The Role of Dead Space Syringes in HIV Epidemics Amount IDU's - Drug Abuse Aspect

死亡空间注射器在艾滋病毒流行中的作用 注射吸毒者数量 - 药物滥用方面

• 批准号: 7682792
• 负责人: WILLIAM A ZULE
• 金额: $ 8.05万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-03-01 至 2011-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7682792
• 关键词: Accounting; Acute; Asia; Belief; Blood; China; Cities; Country; Data; Drug abuse; Eastern Europe; Epidemic; Epidemiologic Studies; Europe; General Population; HIV; HIV Infections; Hepatitis C; Incidence Study; India; Individual; Infection; Injecting drug user; Injection of therapeutic agent; Intervention; Investments; Knowledge; Lead; Link; Low Prevalence; Modeling; Needle Sharing; One-Step dentin bonding system; Play; Population; Prevalence; Process; Recording of previous events; Research Personnel; Resources; Risk; Role; Russia; Sexual Transmission; Site; Syringes; Testing; Time; Unsafe Sex; Virus; comparison group; experience; high risk; mathematical model; novel; premature; public health relevance; transmission process

DESCRIPTION (provided by applicant): HIV continues to spread among injecting drug users (IDUs) in many countries around the world. In recent years, cities in Eastern Europe, the Russian Federation, India, China, and other parts of Asia have experienced rapid increases in HIV prevalence among IDUs, while HIV prevalence has remained low and stable among IDUs in other cities despite high levels of injecting risk. Twenty-five years into the HIV epidemic among IDUs, researchers still do not really know why the virus spreads more in some places than others. Simple rates of syringe sharing and unprotected sex do not account for varying degrees of HIV transmission. One widely overlooked factor that could significantly contribute to these differences in HIV spread is the type of syringes that IDUs are using. The proposed study represents one step in the process of assessing the role of syringe type in HIV epidemics among IDUs. To date, we have established that it is biologically plausible that the type of syringe may play a role in HIV transmission by demonstrating that high dead-space syringes (HDSSs) retain over 1,000 times more blood after use and rinsing than low dead-space syringes (LDSSs) retain. We have linked a history of sharing HDSSs with prevalent HIV and HCV infection, and we have developed mathematical models that suggest injection-related HIV epidemics may not occur in cities, if fewer than 10% of IDUs are using HDSSs. The next step is to collect empirical data to test this finding. Large multisite longitudinal HIV incidence studies that collect data from individual IDUs on the types of syringes that they are using will be needed to establish a causal relationship between HDSSs and HIV infection among IDUs. However, these studies would require a considerable investment in time and money. Thus, we propose to conduct a small exploratory study to identify cities in Europe, Russia, and Asia where HIV prevalence among IDUs is high and cities where HIV prevalence among IDUs is low. We will seek to obtain information on the types of syringes that IDUs are using in these cities. The proposed study has the potential for yielding extremely valuable data for minimal investment. The specific aim of the proposed study is: To compare the types of syringes used by IDUs in cities where HIV prevalence among IDUs is high (>30%) or increasing (>5% per year for >3 years) with the types of syringes that IDUs are using in a matched comparison group of cities with low and stable HIV prevalence (<5% for >5 years). Should we find an ecological association between use of HDSSs and HIV prevalence, we will propose larger studies with the purpose of better delineating causal inference, including the role for sexual transmission. PUBLIC HEALTH RELEVANCE: The information obtained in this project may substantially increase our knowledge of HIV transmission among injecting drug users (IDUs). If we find that the types of syringes used by IDUs influence HIV transmission, this could lead to relatively straightforward interventions that could substantially reduce HIV transmission in this high risk group. This in turn could reduce sexual transmission of HIV from IDUs to the general population.

描述（由申请人提供）：艾滋病毒继续在世界许多国家的注射吸毒者 (IDU) 中传播。近年来，东欧、俄罗斯联邦、印度、中国和亚洲其他地区的城市注射吸毒者中艾滋病毒感染率迅速上升，而其他城市的注射吸毒者中艾滋病毒感染率尽管注射风险较高，但仍保持在较低水平且稳定。艾滋病毒在注射吸毒者中流行已经二十五年了，研究人员仍然不知道为什么这种病毒在某些地方比其他地方传播得更多。简单的共用注射器率和无保护性行为并不能解释不同程度的艾滋病毒传播。注射吸毒者使用的注射器类型是导致艾滋病毒传播差异的一个被广泛忽视的因素。拟议的研究代表了评估注射器类型在注射吸毒者中艾滋病毒流行中的作用过程中的一个步骤。迄今为止，我们通过证明高死腔注射器 (HDSS) 在使用和冲洗后保留的血液比低死腔注射器 (LDSS) 保留的血液多 1,000 倍以上，从生物学角度证明注射器类型可能在 HIV 传播中发挥作用。我们将共享 HDSS 的历史与流行的 HIV 和 HCV 感染联系起来，并且我们开发了数学模型，表明如果少于 10% 的注射吸毒者使用 HDSS，城市中可能不会发生与注射相关的 HIV 流行。下一步是收集经验数据来检验这一发现。需要开展大型多地点纵向艾滋病毒发病率研究，收集个体注射吸毒者所使用注射器类型的数据，以建立 HDSS 与注射吸毒者中艾滋病毒感染之间的因果关系。然而，这些研究需要投入大量的时间和金钱。因此，我们建议进行一项小型探索性研究，以确定欧洲、俄罗斯和亚洲注射吸毒者中艾滋病毒感染率较高的城市和注射吸毒者中艾滋病毒感染率较低的城市。我们将寻求获取有关这些城市注射吸毒者使用的注射器类型的信息。拟议的研究有可能以最少的投资产生极其有价值的数据。拟议研究的具体目的是：将注射吸毒者艾滋病毒感染率较高（>30%）或呈上升趋势（>3年每年>5%）的城市注射吸毒者使用的注射器类型与艾滋病毒感染率较低且稳定的城市（>5年<5%）匹配的对照组中注射吸毒者使用的注射器类型。如果我们发现 HDSS 的使用与艾滋病毒流行之间存在生态关联，我们将提出更大规模的研究，以更好地描述因果推论，包括性传播的作用。 公共卫生相关性：本项目中获得的信息可能会大大增加我们对注射吸毒者 (IDU) 中艾滋病毒传播的了解。如果我们发现注射吸毒者使用的注射器类型会影响艾滋病毒的传播，那么可能会采取相对简单的干预措施，从而大大减少这一高危人群中艾滋病毒的传播。这反过来又可以减少艾滋病毒从注射吸毒者向普通人群的性传播。