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R01DA050470的重新提交建议使用创新的方法来识别“热点”， 定义为艾滋病毒或丙型肝炎病毒感染率高、艾滋病毒载量高或耐药的地理区域 发现了HIV毒株。我们提出了两种新的热点识别方法：1)使用基于Web的 记录观察和自我报告的艾滋病毒和吸毒过量危险行为的地图技术 私有和半公共注射设置(SPI)以及这些风险设置的属性；2)系统化 从注射环境中收集炊具(用于在注射前混合和加热药物的容器)并进行测试 用于艾滋病毒和丙型肝炎病毒抗体(检测锅是约翰霍普金斯大学病毒学实验室开发的一种新方法)。 招募600名HIV阳性和阴性注射吸毒者(PWID)。这些PWID将完成一个 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和 这些注入设置的属性。这些数据将用于识别SPI中的高危行为 人口普查区组(CBG)。这些参与者将被跟踪两年。 研究的这一观察性部分的发现将被用来向创新的飞行员提供信息 制定有针对性的同伴驱动干预措施，以减少艾滋病毒/丙型肝炎传播和过量用药风险 行为。从确定的CBG中，我们将选择60个不连续的CBG进行试点集群随机试验 (CRT)的干预。CBG将被随机分配到以下4种情况之一：1)同伴教育和采购 使用降低风险材料的SPI，2)仅限同伴教育，3)使用降低风险材料的SPI 仅限，以及4)护理标准。根据他们的CBG和SPI使用情况，120个指标PWID参与者将是 从600 PWID中选择。这些指标参与者将接受与分配的 他们的CBG情况。这些指数将针对两个特定的SPI实施干预。每个索引都将 还从他们的CBG中招募PWID作为数据收集员。在SPI中，数据收集器将使用 生态瞬时评估(EMA)和收集炊具以进行艾滋病毒/丙型肝炎病毒检测。来自索引的数据 (N=120)和数据收集器(N=120)将用作四臂干预的结果。

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.