimmon, T., Mergenova, G., Chang, M., Terlikbayeva, A., Primbetova, S., … & Witte, S. S. (2021). A cluster‐randomized controlled trial of a combination HIV risk reduction and microfinance intervention for female sex workers who use drugs in Kazakhstan. Journal of the International AIDS Society, 24(5), e25682. (https://pubmed.ncbi.nlm.nih.gov/33955170/);
    • Yang, L. S., Witte, S. S., Vélez-Grau, C., McCrimmon, T., Terlikbayeva, A., Primbetova, S., … & El-Bassel, N. (2021). The financial lives and capabilities of women engaged in sex work: Can paradoxical autonomy inform intervention strategies?. Global journal of health science, 13(6), 69. (https://pubmed.ncbi.nlm.nih.gov/37163144/).
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    Smart_Couples

    Smart Couples project – Couple-based antiretroviral therapy (ART) adherence intervention for people who inject drugs in Kazakhstan (2019 – 2023)

    Funding: National Institute of Drug Abuse (NIDA)

    Grant amount: 180’652 USD

    The project goal: To develop a couples-based intervention to improve HIV medication adherence among HIV-positive people who inject drugs, which should increase viral suppression and reduce transmission of HIV.

    Project Description: The project developed a couple’s program to improve adherence to HIV treatment among HIV-positive people who inject drugs. The program included social support skills training, use of electronic pill boxes and an integrated smartphone app to improve adherence to ART to increase viral suppression and reduce HIV transmission. The study evaluated the effectiveness of the intervention and its potential to improve ART adherence among people living with HIV who inject drugs. 128 participants were included in the study, 64 were enrolled in the intervention in Almaty.

    The project results: The dyad-based intervention significantly increased self-reported ART adherence among PWID with partners with HIV, indicating the importance of considering dyad-level factors in interventions.

    Publications:

    • Implementation of a Dyad-Based Intervention to Improve Antiretroviral Therapy Adherence Among HIV-Positive People Who Inject Drugs in Kazakhstan: A Randomized Trial (https://pubmed.ncbi.nlm.nih.gov/37576461/);
    • If You Build It, Will They Use It? Preferences for Antiretroviral Therapy (ART) Adherence Monitoring Among People Who Inject Drugs (PWID) in Kazakhstan (https://pubmed.ncbi.nlm.nih.gov/30741397/).
    • Neuenschwander P, Altice FL, Remien RH, Mergenova G, Sarsembayeva L, Rozental E, Gulyayev V, Davis A. A qualitative dyad analysis of barriers and facilitators of antiretroviral therapy (ART) adherence among people who inject drugs (PWID) with HIV in Kazakhstan. AIDS Care. 2024 Oct 15:1-10. doi: 10.1080/09540121.2024.2414078. Epub ahead of print. PMID: 39404196.

     

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    BRDIGE

    GHRCCA is currently launching a four-year research project called “Improving access of vulnerable groups to HIV prevention, diagnosis and treatment services in Kazakhstan” (BRIDGE project) in partnership with the Republican AIDS Center.
    The aim of the study is to increase outreach to people who inject drugs (PWID) through HIV prevention, testing, and treatment services. The study will be conducted in the period of 2016-2020 in Almaty, as well as in Shymkent, Temirtau, and Karaganda. Under the study, surveys will be conducted and clinical and laboratory data will be collected. Research participants will be recited on the basis of Trust Points located at hospitals, regional/city AIDS centers, and non-governmental organizations.

    Project activites:

    Cooperation with AIDS Centers

    1. https://m.facebook.com/story.php?story_fbid=367845100446446&id=100016628772028
    2. https://m.facebook.com/story.php?story_fbid=367907010440255&id=100016628772028
    3. https://www.instagram.com/p/BrXJMJzlCHx/?utm_source=ig_web_button_share_sheet
    4. https://www.instagram.com/p/BrWwzjZlSpG/?utm_source=ig_web_button_share_sheet
    5. https://www.instagram.com/p/Bjox__Qj8AF/?utm_source=ig_web_button_share_sheet
    6. https://www.instagram.com/p/BlpTGbxDiDB/?utm_source=ig_web_button_share_sheet
    7. 08.12.2018 День открытых дверей в пункте доверия  http://ukoaids.kz/kz/442-08-12-2018-den-otkrytykh-dverej-v-punkte-doveriya.html
    8. 12.12.2018 «Психикалық денсаулық орталығында» ашық есік күні – http://ukoaids.kz/kz/439-12-12-2018-psikhikaly-densauly-ortaly-ynda-ashy-esik-k-ni.html
    9. 14.09.2018ж. ҮЕҰ базасында тұрғындардың түйінді топтарын жедел әдіспен тестілеу ұйымдастырылды – http://ukoaids.kz/kz/305-14-09-2018zh-e-bazasynda-t-r-yndardy-t-jindi-toptaryn-zhedel-dispen-testileu-jymdastyryldy.html
    10. 16.07.2018 Обучающий семинар по проекту «БРИДЖ» – http://ukoaids.kz/kz/285-16-07-2018-obuchayushchij-seminar-po-proektu-bridzh.html
    11. Автобус здоровья курсировал по Алматы. 27 ноября еще 114 алматинцев сегодня узнали свой ВИЧ-статус.  https://gcaids.kz/ru/novosti/101-avtobus-zdorovya-kursiroval-po-almaty

     

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    Renaissance

    «RENAISSANCE» PROJECT – HIV and STI prevention among heterosexual couples injecting  drugs in Almaty

    Prevalence of the injecting drug users in Kazakhstan remains one of the highest in the world. Fifteen percent of the adult population in some localities is injection drug users. The main base of the research is Almaty city where the estimated number of IDUs is 22,700 (2008). More than 80 percent of these IDUs are less than 30 years old, and a major part of them are sexually active. The proposed project is considered in the category of a family HIV preventive research.

           “Renaissance” Project is a five years research (2008 — 2013) implemented by the Global Health Research Center of Central Asia (GHRCCA) aimed at the preventive activity effectiveness evaluation to reduce the risks of HIV, hepatitis C and other sexually transmitted infections (STI). Research outcomes will allow addressing the wide range of aspects related to forming different HIV and STIs risks factors, and developing effective preventive measures against such diseases that in turn allow improving health and treatment services in Kazakhstan and other Central Asia countries. The main research result are the development of the new HIV and STI science-based preventive methods in working with heterosexual couples, adapted to the local conditions, obtaining the proof of the effectiveness, appropriateness, stability and need in applying the programs in public and treatment facilities activity in Kazakhstan, HIV, HCV and STI prevalence reduction in the country.

    Project goal:

    The proposed research is aimed at testing the effectiveness of couple-based HIV, HCV and STI preventive intervention to reduce the risk of these diseases, increase condom use and reduce the probability of unsafe behaviors among injecting drug users and their heterosexual partners in Almaty, Kazakhstan.

    Research short description:

    The project is a randomized controlled study among 300 couples (totally 600 participants) consisting of the main member (one out of two IDUs in a couple, who completed screening and met all selection criteria) and his/her partner, both randomly selected for one out of two categories: (1) HIV/STIs risk reduction, consisting of five sessions in the couple group; or (2) Wellness promotion, consisting of five sessions in the couple group which was used as a control. Behavioral and biological data will be collected at the following stages: during the baseline interview, and at 3, 6, and 12 months after intervention completion.

    Possible benefits from the participation in the project:

    • Gaining knowledge and practical skills in HIV, HCV and STI prevention;
    • Acquisition skills of effective communication and resolution of problems between the partners;
    • Gaining of knowledge in improving the health conditions and wellness, in particular in terms of nutrition, diet, physical activity and stress control;
    • Possibility to pass HIV, HCV and STI laboratory tests, and free treatment in case of positive test results;
    • Gaining of knowledge in overdose prevention and control.

    Participants’ reference to “Renaissance” Project:

    Having completed the project sessions I’ve got to know much useful information. Work with psychologists allowed me finding the way out of my problematic situation. So I think the project is very good and useful anyway. Regards. Sergey”.

    “The «Renaissance» Project is of great value for those at risk of STIs. I learned a lot how o be safe in this term. Many thanks to the project team — their professionalism and dedication make good work for the society. Through the project I personally received the information to which I paid not much attention earlier. Using such knowledge I learned how to be more tolerant with my partner.  Now we have no closed topics related to STIs and drug use risks.

    Wishes: I would like to participate in the similar project aimed at risks related with alcohol abuse, since the social danger for people using alcohol is not less than that from drug use. Many thanks to the Renaissance Project and project team! Good luck!!”

    “Your project really helped us (me and my husband) to realize the problem, and — what is more important – to get out of our “dirty lifestyle”. Only here I could confess to people around me and myself that I was dependent on drugs and I needed help. We are so grateful to our facilitator, nurse and all group participants for their understanding and help. I hope that other people having the same problems will overcome themselves and realize the problem. The most important thing is to believe and know that you need it! There is nothing to be afraid of. Be honest with yourself and you will be able to eradicate any problems. Many thanks to the project, thanks for my ability to see the sun in different way, to feel the life; to love…I wish you prosperity and very many saved souls!”

    “Hi, Renaissance. I’m very glad that there is such a program. You helped me to think over my life. I gave up drugs after your project, and now do not drink much as I did earlier, I have a desire to live but not to exist. I pay more attention to my relatives and friends. Thank you very much indeed. Dmitriy.” 

    “Renaissance Project, I learned a lot of good and useful things about healthy lifestyle. The entire negative is waning gradually. Study, personality formation in a man, struggle for health, and help in a difficult moment of life — all these I’ve learnt from the project. It’s great that you work in this area. I wish you to open more offices like this, good luck with your patients, and all the best to you… Sergey. «

    “Renaissance Project – You are needed! Needed very much! First of all for those who are dependent and know their problems, but never think over their health and healthy life. Thank you for the sessions on healthy nutrition. I would never read such literature, but having attended the sessions I got to know something new for me. We, the former and current users, really need your help. We not only communicate with each other but see the example of how can we become better and change radically our lives. I wish you to growth and development, and to open branches in different cities and towns.   Thank you! … Olga. «

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    Silk Road

    HIV and STI risk reduction among migrant workers at Kazakhstani markets  Silk Road Health Project

    Migrants from the Central Asia countries working at the wholesale-retail market “Barakholka” in Almaty is a mobile population which is defined as a group exposed to high risk of HIV/STI infection and transmission.

    HIV and STI risk reduction among migrant workers at Kazakhstani markets (Silk Road Health Project) is a four years research (2009 -2013) carried out by the Global Health Research Center in Central Asia (GHRCCA), and aimed at studying of migration impact on the health of men from the Central Asian countries, and obtaining the information for future efforts to reduce HIV/STI heterosexual transmission proportion in Central Asia.

    The research results will allow addressing a wide range of issues related to various HIV/STI sexual transmission risk factors, and developing diseases effective preventive measures, which will improve health and medical services in Kazakhstan and Central Asia.

    The Project is funded by the US National Mental Health Institute and is approved by the International Ethical Committees of both the Columbia University and Kazakhstani Public Health School.

    Aims: The study aims to examine the theoretical multi-level determinants; impact on sexual behavior risks, HIV, Chlamydia, gonorrhea and syphilis among male migrant workers in wholesale and retail market (Barakholka) in Almaty, Kazakhstan.

    Design, methods and sampling  

    Study consists of two phases: the first – qualitative research, the second – quantitative longitudinal study of the target population group.

    Qualitative study:

    60 «Barakholka» market workers were randomly selected to participate in the in-depth interviews in the first phase. To study changes in the sequence of events in the context of cultural backgrounds, values, beliefs, norms of sexual behavior, models and dynamics of relationships that affected the risks of sexual behavior, ethnic and migration characteristics — qualitative data on 48 workers (4 from each group) that were citizens of Kyrgyzstan, Uzbekistan, Tajikistan and Kazakhstan (out of the internal migrants group) were compared with the corresponding data on 12 men from the group of comparison of non-migrants who resided in Almaty and were the citizens of Kazakhstan.

    Longitudinal study:

    For the longitudinal study of the main quantitative phase, 1600 » Barakholka » market workers were recruited using RDS sampling method (respondent driven sampling). The sample consisted of 1280 migrants from Kazakhstan, Kyrgyzstan, Uzbekistan and Tajikistan, and 320 market workers, non-migrants, who resided Almaty and were the citizens of Kazakhstan. Participants undergo a baseline assessment at their first visit, and then at 3, 6, 9 and 12 months follow-ups, completing audio computer-assisted interview, reflecting data recognized by the participant on their behavioral risk, migration characteristics and socio-demographic questions. We will collect laboratory data to confirm of HIV/STI status at the first visit to the project office and after 12 months of the project completion.

    Participants’ references

    “Thank you for the project that gives an opportunity for young people to think about their health. The project staff is so careful. Quite pleasant servicing. Nice greeting of participants. As far as the questions are concerned – they are really needed, useful and correct; they are related to the health of people.   Thanks!!!!” Olzhas, project participant. 

    14.07.11.

    “I like this project, since not everybody has an opportunity to pass the tests or medical examination. I wish you all the best with this project!!” Askhat, project participant.

    14.09.11.

    (Translated from Kazakh):

    “I’m grateful to you for free tests. Thank you for such good undertaking. Let your work move ahead. Thank you once again”, Daulet, project participant

     “Thank you very much. I see such project for the first time. You help us greatly! Thank you!” Maksat, project participant, 29.06.11.

      (Translated from Kyrgyz):

    “I really like this project. Being completing the computer survey I answered my own questions and resolved some problems I had. There a lot of people with different diseases, and you are doing a good job for them. Continue your research, study the behavioral models. I would like to thank all staff members working in the project! I wish you to continue and have other similar projects. And God bless you!” Eldiyar, project participant, 31.03.12

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