HCV Treatment among HCV Mono-infected and HIV/HCV Coinfected People who Inject Drugs in Baltimore, Maryland

马里兰州巴尔的摩注射毒品的 HCV 单一感染者和 HIV/HCV 混合感染者的 HCV 治疗

• 批准号: 9925886
• 负责人: Catelyn Coyle
• 金额: $ 3.08万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2020-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9925886
• 关键词: Accounting; Acquired Immunodeficiency Syndrome; Age; Antiviral Agents; Area; Baltimore; Caring; Cause of Death; Censuses; Characteristics; Cities; Clinic; Clinical; Communicable Diseases; Communities; Counseling; Data; Drug usage; Enrollment; Epidemiology; Fellowship; Guidelines; HIV; HIV Infections; HIV Seropositivity; HIV/HCV; Harm Reduction; Health Services Accessibility; Hepatitis C; Hepatitis C Incidence; Hepatitis C Prevalence; Hepatitis C Therapy; Hepatitis C co-infection; Hepatitis C virus; Heroin; Incidence; Individual; Infrastructure; Injecting drug user; Interferons; Intervention; Intravenous; Knowledge; Learning; Link; Liver diseases; Maryland; Medical; Mentors; Neighborhoods; Oral; Outcome Study; Participant; Patients; Penetration; Persons; Pharmaceutical Preparations; Pharmacoepidemiology; Pharmacotherapy; Population; Population Dynamics; Prevalence; Research; Research Personnel; Research Training; Resources; Risk; Services; Structure; Subgroup; Surveys; Training Programs; Universities; Viral; Virus; adverse outcome; aging population; barrier to care; base; cohort; demographics; density; doctoral student; effective therapy; experience; health care availability; innovation; insight; mortality; opioid epidemic; pill; prevent; scale up; service utilization; skill acquisition; skills; social health determinants; standard of care; treatment site; uptake

Project Summary: Significance: HCV incidence is increasing among young, non-urban PWID, consistent with the shifting epidemiology of drug use in the US. However, HCV-related mortality is mainly among an aging population of former PWID, infected when HCV incidence peaked in the 1990s, and can be accelerated by HIV. Furthermore, upwards of 90% of all HIV-positive PWID are coinfected with HCV. Although an effective treatment for HCV emerged in late 2013 via the advent of direct acting antivirals (DAA), treatment rates remain exceedingly low among PWID. Our understanding of barriers to treatment among PWID is based largely on studies conducted in the pre-DAA era and, when treatment itself was a barrier; moreover, these known barriers do not account for the changing demographics of PWID in the broader context of the opioid epidemic. Given this innovation in treatment and shifting population dynamics, new research is needed to understand barriers to HCV treatment among PWID, accounting for HIV status and engagement in HIV care. Ultimately, this knowledge will inform interventions to promote HCV treatment uptake among PWID. Aims: We seek to: (1) identify clusters of low HCV treatment penetration in Baltimore, MD and determine if these areas vary by levels of HIV viral suppression; (2) evaluate differences in knowledge of HCV and its treatment by HCV and HIV infection status and other individual and neighborhood-level factors; and (3) compare temporal changes in HCV treatment uptake from 2011-2018 among mono- and coinfected PWID and identify groups with persistent low treatment uptake and associated correlates. Approach: We will accomplish these aims using data from the ALIVE (AIDS Linked to the IntraVenous Experience) study, a community-based cohort of PWID, ongoing since 1988, located in Baltimore, MD. This cohort includes HCV mono-infected and HIV/HCV coinfected PWID, both in and out of HIV care. Aim 1 will identify statistically significant clusters of poor HCV treatment uptake, by census tract, in 2011, 2015, and 2018. To characterize these areas, we will evaluate the extent to which social determinants of health, access to services, and characteristics of HCV-infected individuals explain the clustering. Aim 2 will use a 17-question survey, performed at enrollment and before receipt of HCV counseling, to determine knowledge of HCV and DAAs among participants enrolled 2015-2018, by HCV and HIV status. For Aim 3, we will evaluate temporal changes in the rate of HCV treatment uptake from 2011-2018 by HIV status and HIV viral suppression. Fellowship Information: This study is the dissertation for Ms. Catelyn Coyle, a PhD student in the Department of Epidemiology at Johns Hopkins University. Through a combination of coursework, professional skills development, and mentored research training, the proposed training program will equip Ms. Coyle with the knowledge, skills, and experience to complete the aims of the proposed research and become a successful academic infectious disease researcher.

项目概要： 意义：HCV的发病率在年轻的非城市PWID中增加，这与 美国的毒品使用流行病学。然而，HCV相关的死亡率主要是在老龄化人口中， 前PWID，在20世纪90年代HCV发病率达到高峰时感染，并可被HIV加速。 此外，超过90%的HIV阳性PWID与HCV合并感染。虽然有效的 2013年底，随着直接作用抗病毒药物（DAA）的出现，HCV的治疗出现了，治疗率仍然保持不变。 在PWID中非常低。我们对PWID治疗障碍的理解主要基于 在前DAA时代进行的研究，当治疗本身是一个障碍时，这些已知的障碍 不能解释在阿片类药物流行病的更广泛背景下PWID人口统计学的变化。给定 这种治疗创新和人口动态的变化，需要新的研究来了解 PWID中的HCV治疗，占艾滋病毒状态和参与艾滋病毒护理。最终这 知识将为干预措施提供信息，以促进PWID中的HCV治疗。 目的：我们寻求：（1）确定巴尔的摩，MD低HCV治疗渗透率的集群，并确定是否 这些领域因HIV病毒抑制水平而异;（2）评估HCV知识及其 根据HCV和HIV感染状况以及其他个人和社区水平因素进行治疗;以及（3） 比较2011-2018年单感染和合并感染PWID中HCV治疗摄取的时间变化， 确定持续低治疗吸收率的群体和相关的相关因素。 方法：我们将使用来自ALIVE（与静脉注射相关的艾滋病）的数据来实现这些目标。 经验）研究，一个以社区为基础的PWID队列，自1988年以来一直在进行，位于马里兰州的巴尔的摩。这 队列包括HCV单一感染和HIV/HCV合并感染的PWID，包括HIV护理中和非HIV护理中。目标1将 在2011年和2015年，按人口普查区域确定具有统计学意义的HCV治疗效果差的集群， 2018.为了描述这些领域的特点，我们将评估健康、获得和发展的社会决定因素在多大程度上影响了这些领域， 服务，和HCV感染者的特点解释了集群。目标2将使用17个问题 在入组时和接受HCV咨询前进行调查，以确定对HCV的了解， 2015-2018年入组的参与者中的DAA，按HCV和HIV状态分类。对于目标3，我们将评估时间 2011-2018年按HIV状态和HIV病毒抑制分类的HCV治疗率变化。 奖学金信息：这项研究是博士生Catelyn Coyle女士的论文， 约翰霍普金斯大学流行病学系。通过课程作业，专业 技能发展，并指导研究培训，拟议的培训计划将配备科伊尔女士与 知识，技能和经验，以完成拟议的研究目标，并成为一个成功的 学术传染病研究员