Colliding Epidemics During an Opioid Crisis: Impact of the COVID-19 Pandemic on Determinants of HIV and HCV Transmission Among People Who Inject Drugs

阿片类药物危机期间的流行病冲突：COVID-19 大流行对注射吸毒者中 HIV 和 HCV 传播决定因素的影响

• 批准号: 10471832
• 负责人: Eshan Uday Patel
• 金额: $ 4.68万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10471832
• 关键词: Acquired Immunodeficiency Syndrome; Age; Antiviral Therapy; Anxiety; Area; Baltimore; Behavioral; Biological Factors; COVID-19 pandemic; COVID-19 pandemic effects; COVID-19 vaccination; Cities; Communities; Coupled; Data; Disease Outbreaks; Environment; Epidemic; Epidemiologist; Epidemiology; Equation; Equipment; Feeling; Frequencies; Future; Goals; HIV; HIV Infections; HIV/HCV; Harm Reduction; Health; Health Services Accessibility; Healthcare; Hepatitis C; Hepatitis C Incidence; Hepatitis C Prevalence; Hepatitis C Transmission; Hepatitis C Viremia; Hepatitis C co-infection; Hepatitis C virus; Individual; Injecting drug user; Injections; Interruption; Interview; Intravenous; Link; Measures; Mental Depression; Mentors; Methods; National Institute of Drug Abuse; Needle Sharing; Needle-Exchange Programs; Needles; Neighborhoods; Participant; Patient Self-Report; Pattern; Personal Satisfaction; Persons; Pharmaceutical Preparations; Phase; Population; Population Decreases; Prevalence; Psychosocial Factor; Public Health; Public Health Schools; Qualitative Research; Research; Research Training; Risk; Risk Factors; Running; Sampling; Series; Services; Social Distance; Social isolation; Stress; Subgroup; Time; Time Series Analysis; Time trend; Training Programs; Transportation; United States; United States Public Health Service; Vaccination; Viremia; antiretroviral therapy; base; cohort; doctoral student; effective therapy; experience; follow-up; health care availability; high risk; improved; injection drug use; long term consequences of COVID-19; opioid epidemic; opioid injection; opioid overdose; opioid use disorder; pandemic disease; prevention service; psychosocial; residence; response; scale up; service uptake; service utilization; social contact; sociodemographics; statistics; substance use; testing services; transmission process; treatment services; trend; uptake

PROJECT SUMMARY/ABSTRACT The U.S. plans to End the HIV Epidemic (EHE) and eliminate hepatitis C virus (HCV) infection by 2030. While progress has been made in many groups including people who inject drugs (PWID), recent outbreaks of HCV and HIV infection have been documented among PWID in the U.S and HCV incidence is increasing nationally due to the opioid crisis. The COVID-19 pandemic, including the public health response, has resulted in disruptions in access to services and created an environment that enables substance use. Indeed, the COVID- 19 pandemic may further threaten the U.S.' plan to EHE and eliminate HCV by exacerbating the opioid crisis. The objective of this study is to assess the short- and long-term impacts of the COVID-19 pandemic on individual- and community-level determinants of HIV and HCV transmission among PWID in Baltimore, MD. The specific aims are to: (1) identify individual-level predictors of high-risk injection practices among PWID during the COVID-19 pandemic, (2) examine trends in harm reduction utilization and identify associated barriers and facilitators among PWID during the COVID-19 pandemic, and (3) evaluate the impact of the COVID-19 pandemic on the population-level prevalence of HIV and HCV viremia among PWID. These aims will be achieved by leveraging data from one of the largest and longest running cohorts of community-based PWID worldwide—the AIDS Linked to the IntraVenous Experience (ALIVE) study in Baltimore, MD. Aim 1 will identify pre-pandemic sociodemographic, behavioral, psychosocial, and biological factors associated with high- risk injection practices during the pandemic using modified Poisson regression with generalized estimating equations. Aim 2 will use a mixed-methods sequential explanatory approach to examine changes in the population-level uptake of needle/syringe exchange services and medication for opioid use disorder before and during different phases of the pandemic (2015-2021). In-depth interviews will be conducted with 25-30 PWID to explore new barriers and facilitators to service utilization. Aim 3 will use an interrupted time-series analytic approach to estimate the effect of the pandemic on the prevalence of HIV viremia and HCV viremia (2015- 2023). This study will inform whether the pandemic poses a major threat to the local and national goals to EHE and eliminate HCV infection. This study will also inform the implementation of surveillance and programmatic strategies to mitigate HIV/HCV transmission during the ongoing pandemic and opioid crisis as well as during future periods of unrest and instability. The proposed study, which covers a high priority area for NIDA, will serve as the doctoral dissertation for Mr. Eshan Patel, a PhD student in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. A comprehensive training program including mentored research training from experts in HIV, HCV, and substance use epidemiology, psychosocial statistics, qualitative research, and causal inference will provide the applicant a tailored experience to achieve his goal of becoming an academic epidemiologist that contributes to the elimination of HIV and HCV among PWID.

项目概要/摘要 美国计划到 2030 年结束艾滋病毒流行 (EHE) 并消除丙型肝炎病毒 (HCV) 感染。 许多群体都取得了进展，包括注射吸毒者 (PWID)、最近爆发的丙肝病毒 (HCV) 在美国，吸毒者中已有 HIV 感染记录，且全国范围内的 HCV 发病率正在上升 由于阿片类药物危机。 COVID-19 大流行，包括公共卫生应对措施，导致 服务获取中断并创造了有利于物质使用的环境。事实上，新冠肺炎—— 19日大流行可能进一步威胁美国”计划通过加剧阿片类药物危机来消除 EHE 和消除 HCV。 本研究的目的是评估 COVID-19 大流行对人们的短期和长期影响 马里兰州巴尔的摩注射吸毒者中艾滋病毒和丙型肝炎病毒传播的个人和社区层面的决定因素。 具体目标是：（1）确定注射吸毒者中高风险注射行为的个体水平预测因素 在 COVID-19 大流行期间，(2) 检查减少危害利用的趋势并确定相关的 COVID-19 大流行期间注射吸毒者的障碍和促进因素，以及 (3) 评估吸毒者的影响 COVID-19 大流行对吸毒者中 HIV 和 HCV 病毒血症人群流行率的影响。这些目标 将通过利用最大且运行时间最长的社区群体之一的数据来实现 全球注射吸毒者——在马里兰州巴尔的摩进行的艾滋病与静脉注射经历相关 (ALIVE) 研究。目标1将 确定大流行前与高风险相关的社会人口、行为、心理和生物因素 大流行期间使用修正泊松回归和广义估计进行风险注​​入实践 方程。目标 2 将使用混合方法顺序解释方法来检查 在使用针头/注射器交换服务和阿片类药物使用障碍药物之前和之后，人群接受针头/注射器交换服务和药物的情况 在大流行的不同阶段（2015-2021）。将对 25-30 名注射吸毒者进行深入访谈，以 探索服务利用的新障碍和促进因素。目标 3 将使用中断时间序列分析 估计大流行对 HIV 病毒血症和 HCV 病毒血症流行率影响的方法（2015- 2023）。这项研究将告知该流行病是否对地方和国家的 EHE 目标构成重大威胁 并消除HCV感染。这项研究还将为监测和计划的实施提供信息 在持续的大流行和阿片类药物危机期间以及在 未来的动荡和不稳定时期。拟议的研究涵盖了 NIDA 的高度优先领域，将 作为该校流行病学系博士生 Eshan Patel 先生的博士论文 约翰霍普金斯大学彭博公共卫生学院。全面的培训计划，包括指导 由艾滋病毒、丙型肝炎病毒和药物滥用流行病学、心理社会统计学专家提供的研究培训， 定性研究和因果推理将为申请人提供量身定制的体验，以实现他的目标 成为一名学术流行病学家，为消除吸毒者中的艾滋病毒和丙肝病毒做出贡献。