A geospatial analysis of hotspots and targeted injection settings pilot intervention for HIV prevention among people who inject drugs in Baltimore, Maryland

项目摘要 申请R 01 DA 050470的重新提交提议使用创新方法来识别“热点”， 定义为HIV或HCV感染率高、HIV病毒载量高或耐药的地理区域 我们提出了两种识别热点的新方法：1）使用基于网络的 映射技术，以记录观察到的和自我报告的艾滋病毒和吸毒过量的风险行为， 私人和半公共注射设置（SPIS）和这些风险设置的属性; 2）系统地 从注射场所收集炊具（注射前用于混合和加热药物的容器）并对其进行测试 检测HIV和HCV抗体（测试炊具是约翰霍普金斯病毒学实验室开发的一种新方法）。 我们将招募600名艾滋病毒阳性和阴性的注射吸毒者（PWID）。这些PWID将完成 使用我们团队开发的软件程序进行调查，以定位和绘制他们注入的区域， 这些进样设置的属性。这些数据将用于识别SPIS中的高风险行为， 人口普查区块组（CBG）。这些参与者将被随访2年。 这项研究的观察部分的结果将用于告知创新飞行员， 注射设置有针对性的同行驱动的干预，以减少艾滋病毒/丙型肝炎病毒的传播和过量的风险 行为。从确定的CBG中，我们将选择60个非连续CBG进行试点随机分组试验 (CRT)的干预。CBG将被随机分配到4个条件之一：1）同伴教育和放养 2）仅进行同伴教育，3）为SPIS储备风险降低材料 （4）护理标准。根据CBG和SPIS的使用情况，将有120名指数PWID参与者 从600 PWID中选择。这些索引参与者将接受与分配的 他们的CBG。这些指数将针对两个特定的SPIS实施干预措施。每个索引将 还从CBG招募PWID作为数据收集员。在SPIS中，数据收集器将使用 生态瞬时评估（EMA）和收集炊具进行艾滋病毒/丙型肝炎病毒检测。来自指数的数据 （N=120）和数据收集器（N=120）将用作4组干预的结局。

Project Summary This resubmission of application R01DA050470 proposes to use innovative approaches to identify “hotspots,” defined as geographic areas in which high rates of HIV or HCV infection, high HIV viral loads, or drug-resistant HIV strains are found. We propose two novel approaches for identifying hotspots: 1) Use of web-based mapping technology to document observed and self-reported HIV and overdose risk behaviors among PWID in private and semi-public injection settings (SPIS) and the attributes of these risk settings; 2) Systematically collect cookers (containers used to mix and heat drugs before injecting) from injection settings and test them for HIV and HCV antibodies (testing cookers is a novel method developed in the Johns Hopkins Virology lab). We will recruit 600 HIV positive and negative people who inject drugs (PWID). These PWID will complete a survey using a software program developed by our team to locate and map the areas where they inject and attributes of these injection settings. These data will be used to identify high-risk behaviors in SPIS within census block groups (CBGs). These participants will be followed for 2 years. The findings from this observational portion of the study will then be used to inform an innovative pilot of an injection setting targeted peer-driven intervention to reduce HIV/HCV transmission and overdose risk behaviors. From the identified CBGs, we will select 60 non-contiguous CBGs for a pilot cluster randomized trial (CRT) of the intervention. The CBGs will be randomized to one of 4 conditions: 1) Peer education and stocking of SPIS with risk reduction materials, 2) Peer education only, 3) Stocking SPIS with risk reduction materials only, and 4) The standard of care. Based on their CBG and SPIS use, 120 index PWID participants will be selected from the 600 PWID. These index participants will receive training corresponding to the assigned condition of their CBG. The indexes will implement the intervention targeting two specific SPIS. Each index will also recruit PWID from their CBG to serve as data collectors. In the SPIS, the data collectors will use Ecological Momentary Assessment (EMA) and collect cookers for HIV/HCV testing. Data from the indexes (N=120) and data collectors (N=120) will be used as outcomes of the 4-arm intervention.