Contextual risk factors for hepatitis C among young persons who inject drugs

7.项目摘要 背景：丙型肝炎病毒（HCV）感染在年轻人中流行， 注射毒品（PWID）来自郊区和农村地区。HCV主要通过与HCV相关的风险行为传播。 注射毒品（IDU）2016年，美国国家科学院（NAS）研究了 在美国消除HCV，定义为病毒在这个国家的传播停止。在其第一阶段报告中， NAS确定年轻的PWID是HCV风险最高的人群，也是HCV的主要驱动因素 目前，在美国非城市社区的发病率，以前有低到中等的HCV感染率。到 迄今为止，没有已知的研究充分阐明为什么HCV的发病率在这“新一代”PWID中增加 （NG-PWID），主要由来自郊区和农村社区的非西班牙裔白人组成。 我们最近的研究表明，在过去十年中， 增加郊区NG-PWID感染HCV风险的因素。目的：我们提出一个 NG-PWID及其个人（自我中心）注射，性和支持网络之间的纵向研究。 我们将每6个月收集一次数据，持续36个月，以评估随着时间的推移对HCV风险的影响：（i）社会 网络因素，（ii）物理和社会地理因素，（iii）IDU的社会规范，（iv）感知IDU， 丙肝污名化。方法：我们将招募420名PWID（18 - 30岁）及其注射网络中的约1，156名 来自伊利诺伊州芝加哥及周边郊区的会员（18岁及以上）。招聘将在 大型注射器服务计划（SSP）的两个社区实地站点，并通过大型开放式 毒品市场。将收集六种类型的数据，包括参与者及其注射、性行为和 支助网络成员：㈠参与者的社会人口特征、吸毒模式和做法， （二）网络规模、特点和网络成员之间关系的特点 (e.g.,联系强度），（iii）通过检测确定的HIV和HCV感染状况，（iv）关于地点的地理数据， 参与者及其网络成员居住、购买毒品、注射和 满足性和注射伙伴，（五）评估参与者网络内的社会规范， 具体的行为设置，和（vi）评估认识到IDU和HCV的耻辱。公共卫生 意义：本研究将（i）提高我们对语境和结构因素的理解 推动NG-PWID中的HCV发病率，（ii）为NG-PWID创新策略的制定提供信息 (e.g.,网络干预，直接抗病毒HCV治疗规模扩大），以实现消除HCV的目标 美国由DHHS提出，（iii）提供开发更现实的计算模型所需的关键数据 这些研究解决了影响HCV发病率的个体、社会和结构水平因素之间的复杂相互作用， 以确定实现HCV消除的最有效干预策略组合。

7. PROJECT SUMMARY Background: An emerging epidemic of hepatitis C virus (HCV) infection exists among young persons who inject drugs (PWID) from suburban and rural areas. HCV is primarily transmitted via risk practices associated with injection drug use (IDU). In 2016, the National Academy of Sciences (NAS) examined the feasibility of HCV elimination in the U.S., defined as cessation of viral transmission in this country. In its phase-1 report, NAS determined that young PWID are the people at greatest risk for HCV and are the primary drivers of HCV incidence today in non-urban U.S. communities that previously had low to modest rates of HCV infection. To date, no known study has fully elucidated why HCV incidence is increasing in this “new generation” of PWID (NG-PWID), which is composed predominantly of non-Hispanic Whites from suburban and rural communities. Our recent study suggests that what may have changed over the past decade are contextual and structural factors that heighten suburban NG-PWID's risk of becoming HCV-infected. Objective: We propose a longitudinal study among NG-PWID and their personal (egocentric) injection, sexual, and support networks. We will collect data every 6 months for 36 months to assess over time the impact on HCV risk of (i) social network factors, (ii) physical and social geographic factors, (iii) social norms of IDU, and (iv) perceived IDU and HCV stigma. Methods: We will recruit 420 PWID (ages 18-30) and about 1,156 of their injection network members (age 18 and over) from Chicago, Illinois, and surrounding suburban areas. Recruitment will occur at two community field sites of a large syringe services program (SSP) and through direct outreach in large, open drug market areas. Six types of data will be collected on both participants and their injection, sexual, and support network members: (i) participant socio-demographic characteristics, drug use patterns and practices, and sexual practices, (ii) network size, characteristics, and features of relationships among network members (e.g., strength of tie), (iii) HIV and HCV infection status through testing, (iv) geographic data on the location and characteristics of places where participants and their network members reside, purchase drugs, inject, and meet sex and injection partners, (v) an assessment of social norms within both the participant's network and specific behavioral settings, and (vi) an assessment of perceived IDU and HCV stigma. Public Health Significance: The proposed research will (i) improve our understanding of the contextual and structural factors driving HCV incidence among NG-PWID, (ii) inform the development of innovative strategies for NG-PWID (e.g., network interventions, direct antiviral HCV treatment scale up) toward the goal of HCV elimination in the U.S. set forth by DHHS, and (iii) provide crucial data needed to develop more realistic computational models that address the complex interplay of individual, social, and structural level factors affecting HCV incidence in order to identify the most effective combination(s) of intervention strategies for achieving HCV elimination.