Ethno-epidemiology of HCV, HIV and Overdose associated with Drug Markets and Drug Tourism

这项研究将描述与两国药物相关的艾滋病毒、丙型肝炎病毒和吸毒者的发病率趋势 墨西哥圣地亚哥(SD)和提华纳(TJ)之间的市场和毒品旅游(DT)。TJ坐在一个主要的 海洛因、芬太尼、冰毒和可卡因被贩运到美国的贩毒路线。在墨西哥之后 2009年将少量毒品部分合法化，SD每6名注射毒品者中就有1人(PWID) 据报道，在TJ注射毒品，那里的毒品“更便宜，更容易买到”。自从墨西哥最近 放宽阿片类处方法，SD和TJ在药品可获得性和价格方面的差距将 可能会扩大，导致DT增加，这将影响上述健康结果。我们假设 芬太尼在当地毒品市场的更大渗透率将与更高的风险行为相关，这些行为 增加艾滋病毒和丙型肝炎病毒的发病率。我们的研究是及时的，因为提华纳的药品零售市场正在发生变化 吸毒的游客可能会获得更高的风险行为。这些边境城市的健康结果可能 作为美国其他城市的“领头羊”。我们提议的研究的具体目标是La Línea 目标1.前瞻性地描述SD和TJ之间的跨境DT及其 与药品零售市场特点相关联。目标2.描述#年药品零售市场趋势 TJ与SD通过进行流行病学和人种学监测，三角测量定量和 定性结果和DEA管理数据。目的3.研究实时丙型肝炎病毒和艾滋病病毒的跨境 PWID间传播的分子流行病学研究目的4.描述过量服药发生率及其影响因素 与药品零售市场和DT的联系。目的5.对未来的艾滋病毒、丙型肝炎病毒进行动态建模 在药品零售市场变化的背景下，PWID在SD的OD发病率通知 预防干预措施。La Línea将进行前瞻性的定量和定性监测 SD和TJ的药品零售市场，以及600 PWID(200)的流行病学数据收集 来自SD的毒品游客；来自SD的200名非毒品游客和来自TJ的200名非毒品游客)和An 人种学亚群(N=75，每组25人)。我们将分析PWID的艾滋病毒和丙型肝炎病毒测序数据 以前瞻性地评估跨境传播。我们将合并关于两国的纵向数据 将药品零售市场和艾滋病毒、丙型肝炎病毒测序数据转化为动态数学模型进行预测 未来艾滋病毒、丙型肝炎和吸毒的发病率趋势。由于艾滋病毒跨境传播的方向现在是 首次从墨西哥发生到美国，在TJ的PWID中艾滋病毒发病率很高， 监测边境地区艾滋病毒和丙型肝炎病毒感染的趋势对于避免未来美国 疫情爆发。这项研究涉及NIDA的Hear倡议和Oar的Trans-NIH计划， 通过开展对时间敏感的研究，为实施及时的干预措施提供信息，以减少 艾滋病、丙型肝炎和吸毒者的发生率。

This study will characterize trends in incidence of HIV, HCV and OD associated with binational drug markets and drug tourism (DT) between San Diego (SD) and Tijuana (TJ), Mexico. TJ sits on a major drug trafficking route whereby heroin, fentanyl, meth & cocaine are trafficked to the US. After Mexico partially decriminalized small amounts of drugs in 2009, 1 in 6 people who inject drugs (PWID) in SD reported injecting drugs in TJ, where drugs were “cheaper and easier to buy”. Since Mexico recently relaxed its opiate prescription laws, disparities in drug availability and price between SD and TJ will likely widen, fueling increased DT that will impact the above health outcomes. We hypothesize that greater penetration of fentanyl into local drug markets will be associated with riskier behaviors that increase HIV and HCV incidence. Our study is timely since retail drug markets are changing in Tijuana with drug tourists likely to be acquiring riskier behaviors. Health outcomes in these border cities likely serve as a ‘bellwether’ for other U.S. cities. The specific aims for our proposed study, called La Línea (“The Line”) are: AIM 1. To prospectively characterize cross-border DT between SD and TJ and its association with retail drug market characteristics. AIM 2. To characterize retail drug market trends in TJ versus SD by conducting epidemiologic and ethnographic surveillance, triangulating quantitative and qualitative findings and DEA administrative data. AIM 3. To study real-time HCV and HIV cross-border transmission among PWID with molecular epidemiology. AIM 4. To characterize OD incidence and its associations with drug retail markets and DT. AIM 5. To conduct dynamic modeling of future HIV, HCV and OD incidence among PWID in SD in the context of changing drug retail markets to inform prevention interventions. La Línea will conduct prospective quantitative and qualitative surveillance of retail drug markets in both SD and TJ, coupled with epidemiologic data collection of 600 PWID (200 drug tourists from SD; 200 non-drug tourists from SD and 200 non-drug tourists from TJ) and an ethnographic sub-cohort (N=75; 25 per group). We will analyze PWIDs’ HIV and HCV sequencing data to prospectively assess cross-border transmission. We will incorporate longitudinal data on binational retail drug markets and HIV and HCV sequencing data into dynamic mathematical models to forecast future HIV, HCV and OD incidence trends. Since the direction of cross-border HIV transmission is now occurring from Mexico to the US for the first time and HIV incidence among PWID in TJ is high, monitoring trends in HIV and HCV incidence in the border region is critical to avoid future US outbreaks. This study addresses both the NIDA’s HEAL initiative and the Trans-NIH plan of the OAR, by conducting time-sensitive research to inform implementation of timely interventions to reduce incidence of HIV, HCV and OD.