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

项目概要 此次重新提交的申请 R01DA050470 建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 发现了艾滋病毒株。我们提出了两种识别热点的新方法：1）使用基于网络的 绘图技术可记录注射吸毒者中观察到的和自我报告的艾滋病毒和服药过量风险行为 私人和半公共注入环境（SPIS）以及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）并进行测试 HIV 和 HCV 抗体（测试炊具是约翰·霍普金斯大学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射的区域 这些注入设置的属性。这些数据将用于识别 SPIS 内的高风险行为 人口普查区块组 (CBG)。这些参与者将被跟踪两年。 该研究的观察部分的结果将用于为创新试点提供信息 注射设置有针对性的同伴驱动干预，以减少 HIV/HCV 传播和过量风险 行为。从已确定的 CBG 中，我们将选择 60 个不连续的 CBG 进行试点整群随机试验 （CRT）干预。 CBG 将随机分配到以下 4 个条件之一：1) 同伴教育和储备 包含风险降低材料的 SPIS，2) 仅同伴教育，3) 储备包含风险降低材料的 SPIS 仅，以及 4) 护理标准。根据 CBG 和 SPIS 使用情况，120 名索引 PWID 参与者将被 从 600 名 PWID 中选出。这些指数参与者将接受与分配的任务相对应的培训 他们的 CBG 状况。该指数将针对两个特定 SPIS 实施干预。每个索引都会 还从其 CBG 招募注射吸毒者作为数据收集者。在 SPIS 中，数据收集者将使用 生态瞬时评估 (EMA) 并收集炊具进行 HIV/HCV 检测。来自索引的数据 (N=120) 和数据收集器 (N=120) 将用作 4 臂干预的结果。

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.