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

项目总结/摘要 尽管几十年来注射吸毒者中艾滋病毒发病率呈下降趋势， 由于COVID-19大流行以及应对措施可能造成的不稳定性， 特别是在弱势群体中。COVID-19将破坏获得导致 降低残疾人中的艾滋病毒感染率，包括减少伤害服务和抗逆转录病毒疗法。作为 因此，COVID-19有可能使美国结束艾滋病毒流行的努力付诸东流。最近几次艾滋病毒爆发， 美国因合成阿片类药物的使用和暴露增加而导致的疫情凸显了COVID-19 大流行病正在叠加到美国现有的公共卫生紧急情况上， 影响PWID人群。目前尚不清楚阿片类药物危机和COVID-19大流行的交叉点将如何影响 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， 使PWID人群不稳定，足以支持HIV的复苏。因此迫切需要进行研究 研究COVID-19对PWID的直接影响和下游后果。的目的 因此，建议是确定艾滋病毒死灰复燃的潜在PWID由于的影响， COVID-19疫情对个人和网络因素的影响。我们的核心假设是，COVID-19将增加 个人和社会网络的不稳定足以促使艾滋病毒在艾滋病感染者人群中爆发。我们 提出以下三个具体目标：1）研究对心理社会、经济和行为的威胁 在COVID-19大流行期间，现有PWID队列的稳定性和艾滋病毒控制; 2）了解 COVID-19大流行期间及之后的社会和药物使用网络稳定性;以及3）估计 由于COVID-19大流行，艾滋病毒在PWID中可能死灰复燃。为了实现这些目标，我们 将利用正在进行的行为，实验室和临床数据收集范围内的艾滋病与 静脉内经验（ALIVE）队列，并收集新的纵向社交网络数据和定性数据， 描述COVID-19造成的破坏。重要的是，我们将进一步了解个人如何 物质使用，艾滋病毒相关的风险行为和社会网络特征已经改变， COVID-19，完全没有特征的关系。由此产生的证据表明， 研究将为正在进行的针对PWID的干预措施设计提供信息，不仅是为了预防艾滋病毒的出现， 疫情，但支持在护理中断的情况下改善PWID健康的努力， 服务鉴于COVID-19大流行可能会对PWID产生长期影响，原因是持续的 SARS-CoV-2在城市地区的传播和非药物干预措施（NPI）的持续循环 在更有效的预防和治疗策略出现之前，这里提出的研究将有 对实践产生直接和实质性影响。

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.