Vancouver Drug Users Study: The Impacts of Evolving Drug Use Patterns on HIV/AIDS

温哥华吸毒者研究：不断变化的吸毒模式对艾滋病毒/艾滋病的影响

• 批准号: 10371084
• 负责人: Kora Debeck
• 金额: $ 136.19万
• 依托单位: SIMON FRASER UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-03-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10371084
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Adult; American; Area; Basic Science; Biological Markers; British Columbia; Canada; Charge; Cities; Cohort Studies; Communities; Development; Disease; Disease Outbreaks; Drug usage; Drug user; Environment; Environmental Risk Factor; Epidemic; Ethnography; Evaluation; Event; Funding; Future; Grant; Growth; HIV; HIV Seronegativity; HIV Seropositivity; Health; Healthcare; High Prevalence; Home; Illicit Drugs; Incidence; Individual; Inflammation; Injecting drug user; Injections; Insurance; International; Intervention; Investigation; Long-Term Effects; Medicine; Methamphetamine; NIH Office of AIDS Research; National Institute of Drug Abuse; Neurocognitive Deficit; Opioid; Outcome; Pain; Participant; Pattern; Peer Review; Pharmaceutical Preparations; Policies; Population; Positioning Attribute; Premature aging syndrome; Prevalence; Prospective cohort study; Public Health; Publications; Qualitative Research; Randomized Controlled Trials; Research; Research Methodology; Research Personnel; Research Priority; Research Training; Resources; Running; Sampling; Scheme; Science; Scientist; Sister; Site; Stimulant; Sum; Supervision; Training; United States National Institutes of Health; Work; addiction; adolescent drug use; aged; barrier to care; base; cohort; comorbidity; cost; cost effectiveness; data access; data harmonization; effectiveness study; experience; high risk; illicit drug use; immune activation; implementation science; innovation; mathematical model; medication-assisted treatment; member; methamphetamine use; microbicide; mortality; multidisciplinary; next generation; novel strategies; opioid epidemic; opioid use; opioid use disorder; pandemic disease; pre-exposure prophylaxis; programs; recruit; response; scale up; social structure; substance use; synthetic opioid; uptake; vaginal microbiome; virtual; willingness

PROJECT SUMMARY / ABSTRACT This competing renewal U01 application proposes an investigation of the impact of rapidly evolving substance use patterns on HIV prevention and HIV-associated co-morbidities. We propose to undertake this work in Vancouver, Canada, where, as in many areas in the US, exponential growth in synthetic opioid use has become a health crisis. Accordingly, we seek to characterize emerging drug use patterns and the associated impacts on engagement in HIV prevention and medication assisted treatments for opioid use disorder (MAT). We also aim to assess willingness to use, uptake of, and adherence to new and emerging HIV-focused biomedical interventions (e.g., pre-exposure prophylaxis [PrEP], microbicides). In Vancouver, PrEP has recently been made available at no cost to those at high risk of HIV acquisition, including people who inject drugs (PWID). We further aim to examine key HIV-associated co-morbidities, in particular pain and neurocognitive impairment, among a combined sample of HIV-negative and HIV-positive PWID and the related impacts on substance use patterns, engagement in HIV prevention and MAT. This project involves the continuation of the Vancouver Drug Users Study (V-DUS; n = 1800), which is one of the longest-running prospective cohort studies of community-recruited people who use illicit drugs (PWUD) internationally. The V-DUS is comprised of two nested cohorts following HIV-negative street-involved drug-using youth aged 14-26 years and HIV-negative adult PWID since 1996. Our study setting is a key innovative feature of the proposed work. Vancouver is a port city that continues to experience high availability and prevalent use of a wide range of illicit drugs. It is home to one of the most dramatic outbreaks of HIV among PWID and is now an epicenter of the ongoing synthetic opioid epidemic. In response, a range of pioneering policies and programs specific to illicit drug use have been introduced, and several of these are now being scaled up and/or considered in the US. For example, a broad set of MAT are available for virtually free of charge through the universal healthcare plan and in a low threshold manner, which allows us to examine MAT-related outcomes without the confounding effects of insurance schemes and programmatic barriers associated with high-threshold provision of MAT. The V-DUS is also a member of the C3PNO consortium and thereby ideally positioned to advance team science approaches. V-DUS has been highly productive and is a globally unique, valuable resource for advancing HIV research and training future HIV researchers. During the past grant cycle, >130 of >160 peer-reviewed publications have been led by >70 trainees. The V-DUS is also harmonized with an ongoing NIDA-funded cohort of HIV-positive PWUD and therefore a key control/comparison in work focused on HIV/AIDS among PWUD is possible. Given our environment and track record to date, we are well positioned to generate important scientific evidence on HIV prevention and HIV- associated co-morbidities thereby contributing to high and medium research priorities identified by the NIH Office of AIDS Research and informing efforts to end the HIV/AIDS pandemic.

项目总结/摘要 该竞争性更新U 01申请提出了对快速演变物质的影响进行调查 艾滋病毒预防和艾滋病毒相关共病的使用模式。我们建议在 加拿大温哥华，与美国许多地区一样，合成阿片类药物的使用呈指数增长， 健康危机。因此，我们力求描述新出现的吸毒模式及其对 参与艾滋病毒预防和阿片类药物使用障碍（MAT）的药物辅助治疗。我们还旨在 评估使用、吸收和坚持新的和新兴的以艾滋病毒为重点的生物医学 干预（例如，暴露前预防[PrEP]、杀微生物剂）。在温哥华， 向艾滋病毒感染高风险人群免费提供，包括注射毒品者（PWID）。我们进一步 目的是检查关键的艾滋病毒相关的合并症，特别是疼痛和神经认知障碍， HIV阴性和HIV阳性PWID的合并样本以及对物质使用模式的相关影响， 参与艾滋病毒预防和MAT。该项目涉及温哥华吸毒者的延续 研究（V-DUS; n = 1800），这是一项持续时间最长的社区招募的前瞻性队列研究。 非法药物使用者（PWUD）V-DUS由以下两个嵌套队列组成： 自1996年以来，艾滋病毒阴性的14-26岁街头吸毒青年和艾滋病毒阴性的成年PWID。我们 研究背景是拟议工作的一个关键创新特点。温哥华是一个港口城市， 非法药物供应量大，使用普遍。这里是世界上 艾滋病毒在PWID中的急剧爆发，现在是正在进行的合成阿片类药物流行病的中心。在 针对这一问题，出台了一系列针对非法药物使用的开创性政策和方案， 其中的几个现在正在美国按比例增加和/或考虑。例如，一系列广泛的MAT是 通过全民医疗保健计划以低门槛的方式几乎免费提供， 允许我们检查MAT相关的结果，而不受保险计划的混淆影响， 与高门槛提供MAT相关的方案障碍。V-DUS也是 C3 PNO联盟，从而理想地定位于推进团队科学方法。V-DUS已经高度 是全球独一无二的宝贵资源，可用于推进艾滋病毒研究和培训未来的艾滋病毒感染者。 研究人员在上一个赠款周期，在超过160份同行评审出版物中，超过130份是由超过70名受训人员领导的。 V-DUS还与正在进行的由NIDA资助的艾滋病毒阳性PWUD队列相协调，因此是一个关键的 在工作中对艾滋病毒/艾滋病进行控制/比较是可能的。考虑到我们的环境和轨道 迄今为止，我们有能力为艾滋病毒预防和艾滋病毒- 相关共病，从而有助于NIH办公室确定的高和中等研究优先事项 艾滋病研究和宣传工作，以结束艾滋病毒/艾滋病的流行。