Crossing Borders: HIV and Substance use at the Gateway to North America

跨境：北美门户的艾滋病毒和药物使用

• 批准号: 8517063
• 负责人: Kimberly C Brouwer
• 金额: $ 37.7万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-15 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8517063
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adult; Affect; Alcohol or Other Drugs use; American; Anti-Retroviral Agents; Antiretroviral drug resistance; Area; Automobile Driving; Behavior; Border Crossings; Central America; Central American; Cocaine; Collaborations; Consumption; Corridor Disease; DA10; Data; Development; Drug resistance; Drug usage; Economic Conditions; Epidemic; Epidemiology; Female; Focus Groups; Fostering; Geography; Goals; Grant; Guatemala; Guatemalan; HIV; HIV Seropositivity; HIV-1; Head; Health; Health Services Accessibility; Hepatitis C virus; Human Herpesvirus 2; Human immunodeficiency virus test; Infection; Institution; International; Intervention; Interview; Knowledge; Latin America; Marketing; Measures; Methods; Mexican; Mexico; Migrant Workers; Molecular; Molecular Epidemiology; Monitor; National Institute of Drug Abuse; Nomads; North America; Pattern; Persons; Pharmaceutical Preparations; Population; Predisposition; Prevalence; Prevention program; RNA-Directed DNA Polymerase; Recombinants; Recording of previous events; Recruitment Activity; Research; Research Personnel; Respondent; Risk; Risk Behaviors; Role; Route; Sampling; Seeds; Sexually Transmitted Diseases; Side; Site; South America; South American; Staging; Subgroup; Substance abuse problem; Syphilis; Virulence; Work; Youth; age group; aged; base; cocaine use; cohort; contextual factors; disease transmission; high risk; injection drug use; instrument; meetings; men who have sex with men; migration; peer; pol genes; prevent; resistant strain; response; sex; stem; trafficking; transmission process; vaccine development; young woman

DESCRIPTION (provided by applicant): The overarching goal of this study is to explore the context of rising drug use along the Mexico/Guatemala border and define its relationship to the local epidemiology and phylo-geography of HIV and sexually transmitted infections (STIs). Shifting drug trafficking routes, poor economic conditions, and increasing popularity of hard drugs among youth may be some of the factors driving substance use. Numerous regional and international migrants passing through the area likely contribute to the spread of HIV and STIs. However, data is lacking on the relationship between drug use and HIV/STIs in the region. Based on the above, the specific aims of this project are to: 1) describe the contextual factors affecting drug use and patterns of use in high risk populations along the Mexico/Guatemala border; 2) determine the prevalence and correlates of HIV, hepatitis C virus (HCV), and STIs among substance users; and 3) explore the phylo-geography and molecular epidemiology of HIV-1 infection in at-risk groups. To meet Aim 1, 20 in-depth interviews with a diverse sample of substance users in Tapachula/Ciudad Hidalgo, Mexico and 20 in the Teczn Uman/Quetzaltenango area of Guatemala will be conducted to provide contextual data on risk behaviors and help refine study instruments and methods. Additionally, focus groups with substance using men who have sex with men (MSM), female sex workers (FSW), and migrants, as well as with organizations serving those at-risk for HIV will be conducted. To meet Aim 2, three consecutive cross-sectional cohorts (n=400, 200 on each side of the border) will be recruited using respondent-driven sampling (RDS). Face-to-face interviews will collect information on sociodemographics, HIV/STI knowledge, risk behaviors, and access to health services. All will be tested for HIV, syphilis, herpes simplex virus-2, and HCV, and treated as needed. Round 1 will comprise substance using FSWs; Round 2 will focus on the MSM population; and Round 3 will begin with peer recruiters ("seeds") drawn from "mobile" persons- including truck drivers, deportees and regional and international migrants. We anticipate and will be able to measure the overlap between these risk groups. For Aim 3, we will sequence the HIV-1 pol gene, including reverse transcriptase, from those infected with HIV which will enable us to assess if recombinants or drug resistant strains of HIV-1 have emerged in this region and the extent to which there is mixing between at-risk groups. As migration routes have been identified as important corridors of disease transmission in other settings, they may be one of the first places new HIV subtypes will be identified. This project will create and expand ties among investigators in Mexico, Guatemala, and the U.S. and increase regional research capacity. Findings will help inform the development of subsequent HIV interventions and prevention programs that intervene upon risky substance use behaviors before they become further entrenched. Since the HIV epidemic in most of Latin America is still concentrated, there is a critical window of opportunity to prevent transition to a generalized epidemic.

描述（由申请人提供）：本研究的总体目标是探索墨西哥/危地马拉边境沿着毒品使用增加的背景，并确定其与当地流行病学和艾滋病毒和性传播感染（STI）的地理分布的关系。毒品贩运路线的改变、经济状况不佳以及硬毒品在青年中日益流行可能是推动药物使用的一些因素。许多经过该地区的区域和国际移民可能助长了艾滋病毒和性传播感染的传播。然而，缺乏关于该区域吸毒与艾滋病毒/性传播感染之间关系的数据。基于上述情况，该项目的具体目标是：1）描述影响墨西哥/危地马拉边境高危人群吸毒和吸毒模式的背景因素; 2）确定吸毒者中艾滋病毒、丙型肝炎病毒和性传播感染的流行率和相关因素; 3）探索高危人群中艾滋病毒-1感染的地理分布和分子流行病学。为实现目标1，将对墨西哥塔帕丘拉/伊达尔戈城和危地马拉Teczn Uman/克萨尔特南戈地区的不同药物使用者样本进行20次深入访谈，以提供关于风险行为的背景数据，并帮助改进研究工具和方法。此外，还将与使用药物的男男性行为者、女性性工作者和移民以及为艾滋病毒高危人群提供服务的组织建立重点小组。为了满足目标2，将使用应答者驱动抽样（RDS）招募三个连续的横断面队列（n=400，边界两侧各200）。面对面访谈将收集有关社会人口统计、艾滋病毒/性传播感染知识、风险行为和获得医疗服务的信息。所有人都将接受艾滋病毒、梅毒、单纯疱疹病毒2型和丙型肝炎病毒的检测，并根据需要进行治疗。第一轮将包括使用性工作者的物质;第二轮将侧重于男男性行为者群体;第三轮将开始从“移动的”人-包括卡车司机、被驱逐者以及区域和国际移民-中招募同伴（“种子”）。我们预计并将能够衡量这些风险群体之间的重叠。对于目标3，我们将对艾滋病毒感染者的HIV-1 pol基因（包括逆转录酶）进行测序，这将使我们能够评估该地区是否出现了HIV-1重组株或耐药株，以及风险群体之间的混合程度。由于移徙路线已被确定为其他环境中疾病传播的重要走廊，它们可能是最先确定新艾滋病毒亚型的地方之一。该项目将在墨西哥、危地马拉和美国的研究人员之间建立和扩大联系，并提高区域研究能力。研究结果将有助于为随后的艾滋病毒干预和预防计划的发展提供信息，这些计划在危险的物质使用行为进一步根深蒂固之前进行干预。由于艾滋病毒疫情在拉丁美洲大部分地区仍然是集中的，因此有一个关键的机会之窗，可以防止转变为普遍流行病。