Individualized approaches to the HIV/TB epidemic among polysubstance users in Irkutsk

项目摘要/摘要 西伯利亚伊尔库茨克地区的人类免疫缺陷病毒(HIV)流行率高于#年的任何其他地区。 俄罗斯联邦。结核病是全球艾滋病毒携带者的头号杀手，它只是一个简单的 肆虐伊尔库茨克。多物质滥用影响伊尔库茨克艾滋病毒/结核病护理连续体系的多个方面 导致艾滋病毒/结核病死亡率居高不下。尽管患者开始抗逆转录病毒和抗结核病治疗，我们的 数据表明，HIV/TB治疗失败代表了宿主不遵守复杂的 次优但可纠正的抗结核药物引起的用药方案和功能性耐药性 浓度。因此，这个项目试图了解物质使用的预期影响 伊尔库茨克地区依从性、药代动力学和疾病进展的模式。我们已经开发出 测量这些因素的创新方法，包括移动电话(MHealth)增强的生态 依从性和药物使用的瞬时评估，基于尿液的药物浓度分析，以及 从尿液中检测分枝杆菌DNA作为疾病的非侵入性生物标志物。这个项目是建立在 我们之前的美国/俄罗斯研究合作，同时将专家联合起来，提供免费的多学科 在行为科学、临床心理学、艾滋病毒医学、mHealth、药物动力学、艾滋病毒/结核病方面的经验 混合感染、艾滋病毒和结核病耐药性与结核病生物标记物。我们预计该项目的完成将产生 采取有针对性的干预措施，在伊尔库茨克中断药物使用、艾滋病毒和结核病的循环，促进 服务，并将艾滋病毒护理转变为以患者为中心的模式。

PROJECT SUMMARY/ ABSTRACT The human immunodeficiency virus (HIV) prevalence in the Irkutsk, Siberia region is higher than any other in the Russian Federation. Tuberculosis (TB) is the leading killer worldwide of people living with HIV and is simply ravaging Irkutsk. Polysubstance abuse affects multiple aspects of the HIV/TB care continuum in Irkutsk contributing to overwhelming HIV/TB mortality. Despite patients initiating antiretroviral and anti-TB therapy, our data suggests that HIV/TB treatment failure represents the interplay of host nonadherence to complex medication regimens and functional drug-resistance due to suboptimal but correctable anti-TB medication concentrations. Therefore, this project seeks to understand the prospective influence of substance use patterns on adherence, pharmacokinetics and disease progression in the Irkutsk context. We have developed innovative methods for measurement of these factors including mobile phone (mHealth) enhanced ecological momentary assessment of adherence and substance use, urine based medication concentration assays, and mycobacterial DNA detection from the urine as a non-invasive biomarker of disease. This project builds upon our prior US/Russian research collaboration while uniting experts with complimentary and multidisciplinary experience in Behavioral Science, Clinical Psychology, HIV Medicine, mHealth, Pharmacokinetics, HIV/TB coinfection, HIV and TB Drug-Resistance and TB Biomarkers. We expect completion of the project to generate targeted interventions to interrupt the cycle of substance use, HIV and TB in Irkutsk, foster integration of services, and shift HIV care toward a patient-centered model.