Epidemiology of Syphilis among IDUs in Tijuana, Mexico

说明(申请人提供)：本提案的目的是从个人、社会网络以及环境和结构因素方面描述提华纳注射吸毒者中梅毒的流行病学特征，并应用流行病学、地理和网络方法相结合的方法，告知和制定结构性和/或以同伴为基础的减少性风险干预措施。这符合NIDA流行病、服务和预防研究部门的使命声明，即“通过促进综合方法来了解和解决个人与环境之间的互动，从而改善国家的公共健康，这些互动有助于与药物使用有关的一系列问题。”在该项目的头两年，申请者将进行课程作业和独立研究，以建立她在社会网络分析、多层次建模和地理信息系统(GIS)领域的知识库和技能。这些技能的实际应用将通过对提华纳参与“Proyecto El Cuete”的注射吸毒者中梅毒传播的个人、网络和地理方面的建模来获得，“Proyecto El Cuete”是由主要导师Steffanie Strathdee博士建立的预期注射吸毒者队列。在项目的独立阶段，申请者将应用通过这些方法获得的信息来告知和制定结构级别的性风险减少干预措施。干预将侧重于在第一阶段确定的高危群体，并将重点放在结构层面的因素上，根据第一阶段的结果以及这些方法在社区中的接受程度和可行性，采用基于场地的方法和/或同行外联方法。将利用感兴趣社区内的初始焦点小组来评估和制定干预的不同想法，并使用干预前/干预后测试设计来测试干预的有效性。性传播感染仍然是全球的一个重要负担，这既是因为它们本身的长期并发症，也是因为它们对艾滋病毒传播的影响。除了在提华纳的高危人群中增加检测和治疗，进而在圣地亚哥的相关社区中增加检测和治疗的直接好处外，这项提案还着手制定新的方法组合，以有效和高效率地评估高危群体中的传播模式，并揭示可应用于制定干预措施的背景和结构因素。

DESCRIPTION (provided by applicant): The objectives of this proposal are to characterize the epidemiology of syphilis among IDUs in Tijuana, with respect to individual, social network and environmental and structural factors, and to apply a combination of epidemiological, geographical and network methods to inform and develop a structural-level and/or peer-based sexual risk reduction intervention. This addresses NIDA's Division of Epidemiology, Services and Prevention Research mission statement to "improve the nation's public health by promoting integrated approaches to understand and address interactions between individuals and environments that contribute to the continuum of problems related to drug use." During the first two mentored years of the project, the applicant will undertake coursework and independent studies to build her knowledge base and skills in the areas of social network analyses, multi-level modeling and geographic information systems (GIS). Practical application of these skills will be obtained through modeling individual, network and geographical aspects of syphilis transmission among IDUs in Tijuana participating in the 'Proyecto El Cuete', a prospective cohort of IDUs established by the primary mentor, Dr. Steffanie Strathdee. During the independent phase of the project, the applicant will apply the information gained through these methods to inform and develop a structural-level sexual risk reduction intervention. The intervention will focus on high risk groups identified during the first phase, and will focus on structural-level factors, applying either venue-based and/or peer-outreach methods, depending on the results from phase one and the level of acceptance and feasibility of these methods within the community. Initial focus groups within the community of interest will be used to assess and develop different ideas for the intervention, and the effectiveness of the intervention will be tested using a pre/post-intervention test design. STIs remain an important burden globally, both due to their own long-term complications, as well as their impact on HIV transmission. In addition to the immediate benefit of increased testing and treatment among the high risk populations in Tijuana and, by extension, the connected communities in San Diego, this proposal sets out to derive new combinations of methods to effectively and efficiently assess transmission patterns among high risk groups and uncover contextual and structural factors for application in the development of interventions.