Resilience in HIV infected drug users

 描述(申请人提供)：数百万美国人使用非法阿片类药物或可卡因，这会对个人和公共健康造成重大影响。由于阿片类药物和可卡因流行与艾滋病毒流行相交，因此充分了解和减轻药物使用对艾滋病毒疾病的影响至关重要。鉴于坚持服用抗逆转录病毒药物(ARV)是抑制艾滋病毒病毒载量(VL)的关键预测因素，研究重点放在非法药物使用和不坚持用药之间的关联上。人们普遍认为，感染艾滋病毒的吸毒者必须从事药物治疗并努力戒除，才能成功地坚持抗逆转录病毒药物并控制其艾滋病毒疾病。然而，药物使用障碍是慢性和复发性疾病，许多吸毒者无法实现长期戒断。除了参与药物治疗外，人们对吸毒者可以使用哪些策略来实现最佳艾滋病毒结果知之甚少。在一项由美国国立卫生研究院资助的正在进行的研究中，我们令人惊讶地发现，在我们筛查的活跃吸毒者中，近一半实现了VL抑制，尽管持续使用药物。因此，这项研究将使用一种建立在艾滋病毒感染吸毒者弹性基础上的混合方法，探索有助于在活跃的吸毒者中实现VL抑制的因素和行为，而无论他们实现戒毒的能力如何。我们的探索将以减少危害和社会生态模型为指导。我们将利用我们正在进行的NIH资助的研究来有效地招募和筛选参与者，并提取他们的医疗记录数据。 我们将招收170名感染艾滋病毒的活跃吸毒者，包括活跃的非法阿片类药物使用者 VL被抑制的人、VL未被抑制的活跃的非法阿片类药物使用者、VL被抑制的活跃的可卡因使用者和VL未被抑制的活跃的可卡因使用者。我们还将招募10名艾滋病毒和毒品使用领域的专家。这3项研究的目的是：1)定性地探索艾滋病毒感染的主动吸毒者对如何实现最佳艾滋病毒健康结果的看法；2)开发一份量化问卷，以衡量目标1中确定的因素和行为，用于目标3中建议的分析；以及3)定量地探索与艾滋病毒感染的主动吸毒者实现最佳艾滋病毒健康结果相关的因素和行为。这项研究将提高对吸毒者复原力的理解，即他们如何能够在不戒毒的情况下实现最佳的艾滋病毒结果。这项研究的结果最终将被用来为开发一种干预措施提供信息，以帮助艾滋病毒感染的活跃吸毒者实现VL抑制。

 DESCRIPTION (provided by applicant): Millions of Americans use illicit opioids or cocaine, which has substantial individual and public health consequences. Because the opioid and cocaine epidemics intersect with the HIV epidemic, it is crucial to fully understand and mitigate the impact that drug use has on HIV disease. Given that adherence to antiretrovirals (ARVs) is a critical predictor of HIV viral load (VL) suppression, research has focused on the association between illicit drug use and medication non-adherence. It is widely accepted that HIV-infected drug users must engage in drug treatment and strive for abstinence to successfully adhere to ARVs and manage their HIV disease. However, drug use disorders are chronic and relapsing conditions, and many drug users are unable to achieve long-term abstinence. Beyond engagement in drug treatment, little is known about which strategies drug users could use to achieve optimal HIV outcomes. In an ongoing NIH-funded study, we surprisingly found that nearly half of active drug users we screened achieved VL suppression despite ongoing drug use. Therefore, using a mixed methods approach that builds on the resilience of HIV-infected drug users, this study will explore factors and behaviors that facilitate achieving VL suppression among active drug users, regardless of their ability to achieve abstinence. Our exploration will be guided by harm reduction and socioecological models. We will leverage our ongoing NIH-funded study to efficiently recruit and screen participants, and extract their medical record data. We will enroll a total of 170 HIV-infected active drug users, including active illicit opioid users with suppressed VL, active illicit opioid users with non-suppressed VL, active cocaine users with suppressed VL, and active cocaine users with non-suppressed VL. We will also enroll 10 experts in the field of HIV and drug use. The 3 study aims are to: 1) Qualitatively explore HIV- infected active drug users' perceptions of how to achieve optimal HIV health outcomes; 2) Develop a quantitative questionnaire to measure factors and behaviors identified in Aim 1 for analyses proposed in Aim 3; and 3) Quantitatively explore factors and behaviors associated with HIV-infected active drug users achieving optimal HIV health outcomes. This study will improve understanding of drug users' resilience, namely how they are able to achieve optimal HIV outcomes even without abstinence. Findings from this study will ultimately be used to inform the development of an intervention to help HIV-infected active drug users achieve VL suppression.