Combined prevention to reduce initiation into injecting drug use

综合预防以减少注射吸毒的发生

• 批准号: 9752913
• 负责人: Don C Des Jarlais
• 金额: $ 79.25万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-03-01 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9752913
• 关键词: AIDS prevention; Address; Blood; Caring; Cities; Cohort Studies; Collaborations; Couples; Drug usage; Drug user; Effectiveness; Estonia; Evidence based intervention; France; HIV; HIV Infections; HIV/HCV; Heroin; Individual; Injecting drug user; Injections; Intervention; Location; Logic; Modeling; New York City; Opioid user; Outcome; Pharmaceutical Preparations; Prevention; Prevention approach; Process; Public Health; Recording of previous events; Research; Research Personnel; Services; Site; Social Change; Social Network; Social support; Time; United States; Virus; base; community based service; innovation; mathematical model; novel therapeutics; prescription opioid; public health relevance; scale up; service providers; skills; social norm; transmission process; willingness

 DESCRIPTION: Combined prevention and care for HIV among persons who inject drugs (PWID) has led to dramatic reductions in injecting-related HIV transmission in a number of locations, including Holland, France, Vancouver, and numerous cities in the United States. Simultaneous implementation of multiple interventions has generated synergistic effects much greater than the effects of individual interventions. This proposed research would apply the same logic of implementation of multiple evidence-based interventions to initiation into injecting drug use. Reducing initiation into injecting drug use would not only reduce transmission of blood-borne viruses (HIV and HCV) but also the many other individual and societal problems associated with injecting drug use. A broad conceptualization of initiation into injecting drug use will be utilized, from first injection to the transition process through which injecting becomes th dominant mode of drug administration. There are a number of interventions with demonstrated effectiveness in reducing initiation into drug injecting, including: low threshold treatment for drg use, Break the Cycle (in which current injectors are taught to avoid modeling for potential new injectors), the Heroin Sniffer project (in which non-injecting drug users are taught skills and provided with social support to avoid injecting) and Couples-Based HIV prevention (which addresses drug use issues within sexual partnerships). The latter 3 interventions all include social network/social support components and are capable of changing social norms regarding injecting drug use. The research would be conducted in two sites: Tallinn, Estonia, which has very high rates of HIV infection among new drug injectors, and New York City, USA, where there is a growing problem of prescription opiate users transitioning to heroin injecting. Both sites have the organizational capacity for integrating new interventions with existing services, and have well- established, highly productive collaborations among researchers, public health officials and community based service providers. Cohort studies would be used to assess willingness to participate and the outcomes of individuals participating in the multiple interventions. Mathematical modeling would then be used to address scale up and the synergistic effects of combined implementation. The research is ideally suited to the Avant Garde format, and the investigator has a long history of innovative research in HIV among drug users.

 产品说明：注射吸毒者艾滋病毒的综合预防和护理在一些地方，包括荷兰、法国、温哥华和美国的许多城市，导致与注射有关的艾滋病毒传播大幅减少。同时实施多种干预措施所产生的协同效应远远大于单独干预措施的效应。这一拟议的研究将采用同样的逻辑，即实施多种循证干预措施，以开始注射吸毒。减少开始注射吸毒不仅会减少血液传播病毒（艾滋病毒和丙型肝炎病毒）的传播，而且会减少与注射吸毒有关的许多其他个人和社会问题。开始注射吸毒的广义概念 从第一次注射到注射成为药物施用的主要方式的过渡过程。 有一些干预措施在减少开始注射毒品方面证明是有效的，其中包括：drg使用的低阈值治疗，打破循环（其中教导当前的喷射器以避免对潜在的新喷射器建模），海洛因嗅探器项目（向非注射吸毒者传授技能，并向其提供避免注射的社会支持）和基于夫妇的艾滋病毒预防（该文件涉及性伙伴关系中的吸毒问题）。后三项干预措施都包括社会网络/社会支助组成部分，能够改变有关注射吸毒的社会规范。 这项研究将在两个地点进行：爱沙尼亚的塔林和美国的纽约市，前者在新的毒品注射者中艾滋病毒感染率很高，后者处方阿片剂使用者转向海洛因注射的问题日益严重。这两个地点都有将新的干预措施与现有服务相结合的组织能力，并在研究人员、公共卫生官员和社区服务提供者之间建立了良好的、富有成效的合作关系。 队列研究将用于评估参与意愿和参与多种干预措施的个人的结果。然后将利用数学建模来处理扩大规模和联合执行的协同效应问题。 这项研究非常适合前卫的形式，研究人员在吸毒者中进行艾滋病毒创新研究的历史悠久。

项目成果

HIV treatment, antiretroviral adherence and AIDS mortality in people who inject drugs: a scoping review.

• DOI: 10.1093/eurpub/ckad008
• 发表时间: 2023-06-01
• 期刊: EUROPEAN JOURNAL OF PUBLIC HEALTH
• 影响因子: 4.4
• 作者: Uuskula, Anneli;Feelemyer, Jonathan;Des Jarlais, Don C.
• 通讯作者: Des Jarlais, Don C.