Individual, Network and Spatial Drivers of HIV and HCV among PWID in India

印度吸毒者中 HIV 和 HCV 的个体、网络和空间驱动因素

• 批准号: 9694647
• 负责人: Sunil Suhas Solomon
• 金额: $ 99.62万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9694647
• 关键词: Acquired Immunodeficiency Syndrome; Area; Awareness; Biometry; Caring; Cities; Clinical; Cluster randomized trial; Code; Cohort Studies; Computer software; Continuity of Patient Care; Data; Derivation procedure; Diffusion; Drug Monitoring; Drug resistance; Drug usage; Effectiveness; Enrollment; Environmental Risk Factor; Epidemic; Evaluation; Fingerprint; Fingers; Government; HIV; HIV Seropositivity; HIV/HCV; Harm Reduction; Health Services Accessibility; Hepatitis C; Hepatitis C Incidence; Hepatitis C Prevalence; Hepatitis C Transmission; Hepatitis C virus; Home environment; Incidence; India; Individual; Infrastructure; Injecting drug user; Injections; Intervention; Link; Methodology; Network-based; Out-Migrations; Outcome; Participant; Patient Self-Report; Persons; Phylogenetic Analysis; Population; Prevalence; Process; Public Health; Research Personnel; Resources; Respondent; Risk; Role; Sampling; Scanning; Services; Site; Social Network; Techniques; Therapeutic; Time; Update; Ursidae Family; Viral; behavior change; cohort; design; disease transmission; disenfranchised population; experience; health seeking behavior; improved; improved outcome; indexing; innovation; low and middle-income countries; member; mortality; next generation sequencing; novel; opioid user; peer; public health relevance; recruit; research study; residence; social; social metrics; transmission process; trend

 DESCRIPTION: People who inject drugs (PWID) bear a high burden of HIV and hepatitis C virus (HCV) and fare worse along the HIV care continuum. The interplay between individual, network and spatial factors on HIV/HCV risk, particularly in resource-limited settings, has been understudied. Further, most network assessments have been cross-sectional and have focused on egocentric networks. Less is understood about the dynamics of networks over time, relationship of egocentric networks to the broader sociometric or spatial networks, and the impact of these larger networks on disease transmission and health seeking behaviors. India is home to the largest number of opiate users globally; HIV and HCV prevalence is 20% and 50%, respectively. We are currently implementing a cluster-randomized trial to assess the effectiveness of integrated care centers on HIV care continuum outcomes among PWID. In the evaluation of this trial (July - December 2016), we will accrue a sample using respondent driven sampling (RDS) in 12 cities - this will serve as the starting point for this study. The specific ais are: Aim 1: To assess the impact of spatial-, network- and individual-level factors on HIV and HCV incidence among PWID in three Indian cities, selected to reflect diverse HIV/PWID epidemics; Subaim 1a: Use phylogenetic data to characterize HIV/HCV transmission in drug using networks; Aim 2: To assess the social diffusion of behavior change in relation to the HIV care continuum within drug using networks; Aim 3: To develop improved methodology for the application of RDS in PWID populations by overlaying detailed network data on an RDS recruitment process; Subaim 3a: To characterize factors that influence how PWID distribute coupons to members of their networks and the impact of this process on RDS- derived estimates; Subaim 3b: To develop improved RDS recruitment strategies to overcome biases identified in Subaim 3a; Subaim 3c: To determine overlap between the RDS network and phylogenetically-defined clusters to inform the use of RDS for intervention delivery and derivation of population-level estimates; and Aim 4: To establish a platform for future research studies. We will establish a multi-center dynamic cohort across 3 cities with diverse HIV/drug use epidemics in India - Churachandpur, Amritsar and Kanpur. We will characterize the social network of the first 350 participants from the evaluation RDS and recruit those who have injected with these participants in the prior 6 months. We will characterize and recruit eligible network members of new recruits iteratively until no additional new network members are identified (~750 per site; 2250 total). Biometric data, GPS coordinates and network software will facilitate tracking and identifying cross-network linkages. Participants will be followed semi-annually and new network members recruited as identified. Our study is innovative in its ability to track temporal network dynamics, use of novel methodology to characterize sociometric and spatial networks, characterization of network impact on transmission using phylogenetic data, and the social diffusion of health-seeking behaviors related to HIV within PWID networks.

 描述：注射毒品(PWID)的人承受着艾滋病毒和丙型肝炎病毒(丙型肝炎病毒)的沉重负担，在艾滋病毒护理连续过程中情况更糟。关于艾滋病毒/丙型肝炎病毒风险的个人、网络和空间因素之间的相互作用，特别是在资源有限的情况下，研究不足。此外，大多数网络评估都是跨部门的，侧重于以自我为中心的网络。关于网络随时间的动态变化、以自我为中心的网络与更广泛的社会计量或空间网络的关系，以及这些更大的网络对疾病传播和求医行为的影响，人们了解得更少。印度是全球阿片类药物使用者最多的国家；艾滋病毒和丙型肝炎病毒的流行率分别为20%和50%。我们目前正在实施一项整群随机试验，以评估综合护理中心对PWID中艾滋病毒护理连续结果的有效性。在这项试验的评估中(2016年7月至12月)，我们将在12个城市使用受访者驱动抽样(RDS)收集样本-这将作为本研究的起点。具体的辅助措施是：目标1：评估空间、网络和个人层面因素对艾滋病毒和丙型肝炎在印度三个城市的艾滋病毒和丙型肝炎发病率的影响，以反映不同的艾滋病毒/丙型肝炎流行；Subaim 1a：利用系谱数据来表征艾滋病毒/丙型肝炎在吸毒网络中的传播；目标2：评估与吸毒网络内艾滋病毒护理连续体有关的行为变化的社会扩散；目标3：通过覆盖关于RDS招募过程的详细网络数据，改进在PWID人群中应用RDS的方法；Subaim 3a：确定影响PWID向其网络成员分发优惠券的因素以及这一过程对RDS得出的估计的影响；Subaim 3b：制定改进的RDS招募战略，以克服Subaim 3a中确定的偏见；Subaim 3c：确定RDS网络与系统发育定义的集群之间的重叠，以告知使用RDS进行干预提供和得出人口水平的估计；以及目标4：为未来的研究建立一个平台。我们将在印度三个艾滋病毒/毒品使用流行不同的城市--丘拉昌普尔、阿姆利则和坎普尔--建立一个多中心动态队列。我们将从评估RDS中确定前350名参与者的社交网络特征，并招募那些在之前6个月内注射过这些参与者的人。我们将反复确定和招募新招募人员的合格网络成员，直到没有发现任何新的网络成员(每个站点约750名；总共2250名)。生物识别数据、全球定位系统坐标和网络软件将有助于跟踪和识别跨网络联系。参与者将每半年跟踪一次，并在确定的情况下招募新的网络成员。我们的研究在跟踪时间网络动态的能力、使用新的方法来表征社会计量和空间网络、使用系统发生数据来表征网络对传播的影响、以及与HIV相关的寻求健康行为在PWID网络中的社会扩散方面具有创新性。