Colliding Epidemics During an Opioid Crisis: Impact of the COVID-19 Pandemic on Determinants of HIV and HCV Transmission Among People Who Inject Drugs

项目摘要/摘要 美国计划在2030年前结束艾滋病毒流行(EHE)并消除丙型肝炎病毒(HCV)感染。而当 在许多群体中取得了进展，包括注射毒品者(PWID)、最近爆发的丙型肝炎病毒 在美国，HIV感染已在PWID中被记录在案，丙型肝炎病毒的发病率在全国范围内呈上升趋势 由于阿片类药物危机。新冠肺炎大流行，包括公共卫生应对措施，导致 中断了获得服务的机会，并创造了一个能够使用物质的环境。事实上，COVID- 19大流行可能进一步威胁美国计划通过加剧阿片类药物危机来消灭和消除丙型肝炎病毒。 这项研究的目的是评估新冠肺炎大流行对以下方面的短期和长期影响 马里兰州巴尔的摩PWID中艾滋病毒和丙型肝炎传播的个人和社区水平的决定因素。 具体目标是：(1)确定PWID中高风险注射做法的个人水平预测因素 在新冠肺炎大流行期间，(2)检查减少危害利用的趋势并确定与之相关的 新冠肺炎大流行期间PWID之间的障碍和促进者，以及(3)评估 新冠肺炎流行对PWID人群中艾滋病毒和丙型肝炎病毒血症流行的影响。这些目标 将通过利用来自基于社区的最大和运行时间最长的队列之一的数据实现 PWID全球-艾滋病与马里兰州巴尔的摩的静脉注射体验(ALIVE)研究有关。目标1将 确定流行前的社会人口学、行为、心理社会和生物学因素与高- 基于广义估计的改进泊松回归在大流行期间的风险注入实践 方程式。目标2将使用混合方法顺序解释方法来检查 人群接受针头/注射器交换服务和阿片类药物使用障碍的情况 在大流行的不同阶段(2015-2021年)。将与25-30名PWID进行深入访谈，以 探索服务利用的新障碍和促进者。目标3将使用中断的时间序列分析 估计大流行对艾滋病毒和丙型肝炎病毒血症流行率的影响的方法(2015- 2023年)。这项研究将告知大流行是否对EHE的地方和国家目标构成重大威胁 并消除丙型肝炎病毒感染。这项研究还将为实施监测和方案提供信息 在当前大流行和阿片类药物危机期间以及在 未来的动乱和不稳定时期。拟议的研究涵盖NIDA的一个高度优先领域，将 担任麻省理工学院流行病学系博士生埃尚·帕特尔的博士论文 约翰霍普金斯大学布隆伯格公共卫生学院。全面的培训计划，包括导师 来自艾滋病毒、丙型肝炎病毒和药物使用流行病学、心理社会统计专家的研究培训， 定性研究和因果推理将为申请者提供量身定制的经验，以实现他的目标 成为一名学术流行病学家，为消除PWID中的艾滋病毒和丙型肝炎做出贡献。

PROJECT SUMMARY/ABSTRACT The U.S. plans to End the HIV Epidemic (EHE) and eliminate hepatitis C virus (HCV) infection by 2030. While progress has been made in many groups including people who inject drugs (PWID), recent outbreaks of HCV and HIV infection have been documented among PWID in the U.S and HCV incidence is increasing nationally due to the opioid crisis. The COVID-19 pandemic, including the public health response, has resulted in disruptions in access to services and created an environment that enables substance use. Indeed, the COVID- 19 pandemic may further threaten the U.S.' plan to EHE and eliminate HCV by exacerbating the opioid crisis. The objective of this study is to assess the short- and long-term impacts of the COVID-19 pandemic on individual- and community-level determinants of HIV and HCV transmission among PWID in Baltimore, MD. The specific aims are to: (1) identify individual-level predictors of high-risk injection practices among PWID during the COVID-19 pandemic, (2) examine trends in harm reduction utilization and identify associated barriers and facilitators among PWID during the COVID-19 pandemic, and (3) evaluate the impact of the COVID-19 pandemic on the population-level prevalence of HIV and HCV viremia among PWID. These aims will be achieved by leveraging data from one of the largest and longest running cohorts of community-based PWID worldwide—the AIDS Linked to the IntraVenous Experience (ALIVE) study in Baltimore, MD. Aim 1 will identify pre-pandemic sociodemographic, behavioral, psychosocial, and biological factors associated with high- risk injection practices during the pandemic using modified Poisson regression with generalized estimating equations. Aim 2 will use a mixed-methods sequential explanatory approach to examine changes in the population-level uptake of needle/syringe exchange services and medication for opioid use disorder before and during different phases of the pandemic (2015-2021). In-depth interviews will be conducted with 25-30 PWID to explore new barriers and facilitators to service utilization. Aim 3 will use an interrupted time-series analytic approach to estimate the effect of the pandemic on the prevalence of HIV viremia and HCV viremia (2015- 2023). This study will inform whether the pandemic poses a major threat to the local and national goals to EHE and eliminate HCV infection. This study will also inform the implementation of surveillance and programmatic strategies to mitigate HIV/HCV transmission during the ongoing pandemic and opioid crisis as well as during future periods of unrest and instability. The proposed study, which covers a high priority area for NIDA, will serve as the doctoral dissertation for Mr. Eshan Patel, a PhD student in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. A comprehensive training program including mentored research training from experts in HIV, HCV, and substance use epidemiology, psychosocial statistics, qualitative research, and causal inference will provide the applicant a tailored experience to achieve his goal of becoming an academic epidemiologist that contributes to the elimination of HIV and HCV among PWID.