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.

项目摘要/摘要 美国计划在2030年之前结束HIV流行（EHE）并消除丙型肝炎病毒（HCV）。 在包括注射毒品的人（PWID），最近爆发HCV的许多人中取得了进展 在美国的PWID中已经记录了HIV感染，HCV发病率正在增加全国 由于阿片类药物危机。包括公共卫生响应在内的Covid-19-大流行导致 访问服务的破坏并创建了能够使用物质的环境。确实，covid- 19大流行可能进一步威胁到美国。计划通过加剧阿片类药物危机来消除和消除HCV。 这项研究的目的是评估COVID-19大流行对的短期和长期影响 马里兰州巴尔的摩PWID中艾滋病毒和HCV传播的个人和社区级别的决定者。 具体目的是：（1）确定PWID中高风险注射实践的个体水平预测指标 （2）危害减少利用的检查趋势并确定相关的趋势 Covid-19-19大流行期间PWID之间的障碍和促进因子，（3）评估 COVID-19关于PWID中HIV和HCV病毒血症的人口水平患病率的大流行。这些目标 将通过利用数据中的数据之一来实现 全世界的PWID - 与马里兰州巴尔的摩的静脉经历（活着）研究有关的艾滋病。目标1意志 确定与高 - 高的社会人口统计学，行为，心理和生物学因素相关的 大流行期间使用改良的泊松回归的风险注射惯例和广义估计 方程式。 AIM 2将使用混合方法进行顺序挖掘方法来检查 人口级吸收针/注射器交换服务和用于阿片类药物使用障碍的药物 在大流行的不同阶段（2015-2021）。深入的访谈将与25-30 PWID进行 探索新的障碍和促进者以进行服务利用。 AIM 3将使用中断的时间序列分析 估计大流行对HIV病毒血症和HCV病毒血症患病率的影响的方法（2015-- 2023）。这项研究将告知大流行是否对当地和国家目标构成重大威胁 并消除HCV感染。这项研究还将告知监视和程序化的实施 在正在进行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的高优先级，将 作为Eshan Patel先生的博士学位论文，Eshan Patel先生是流行病学系的博士学位学生 约翰·霍普金斯彭博公共卫生学院。包括重要的全面培训计划 来自艾滋病毒，HCV和药物使用流行病学，心理社会统计学专家的研究培训， 定性研究和因果推论将为实现其目标提供适当的量身定制体验 成为一名学术流行病学家，有助于消除PWID中的艾滋病毒和HCV。