The role of depression in HIV transmission among people who inject drugs in Vietnam

摘要 在越南，艾滋病毒在注射毒品(PWID)人群中的流行率超过30%。迫切需要 旨在减缓艾滋病毒持续传播并为大量人群提供治疗服务的预防计划- PWID呈阳性。高水平的共用针头和有限的抗逆转录病毒治疗(ART)导致 HIV在PWID中的发病率持续较高。减少危险行为并使这一人群感染艾滋病毒 护理是一个巨大的挑战，而PWID中抑郁的沉重负担可能是 那些挑战。越南高达50%的PWID被发现患有严重抑郁症 症状，大量研究表明，共病抑郁始终会导致较差的艾滋病毒 治疗结果。然而，抑郁症在艾滋病毒向前传播中的作用仍然不清楚。建议数 一项研究假设，PWID患者中的抑郁增加了注射和性危险行为，并减少了 参与艾滋病毒护理和坚持抗逆转录病毒疗法，导致艾滋病毒病毒载量失控。通过促进 无论是危险行为还是生物传染性，抑郁症都被认为会导致更多的风险。 传染给易感性伴。这项拟议的研究是第一次同时调查 抑郁通过行为和生物途径在HIV感染的前向传播中使用 对这一关键领域可能的干预措施的潜在艾滋病毒预防效益进行量化的数学建模 人口。这项研究将使用从泰国越南新诊断的336例HIV阳性PWID收集的数据， 越南在艾滋病毒确诊前和确诊后的两年内。本研究的目标1和目标2将 评估抑郁症与传播危险行为(目标1)和艾滋病毒病毒载量(目标2)的关系，两者都是 HIV诊断前后。然后，目标3将开发一个前向传输的数学模型 在越南的PWID，以量化抑郁症对新的艾滋病毒感染的贡献。这款车型将是第一款 估计越南HIV阳性PWID中的二次传播事件，并量化HIV感染 可以使用当前的预防策略(抗逆转录病毒治疗、针头更换、美沙酮维持)来避免 项目)和未来可能的干预措施(抑郁症筛查和治疗)。拟议的研究是一项 创新方法，将传统流行病学方法与数学建模相结合，以更好地 了解艾滋病毒在越南的流行情况，并指导越南残疾人中的控制工作。这项研究的重点是 毒品滥用的重要后果，艾滋病毒的传播，并旨在减少这种危害，这些都是研究 被NIDA确定为高度优先的领域。抑郁症筛查和治疗可能是降低风险的关键 行为，实现病毒抑制，最终减缓关键人群中的前向传播 导致了艾滋病毒的流行。

ABSTRACT HIV prevalence is above 30% among people who inject drugs (PWID) in Vietnam. There is an urgent need for prevention programs to slow ongoing transmission and provide treatment services for large populations of HIV- positive PWID. High levels of needle-sharing and limited uptake of antiretroviral therapy (ART) result in persistently high HIV incidence among PWID. Reducing risk behaviors and engaging this population in HIV care present significant challenges, and the high burden of depression among PWID may be at the root of those challenges. Up to 50% of PWID in Vietnam have been found to suffer from severe depressive symptoms, and a large body of research shows that comorbid depression consistently results in poorer HIV treatment outcomes. However, the role of depression in forward HIV transmission is still unclear. The proposed study hypothesizes that depression among PWID increases injecting and sexual risk behaviors and reduces engagement in HIV care and adherence to ART, resulting in uncontrolled HIV viral load. Through facilitating both risk behaviors and biological infectiousness, depression is hypothesized to result in increased forward transmission to susceptible partners. The proposed study is the first to simultaneously investigate the role of depression in forward spread of HIV infection through both behavioral and biological pathways and to use mathematical modeling to quantify the potential HIV prevention benefits of possible interventions in this key population. This study will use data collected from 336 newly diagnosed HIV-positive PWID in Thai Nguyen, Vietnam prior to HIV diagnosis and during the two years after diagnosis. Aims 1 and 2 of this study will estimate the association of depression with transmission risk behaviors (Aim 1) and HIV viral load (Aim 2), both before and after HIV diagnosis. Aim 3 will then develop a mathematical model of forward transmission among PWID in Vietnam to quantify the contribution of depression to new HIV infections. This model will be the first to estimate secondary transmission events among HIV-positive PWID in Vietnam and quantify HIV infections that could be averted using current prevention strategies (ART, needle exchanges, methadone maintenance programs) and potential future interventions (depression screening and treatment). The proposed study is an innovative approach, combining traditional epidemiologic methods with mathematical modeling to better understand the HIV epidemic and guide control efforts among PWID in Vietnam. This study focuses on an important consequence of drug abuse, HIV transmission, and aims to reduce this harm, which are research areas identified by NIDA as high priority. Depression screening and treatment may be critical to reducing risky behaviors, achieving viral suppression, and ultimately, slowing forward transmission in a key population that drives the HIV epidemic.