When pandemics collide: The intersection of the opioid crisis, COVID-19 and HIV pandemics among people who inject drugs in the United States

当流行病发生冲突时：阿片类药物危机、COVID-19 和艾滋病毒流行病在美国注射吸毒者中的交叉点

• 批准号: 10159596
• 负责人: Becky Lynn Genberg
• 金额: $ 66.58万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10159596
• 关键词: 2019-nCoV; AIDS prevention; Acquired Immunodeficiency Syndrome; Affect; Alcohol or Other Drugs use; Anxiety; Baltimore; Behavior; Behavioral; COVID-19; COVID-19 pandemic; Caring; Characteristics; China; Clinical Data; Communities; Data; Data Collection; Disease; Disease Outbreaks; Drug usage; Drug user; Economics; Enrollment; Epidemic; Equation; Equipment; Etiology; Exposure to; Failure; Frequencies; Future; Geography; Goals; HIV; HIV risk; Harm Reduction; Health; Health Services Accessibility; Hepatitis C; Heroin; Homelessness; Incidence; Individual; Injecting drug user; Injections; Interruption; Intervention; Interview; Intravenous; Kentucky; Laboratories; Lead; Link; Massachusetts; Measures; Mental Depression; Mental Health; Methods; Modeling; National Institute of Drug Abuse; Needle Sharing; Overdose; Participant; Pathogenesis; Pennsylvania; Pharmacotherapy; Play; Population; Prevention strategy; Prospective cohort; Public Health; Relapse; Research; Research Priority; Resources; Risk; Risk Behaviors; Risk Factors; Role; Running; Rural; Sampling; Services; Signal Transduction; Social Network; Social isolation; Social support; Sterility; Stress; Structure; Syringes; United States; Viral; Vulnerable Populations; Washington; West Virginia; antiretroviral therapy; base; care systems; cohort; disorder prevention; experience; follow-up; high risk behavior; improved; injection drug use; mortality; operation; opioid epidemic; opioid use; opioid use disorder; pandemic disease; prevent; prevention service; psychosocial; public health emergency; response; social; suburb; synthetic opioid; therapy design; transmission process; treatment strategy; trend; urban area

Project Summary/Abstract Despite the more than decades long downward trend in HIV incidence among people who inject drugs (PWID), there is cause for alarm due to the COVID-19 pandemic and the instability the response will likely cause, particularly among vulnerable populations. COVID-19 will disrupt access to the very interventions that led to declining HIV incidence among PWID, including harm reduction services and antiretroviral therapy (ART). As a result, COVID-19 threatens to undo efforts to end the HIV epidemic in the US. Several recent HIV outbreaks in the US that resulted from increasing use and exposure to synthetic opioids highlights how the COVID-19 pandemic is being layered onto an existing public health emergency in the US that is disproportionately affecting PWID populations. It is unknown how the intersection of the opioid crisis and COVID-19 pandemic will interact to impact the health of PWID in the short term and whether it will create conditions sufficient to destabilize PWID populations enough to support the resurgence of HIV. Research is therefore urgently needed to examine the immediate impact and downstream consequences of COVID-19 on PWID. The objective of this proposal is therefore to determine the potential of HIV resurgence among PWID due to the impact of the COVID-19 pandemic on individual and network factors. Our central hypothesis is that COVID-19 will increase individual and social network instability sufficiently to promote HIV outbreaks among PWID populations. We propose the following three specific aims: 1) To examine threats to psychosocial, economic and behavioral stability and HIV control among an existing cohort of PWID during the COVID-19 pandemic; 2) To understand social and drug-use network stability during and following the COVID-19 pandemic; and 3) To estimate the potential for HIV resurgence among PWID as a result of the COVID-19 pandemic. To achieve these aims, we will leverage ongoing behavioral, laboratory and clinical data collection within the AIDS Linked to the IntraVenous Experience (ALIVE) cohort and collect new longitudinal social network data and qualitative data to characterize the disruption due to COVID-19. Importantly, we will advance our understanding of how individual substance use, HIV-related risk behaviors, and social network characteristics have changed as a result of COVID-19, relationships that are entirely uncharacterized. The evidence generated from this proposed research will inform the ongoing design of interventions targeted to PWID, not only to prevent emerging HIV outbreaks, but to support efforts to improve the health of PWID in the context of disruptions to care and services. Given that the COVID-19 pandemic will likely have prolonged impacts on PWID due to continued SARS-CoV-2 transmission in urban areas and continual cycling of non-pharmaceutical interventions (NPIs) until more effective prevention and treatment strategies are available, the research proposed here will have immediate and substantial impact on practice.

项目摘要/摘要 尽管数十年来注射吸毒者(PWID)的艾滋病毒发病率呈下降趋势， 由于新冠肺炎疫情以及应对措施可能引发的不稳定，我们有理由感到震惊。 特别是在弱势群体中。新冠肺炎将扰乱人们对导致 PWID中艾滋病毒发病率的下降，包括减少危害服务和抗逆转录病毒治疗(ART)。作为一名 因此，新冠肺炎威胁要撤销在美国结束艾滋病毒流行的努力。最近在中国爆发的几起艾滋病毒疫情 由于越来越多地使用和接触合成阿片类药物而导致的美国，突显了新冠肺炎 在美国，大流行是在现有的公共卫生紧急情况下发生的，这种情况不成比例 影响PWID人群。目前尚不清楚阿片类药物危机和新冠肺炎大流行的交汇点将如何 相互作用，在短期内影响PWID的健康，以及它是否会创造足够的条件 破坏PWID人群的稳定，足以支持艾滋病毒的死灰复燃。因此，迫切需要进行研究 研究新冠肺炎对PWID的直接影响和下游后果。这样做的目的是 因此，建议确定由于艾滋病的影响，在PWID中艾滋病毒卷土重来的可能性 新冠肺炎流行受个人和网络因素的影响。我们的中心假设是，新冠肺炎将增加 个人和社会网络的不稳定足以促进残疾人中艾滋病毒的暴发。我们 提出以下三个具体目标：1)审查对心理社会、经济和行为的威胁 新冠肺炎大流行期间PWID现有队列的稳定性和艾滋病毒控制；2)了解 新冠肺炎大流行期间和之后的社会和毒品使用网络稳定性；以及3)估计 由于新冠肺炎大流行，残疾人中艾滋病毒有可能死灰复燃。为了达到这些目标，我们 将利用艾滋病内持续的行为、实验室和临床数据收集与 静脉体验(活)队列并收集新的纵向社交网络数据和定性数据，以 描述一下新冠肺炎造成的中断。重要的是，我们将推进我们对个人如何 物质使用、艾滋病毒相关危险行为和社会网络特征因 新冠肺炎，一段完全没有个性的关系。由这一提议产生的证据 研究将为正在进行的针对PWID的干预设计提供信息，不仅是为了预防新出现的艾滋病毒 疫情，但在护理和保健中断的情况下支持改善PWID健康的努力 服务。鉴于新冠肺炎大流行可能会对PWID产生长期影响， SARS-CoV-2在城市地区的传播与非药物干预措施的持续循环 在更有效的预防和治疗策略出现之前，这里提出的研究将会有 对实践产生直接和实质性的影响。