Impacts of universal access to HIV/AIDS care among HIV+ injection drug users

艾滋病毒注射吸毒者普遍获得艾滋病毒/艾滋病护理的影响

• 批准号: 8442739
• 负责人: Evan Wood
• 金额: $ 46.55万
• 依托单位: UNIVERSITY OF BRITISH COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-17 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8442739
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Antiretroviral drug resistance; Antiretroviral resistance; Attention; British Columbia; Canada; Caring; Characteristics; Charge; Cities; Clinical; Clinical Research; Clinical Trials; Cohort Studies; Communities; Companions; Consensus; Cost Savings; Data; Disease Progression; Drug user; Economics; Environment; Epidemic; Epidemiologic Studies; Epidemiology; Evaluation; Funding; Generations; Geographic Information Systems; Geographic state; HIV; HIV Infections; HIV Seropositivity; HIV risk; Health; Health Services; Healthcare; Healthcare Systems; Highly Active Antiretroviral Therapy; Home environment; Homelessness; Imprisonment; Incidence; Individual; Infection; Injecting drug user; Injection of therapeutic agent; International; Investigation; Knowledge; Laboratories; Light; Link; Marshal; Measures; Medical; Methods; Modeling; Molecular; Molecular Genetics; Monitor; Morbidity - disease rate; National Institute of Drug Abuse; Outcome; Pathogenesis; Pattern; Persons; Pharmaceutical Preparations; Phylogenetic Analysis; Plasma; Policies; Population; Prevalence; Prevention; Province; Public Health; Publications; RNA; Records; Research; Research Activity; Research Infrastructure; Resistance; Risk; Role; Running; Scientific Advances and Accomplishments; Shapes; Social Policies; State Government; Structure; Sum; Testing; Time; Treatment outcome; United States National Institutes of Health; Viral Load result; Vulnerable Populations; addiction; base; cohort; experience; health care service utilization; injection drug use; innovation; interest; mathematical model; member; mortality; prevent; programs; prospective; public health emergency; public health relevance; response; sex; transmission process; uptake

DESCRIPTION (provided by applicant): The purpose of this application is to seek renewed funding for a long-running prospective cohort of HIV- infected individuals who use injection drugs (IDU) linked to comprehensive HIV clinical monitoring to examine the impacts of individual, social, policy, economic, and physical exposures on HIV treatment outcomes. We seek to analyse the effects of these contextual determinants, including incarceration, homelessness, and involvement in the sex trade, on HIV RNA plasma viral load at both the individual and community levels. We will augment our ongoing epidemiologic and clinical research activities with molecular genetics and geographic information systems (GIS) based methods to model the effect of these exposures on community-level plasma viral load, HIV incidence, and the generation of antiretroviral drug resistance. In recognition of the increasing international attention to the HIV "risk environment," a conceptual framework modeling the effect of exogenous and endogenous characteristics on the risk of HIV infection, we will employ this structure to integrate data from individual and community levels in analyses of HIV treatment outcomes. This proposal comes at a time of broad international consensus on the need to respond urgently to persistently elevated levels of HIV-related morbidity and mortality among IDU. Emerging evidence from mathematical modeling, observational cohorts and clinical trials has revealed the close link between the HIV RNA viral load within individuals and at the community level and the risk of HIV transmission between individuals, resulting in lower rates of infection in populations with higher levels of coverage of highly active antiretroviral therapy (HAART.) This observation has led to renewed HIV prevention efforts to seek out members of vulnerable populations, test them for HIV infection, and engage them in healthcare, including treatment for HIV infection, in order to reduce HIV-related morbidity and mortality and lower the incidence of HIV seroconversion. Our proposed study will be conducted during a province-wide "Seek, Test, and Treat" campaign. Given the study infrastructure established to date and our track record evaluating barriers to HAART access and adherence, we are uniquely well placed to prospectively assess second-generation questions regarding the treatment as prevention campaign's impacts on community-level plasma viral loads, HAART resistance, and HIV incidence. In this regard, evaluations of treatment as prevention are an urgent priority in the FY 2012 Trans-NIH Plan for HIV-Related Research. In addition to the "Seek, Test, and Treat" campaign, our study setting of Vancouver, Canada, is ideally suited to our study aims. The universal healthcare system provides all medical care, including HAART, free of charge. Confidential record linkages allow the accurate attainment of all key measures, including health service utilization and HIV clinical outcomes. This application proposes a program of rigorous and innovative study that will marshal epidemiologic, geographic, and phylogenetic approaches to critically inform efforts to respond to HIV transmission and pathogenesis among IDU.

描述（由申请人提供）：本申请的目的是为使用注射药物（IDU）的HIV感染者的长期前瞻性队列寻求新的资金，该队列与全面的HIV临床监测相关，以检查个人、社会、政策、经济和身体暴露对HIV治疗结果的影响。我们试图分析这些环境决定因素，包括监禁、无家可归和参与性交易，在个人和社区层面上对HIV RNA血浆病毒载量的影响。我们将利用基于分子遗传学和地理信息系统（GIS）的方法来加强我们正在进行的流行病学和临床研究活动，以模拟这些暴露对社区水平血浆病毒载量、艾滋病毒发病率和抗逆转录病毒耐药性产生的影响。认识到国际上对艾滋病毒“风险环境”的关注日益增加，这是一个概念框架，对外源性和内源性特征对艾滋病毒感染风险的影响进行建模，我们将采用这一结构来整合来自个人和社区层面的数据，以分析艾滋病毒治疗结果。这项建议是在国际上就需要紧急应对注射吸毒者中与艾滋病毒有关的发病率和死亡率持续上升的问题达成广泛共识的时候提出的。来自数学模型、观察队列和临床试验的新证据表明，个人和社区层面的艾滋病毒RNA病毒载量与个人之间的艾滋病毒传播风险之间存在密切联系，从而导致高活性抗逆转录病毒治疗（HAART）覆盖率较高的人群的感染率较低。这一观察结果促使重新开展艾滋病毒预防工作，寻找弱势群体成员，对他们进行艾滋病毒感染检测，并使他们参与包括艾滋病毒感染治疗在内的保健工作，以减少与艾滋病毒相关的发病率和死亡率，并降低艾滋病毒血清转化的发生率。我们提出的研究将在全省范围内的“寻求、检测和治疗”活动中进行。鉴于迄今为止建立的研究基础设施和我们评估HAART获取和依从性障碍的记录，我们具有独特的优势，可以前瞻性地评估关于治疗作为预防运动对社区水平血浆病毒载量、HAART耐药性和HIV发病率的影响的第二代问题。在这方面，将治疗作为预防的评估是2012财年跨nih艾滋病相关研究计划的当务之急。除了“寻找、测试和治疗”活动外，我们在加拿大温哥华的研究环境非常适合我们的研究目标。全民医疗保健系统免费提供包括HAART在内的所有医疗服务。保密记录联系可以准确实现所有关键措施，包括保健服务利用和艾滋病毒临床结果。本申请提出了一个严谨和创新的研究项目，将汇集流行病学、地理和系统发育方法，为应对注射吸毒者之间的艾滋病毒传播和发病机制提供重要信息。