Columbia University Mailman School of Public Health, New York, NY, USA.
Global Health Research Center of Central Asia, Almaty, Kazakhstan.
Glob Health Sci Pract. 2022 Apr 29;10(2). doi: 10.9745/GHSP-D-21-00619. Print 2022 Apr 28.
The coronavirus disease (COVID-19) pandemic and resulting lockdowns have disrupted health care service delivery globally. This includes disruptions in harm reduction and HIV service delivery for people who inject drugs (PWID), a population at high risk for not only COVID-19 but also poor HIV and drug-treatment access. However, little is known about these issues in Kazakhstan. We examined harm reduction provider experiences with delivering services and regulatory changes during the COVID-19 pandemic.
We conducted in-depth interviews with 24 nurses, social workers, and doctors serving both HIV-positive and HIV-negative PWID at 13 needle and syringe programs (NSPs) and 4 AIDS Centers (HIV treatments centers) in Kazakhstan from May to August 2020. Participants were asked how the COVID-19 pandemic had impacted their PWID clients' risks, their organizational environment, and the services offered to PWID over the prior 3-6 months. Thematic content analysis was used to elicit findings.
The COVID-19 pandemic considerably impacted NSP and AIDS Center operations. Participants perceived high risks of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection for themselves and their clients, as well as pandemic-related increases in substance use and HIV risks for clients. Organizations instituted several policy and regulatory changes to adapt to the pandemic, most notably tasking NSPs with delivering HIV medications; these changes necessitated new roles and responsibilities for many providers. Despite this stressful changing environment and increased service demands, participants still shared examples of persistence and resilience as they worked to meet client needs during these challenging times.
NSPs in Kazakhstan are well-positioned to reach key populations with crucial information and flexible services during the COVID-19 pandemic. However, they need recognition as essential organizations and additional equipment and staff support to protect staff and clients, maintain pandemic-related regulatory changes, and address additional challenges such as overdose prevention among clients.
冠状病毒病（COVID-19）大流行及其导致的封锁扰乱了全球的医疗保健服务提供。这包括减少伤害和艾滋病毒服务的中断，为注射毒品者（PWID）提供服务，该人群不仅面临 COVID-19 的高风险，而且还面临艾滋病毒和药物治疗获取机会不足的风险。然而，哈萨克斯坦对这些问题了解甚少。我们研究了在 COVID-19 大流行期间，减少伤害服务提供者提供服务和监管变化的经验。
我们于 2020 年 5 月至 8 月在哈萨克斯坦的 13 个针具交换项目（NSP）和 4 个艾滋病中心（HIV 治疗中心）对为 HIV 阳性和 HIV 阴性 PWID 提供服务的 24 名护士、社会工作者和医生进行了深入访谈。参与者被问及 COVID-19 大流行如何影响他们的 PWID 客户的风险、他们的组织环境以及在过去 3-6 个月内向 PWID 提供的服务。采用主题内容分析法来引出研究结果。
COVID-19 大流行对 NSP 和艾滋病中心的运作产生了重大影响。参与者认为自己和客户感染严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的风险很高，以及与大流行相关的客户物质使用和艾滋病毒风险增加。各组织制定了若干政策和监管变更，以适应大流行，最显著的是将 HIV 药物的提供任务交给 NSP；这些变更需要许多提供者承担新的角色和责任。尽管面临这种压力不断变化的环境和服务需求的增加，参与者在努力满足客户需求时，仍然分享了坚持和韧性的例子。
哈萨克斯坦的 NSP 在 COVID-19 大流行期间为关键人群提供关键信息和灵活的服务，具有得天独厚的优势。然而，他们需要得到认可，成为必不可少的组织，并获得额外的设备和人员支持，以保护工作人员和客户，维持与大流行相关的监管变更，并应对客户中的药物过量预防等额外挑战。
