The Diversion of Antiretroviral Medications to Street Markets

抗逆转录病毒药物转移到街头市场

• 批准号: 8223567
• 负责人: HILARY L SURRATT
• 金额: $ 29.5万
• 依托单位: NOVA SOUTHEASTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-12-01 至 2012-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8223567
• 关键词: AIDS/HIV problem; Address; Adherence; Anti-Retroviral Agents; Area; Attitude; Benzodiazepines; Caring; Combivir; Communication; County; Deterioration; Development; Dimensions; Drug Delivery Systems; Drug Prescriptions; Drug resistance; Drug usage; Drug user; Economics; Environmental Monitoring; Environmental Risk Factor; Exposure to; Family; Florida; Foundations; Fraud; Frequencies; Funding; Gilead brand of tenofovir disoproxil fumarate; Goals; Government Agencies; HIV; HIV Infections; HIV Seropositivity; HIV drug resistance; Health; Health Personnel; Healthcare; Healthcare Systems; Homelessness; Indigent; Individual; Industry; Injection of therapeutic agent; Internet; Intervention; Interview; Lamivudine; Left; Legal; Literature; Location; Lopinavir/Ritonavir; Marketing; Medicaid; Medical; Medicare/Medicaid; Mental Health; Methods; Modeling; Motivation; Narcotic Analgesics; National Institute of Drug Abuse; Nature; Nelfinavir Monomethane Sulfonate; Newly Diagnosed; Opioid; Oxycodone; Patients; Pattern; Percocet; Pharmaceutical Preparations; Pharmacologic Substance; Pharmacy facility; Phase; Physicians' Offices; Policies; Prevention; Price; Process; Provider; Public Health; Published Comment; Qualitative Research; Recording of previous events; Recruitment Activity; Regimen; Reporting; Research; Research Personnel; Risk Management; Ritonavir; Sampling; Site; Source; Stavudine; Substance abuse problem; Tenofovir; Testing; Tetrahydrocannabinol; Time; Treatment Protocols; Trizivir; Unsafe Sex; Vulnerable Populations; Waiting Lists; Work; Zidovudine; abacavir; abacavir sulfate; base; drug abuser; drug resistant virus; efavirenz; effective therapy; emtricitabine; experience; follow-up; health care service utilization; health organization; pill; prescription drug abuse; pressure; programs; resistant strain; sustiva; theories; transmission process; truvada; viracept

DESCRIPTION (provided by applicant): Prescription drug "diversion" -- the unlawful channeling of regulated pharmaceuticals from legal sources to the illicit marketplace -- has been a topic of widespread commentary since the latter part of the 1990s, and a number of recent studies have addressed patterns of narcotic analgesic abuse and diversion. The scientific literature, however, has been virtually silent regarding the diversion of antiretroviral medications (ARV) for HIV. Nevertheless, pilot work conducted by the investigators of this application suggests that ARV diversion is a growing problem among drug-involved individuals in Miami, and is likely occurring in other large urban centers where rates of HIV infection are high. The ramifications of this diversion are potentially significant. Importantly, those prescribed ARV medications may not be consistently adhering to their treatment regimens, resulting in a deterioration of their own health and increasing the potential for the emergence of medication-resistant strains of HIV. From a public health perspective, the widespread transmission of drug-resistant HIV could leave newly-infected individuals with few viable treatments. Within this context, the overall goals of the proposed 4-year project are to examine the patterns and predictors of ARV diversion among drug-involved HIV-positive individuals in Miami (Dade County), Florida, and to describe the dynamics of ARV medication diversion to local street markets. The study will utilize a theory-driven, mixed method approach to achieve these goals. The specific aims of the qualitative component of the proposed research are to: 1) Describe the key individual, provider, and environmental factors that influence ARV diversion through formative qualitative research; and, 2) Adapt and refine the Andersen model of health services utilization to include the key dimensions of ARV diversion identified in the formative qualitative research phase. Aims 1 and 2 will be accomplished by: 1) Conducting baseline and follow-up in-depth interviews with 90 drug-involved, indigent, HIV positive ARV diverters and non-diverters to examine motivations for diversion and non-diversion over time; 2) Conducting baseline and follow-up in-depth interviews with 30 "pill brokers" to document their ARV diversion activities over time; and, 3) Conducting in-depth baseline and follow-up interviews with 45 HIV positive buyers of illicit ARVs to examine motivations for illicit ARV purchases over time. The primary specific aim of the quantitative component of the research is to: 3) Compare the key differences between ARV diverters and non-diverters on individual, provider, and environmental level factors described by the modified Andersen Model of health services utilization, and examine their effects on patterns of ARV medication diversion. Aim 3 will be accomplished by: 1) Recruiting a sample of 500 indigent, HIV positive individuals who are current drug users [250 of whom divert ARV medications and 250 who do not]; and, 2) assessing the constellation of individual, provider and environmental factors hypothesized to predict ARV diversion. PUBLIC HEALTH RELEVANCE: A comprehensive understanding of the nature, motivations for, and mechanisms of ARV medication diversion is critical for funding and regulatory agencies, industry, public health organizations, and health care providers as they attempt to develop appropriate prevention, risk management, treatment, and policy initiatives. Most importantly, this study will inform interventions targeting the significant health consequences of ARV diversion and non-adherence by highly vulnerable populations.

描述（由申请人提供）：处方药“转移”--将受监管的药品从法律的来源非法转移到非法市场--自20世纪90年代后期以来一直是广泛评论的话题，最近的一些研究已经解决了麻醉镇痛药滥用和转移的模式。然而，科学文献几乎没有提到用于艾滋病毒的抗逆转录病毒药物的转移。然而，本申请的调查人员进行的试点工作表明，抗逆转录病毒药物转移是迈阿密吸毒者中日益严重的问题，而且很可能发生在艾滋病毒感染率高的其他大城市中心。这种转移的后果可能很严重。重要的是，这些处方抗逆转录病毒药物可能无法始终坚持其治疗方案，导致其自身健康状况恶化，并增加了出现抗药性艾滋病毒菌株的可能性。从公共卫生的角度来看，抗药性艾滋病毒的广泛传播可能使新感染者几乎没有可行的治疗方法。在此背景下，拟议的4年期项目的总体目标是研究佛罗里达迈阿密（戴德县）涉及毒品的艾滋病毒阳性个体中抗逆转录病毒药物转移的模式和预测因素，并描述抗逆转录病毒药物转移到当地街头市场的动态。本研究将采用理论驱动的混合方法来实现这些目标。拟议研究的定性部分的具体目标是：1）通过形成性定性研究描述影响抗逆转录病毒药物转移的关键个人、提供者和环境因素; 2）调整和完善卫生服务利用的安德森模型，以包括形成性定性研究阶段确定的抗逆转录病毒药物转移的关键维度。目标1和2将通过以下方式实现：⑴对90名吸毒、贫穷、艾滋病毒阳性的抗逆转录病毒药物转用者和非转用者进行基线和后续深入访谈，以审查长期转用和非转用的动机; ⑵对30名“药丸经纪人”进行基线和后续深入访谈，以记录其长期转用抗逆转录病毒药物的活动;对45名HIV阳性的非法抗逆转录病毒药物购买者进行深入的基线和随访访谈，以检查随着时间的推移非法购买抗逆转录病毒药物的动机。定量研究的主要目的是：3）比较ARV药物转移者和非转移者在卫生服务利用的修正Andersen模型所描述的个人、提供者和环境水平因素上的关键差异，并检查它们对ARV药物转移模式的影响。目标3将通过以下方式实现：1）招募500名贫困、艾滋病毒呈阳性、目前吸毒者的样本[其中250人转移了抗逆转录病毒药物，250人没有转移];和，2）评估个人、提供者和环境因素的组合假设来预测抗逆转录病毒药物的转移。公共卫生关系：全面了解抗逆转录病毒药物转移的性质、动机和机制，对于资助和监管机构、行业、公共卫生组织和医疗保健提供者来说至关重要，因为他们试图制定适当的预防、风险管理、治疗和政策举措。最重要的是，这项研究将为针对高度脆弱人群的抗逆转录病毒药物转用和不依从的重大健康后果的干预措施提供信息。