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

本研究将描述与两国药物相关的HIV、HCV和OD发生率的趋势 市场和毒品旅游（DT）之间的圣地亚哥（SD）和蒂华纳（TJ），墨西哥。TJ坐在一个主要的 毒品贩运路线，海洛因，芬太尼，冰毒和可卡因被贩运到美国。仅次于墨西哥 2009年，少量毒品部分合法化，SD每6名注射毒品者中就有1人 报告说，在TJ注射毒品，那里的毒品“更便宜，更容易购买”。自从墨西哥最近 放松了阿片类药物处方法，SD和TJ之间的药物供应和价格差异将 可能会扩大，导致DT增加，从而影响上述健康结果。我们假设 芬太尼对当地毒品市场的更大渗透将与更危险的行为有关， 增加艾滋病毒和HCV感染率。我们的研究是及时的，因为零售药品市场正在发生变化，在天津 吸毒游客可能会有更危险的行为。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”。我们提出的研究的具体目标，称为La Línea （“线”）是：目的1。前瞻性描述SD和TJ之间的跨境DT及其 与零售药品市场特点的关联。AIM 2.描述零售药品市场趋势， 通过进行流行病学和民族志监测、定量和三角测量来比较TJ与SD 定性调查结果和DEA行政数据。AIM 3.研究实时HCV和HIV跨界 传播的分子流行病学研究。目标4.描述OD发生率及其 与药品零售市场和DT的关联。AIM 5.对未来的HIV、HCV进行动态建模 在不断变化的药品零售市场的背景下， 预防干预。La Línea将对以下方面进行前瞻性定量和定性监测： SD和TJ的零售药品市场，加上600个PWID（200 200名来自SD的非毒品游客和200名来自TJ的非毒品游客）和一名 人种学子队列（N=75;每组25）。我们将分析PWID的HIV和HCV测序数据， 以前瞻性地评估跨境传播。我们将纳入两国的纵向数据 零售药品市场和HIV和HCV测序数据转化为动态数学模型进行预测 未来HIV、HCV和OD发病趋势。由于目前艾滋病毒的跨境传播方向是 首次从墨西哥到美国发生，TJ的PWID中艾滋病毒发病率很高， 监测边境地区HIV和HCV发病率的趋势对于避免未来美国 爆发这项研究涉及NIDA的HEAL倡议和OAR的Trans-NIH计划， 开展时间敏感的研究，为及时采取干预措施提供信息， 艾滋病毒、丙型肝炎病毒和OD的发病率。

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.