Risk Factors for AIDS among Persons Who Inject Drugs: HIV and COVID-19

摘要 很难低估新冠肺炎大流行对人类健康的潜在影响 新爆发的艾滋病病毒在PWID中。在公共卫生规模化实施“防防结合”的同时 PWID的“关爱艾滋病毒”使许多高收入国家的艾滋病毒传播大幅减少， 例如，在美国、西欧和东欧以及以色列也发生了多次艾滋病毒暴发。而当 每一次暴发都有不同的特征，在各次暴发中都注意到了一些共同特征， 包括：1)社区经济混乱，2)艾滋病毒预防服务不足或中断，3)当地 引入新的注射药物，以及4)无家可归的PWID是一个非常高风险的群体。新冠肺炎 大流行及其相关的封锁/控制措施似乎正在重新创造 在新冠肺炎时代之前的PWID中产生了艾滋病毒爆发。FDA最近的紧急使用 有效的SARS-CoV-2疫苗的授权提供了一个关键的机会来缓解一些--但肯定的 不是所有的--对艾滋病毒预防的威胁。然而，快速接种大型疫苗的重要潜在困难 存在多个PWID。我们建议研究艾滋病毒、新冠肺炎和种族/民族之间的关系 纽约市PWID之间的差异，该地区经历了世界上最大的地方艾滋病毒流行 PWID是世界上最大的地区性新冠肺炎流行病之一，通过四个具体目标： 1.评估新冠肺炎大流行对纽约市残疾人中艾滋病毒风险的短期(3年内)影响， 包括关键生物行为风险(艾滋病毒传播的综合风险和综合风险)的潜在增加 多人感染艾滋病毒的风险)。 2.对纽约市PWID人群SARS-CoV-2疫苗接种情况进行长期监测。确定与接收相关的因素 疫苗接种，包括“潜在健康状况”、社会人口统计，特别是种族/族裔和 就业、疫苗意识和态度，以及跨药物使用模式。检查同辈、家庭和 “可信来源”对接种疫苗的影响。对参与者进行SARS-CoV-2疫苗的教育， 包括可获得性、类型、副作用和计划。评估“群体免疫”的程度 在PWID中实现。 3.利用抗体检测评估PWID既往和曾经感染新冠肺炎的情况，识别风险 感染的因素，包括种族/民族，以及实行保护行为是否与 较低的血清阳性率。 4.使用主成分分析(PCA)，检查多个健康问题与 纽约市残疾人健康的社会决定因素，包括艾滋病毒、新冠肺炎、丙型肝炎病毒、阿片类药物和兴奋剂的使用， 在新冠肺炎大流行期间，吸毒过量、无家可归以及经济和粮食不安全。考查 健康群组和健康的社会决定因素之间的种族/族裔差异的模式。

Abstract It is difficult to underestimate the potential public health significance of the COVID-19 pandemic for generating new outbreaks of HIV among PWID. While public health scale implementation of “combined prevention and care for HIV” among PWID has led to dramatic reductions in HIV transmission in many high-income countries, multiple outbreaks of HIV have also occurred, e.g., in the US, Western and Eastern Europe, and Israel. While there were distinct features of each outbreak, a number of common features were noted across the outbreaks, including: 1) community economic dislocations, 2) inadequate or interrupted HIV prevention services, 3) local introduction of new injectable drugs, and 4) homeless PWID as a very high-risk group. The COVID-19 pandemic and its associated lockdown/control measures appear to be re-creating the very conditions that generated HIV outbreaks among PWID in the pre- COVID-19 era. The recent FDA emergency use authorization of effective SARS-CoV-2 vaccines provides a critical opportunity to alleviate some—but certainly not all—of the threats to HIV prevention. However, important potential difficulties in rapidly vaccinating large numbers of PWID exist. We propose to examine relationships between HIV, COVID-19, and racial/ethnic disparities among PWID in NYC, a location that has experienced the world’s largest local HIV epidemic among PWID, and one of the world’s largest local COVID-19 epidemics, through four specific aims: 1. Assess short term (within 3 years) impact of the COVID-19 pandemic on HIV risk among PWID in NYC, including potential increases in critical bio-behavioral risks (composite risk for HIV transmission and composite multi-person risk for HIV acquisition). 2. Monitor SARS-CoV-2 vaccination over time among PWID in NYC. Identify factors associated with receiving vaccination, including ‘underlying health conditions,” socio-demographics, particularly race/ethnicity and employment, vaccine awareness and attitudes, and across patterns of drug use. Examine peer, family and “trusted sources” influences on receiving vaccination. Educate participants on SARS-CoV-2 vaccines, including availability, types, side effects and scheduling. Assess the extent to which “herd immunity” is being achieved among PWID. 3. Utilize antibody testing to estimate past and incident COVID-19 infection among PWID, identifying risk factors for infection, including race/ethnicity, and whether practicing protective behaviors is associated with lower seroprevalence. 4. Using principal component analysis (PCA), examine relationships between multiple health problems and social determinants of health among PWID in NYC, including HIV, COVID-19, HCV, opioid and stimulant use, drug overdose, homelessness, and economic and food insecurity, during the COVID-19 pandemic. Examine patterns of racial/ethnic disparities among the clusters of health and social determinants of health.