PT - JOURNAL ARTICLE AU - Tara McCrimmon AU - Anne Sundelson AU - Meruyert Darisheva AU - Louisa Gilbert AU - Timothy Hunt AU - Assel Terlikbayeva AU - Sholpan Primbetova AU - Nabila El-Bassel TI - HIV Care Continuum Services for People Who Inject Drugs in Kazakhstan During COVID-19: A Qualitative Study of Service Provider Perspectives AID - 10.9745/GHSP-D-21-00619 DP - 2022 Apr 28 TA - Global Health: Science and Practice PG - e2100619 VI - 10 IP - 2 4099 - http://www.ghspjournal.org/content/10/2/e2100619.short 4100 - http://www.ghspjournal.org/content/10/2/e2100619.full SO - GLOB HEALTH SCI PRACT2022 Apr 28; 10 AB - Key FindingsAs organizations implemented policy and regulatory changes in response to the pandemic, service providers at needle and syringe programs (NSPs) and AIDS Centers (HIV treatments centers) demonstrated flexibility and persistence in taking on new roles and responsibilities while continuing to meet the needs of people who inject drugs (PWID).NSPs are well-positioned to provide services to marginalized groups during the pandemic because they have community connections and flexibility that traditional health facilities may not have.Providers at NSPs were hampered by a lack of resources, limited personal protective equipment access, low salaries, and the designation of NSPs as nonessential services, which forced NSPs to close during the peaks of the pandemic. This underinvestment in NSPs undermines their potential to provide care to key populations during the pandemic.Key ImplicationsDifferentiation-of-care approaches are essential to continue reaching marginalized groups during a crisis on the scale of the pandemic, which deeply impacted service provision through traditional medical systems.Kazakhstan's national health care policy makers should increase resources and support for NSP operations during COVID-19 to ensure that PWID continue to receive necessary services for HIV and harm reduction.Introduction: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.Methods: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.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.Discussion: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.