The effect of opioids, stimulants, and the simultaneous use of both on the hepatitis C virus (HCV) cascade of care in rural communities in the United States

项目总结 由于增加注射，美国急性丙型肝炎病毒(丙型肝炎病毒)感染人数稳步上升 药物使用(IDU)。静脉注射毒品的增长不成比例地导致了农村地区急性丙型肝炎病毒感染 这是因为社区的发病率是城市地区的两倍多。描述了丙型肝炎病毒的管理。 使用丙型肝炎病毒级联护理(CoC)，包括检测和治疗完成。有一种迫切的需要 增加注射吸毒者的丙型肝炎病毒检测(PWID)。每年的丙型肝炎病毒检测率只有7.7% 在美国临床确诊为PWID的人中，在检测出丙肝病毒阳性的农村PWID中，59% 在结果出来的18个月内联系了医疗保健提供者，14%的人报告说正在寻求丙型肝炎病毒治疗，以及 只有8%的人报告接受了丙型肝炎病毒治疗。此外，兴奋剂的使用，定义为甲基苯丙胺， 安非他命或可卡因的使用正在卷土重来。阿片类药物和兴奋剂的多物质使用正在增加 农村PWID，与共用注射器等丙型肝炎传播因素增加有关。然而， 兴奋剂和多物质的使用对丙型肝炎病毒检测和治疗的影响尚不清楚。建议数 研究旨在降低农村社区中与丙型肝炎相关的发病率和死亡率。 拟议的项目将利用美国国立卫生研究院资助的八项农村阿片类药物倡议研究中收集的数据 (ROI)(NIDA U24DA048538)。我们将利用这一全面的数据收集和集成 用流行病学和空间方法确定阿片类药物、兴奋剂(甲基苯丙胺、 苯丙胺、可卡因)及其在丙型肝炎病毒感染、检测和治疗中的同时和同时使用 包括在投资回报基础设施中的农村社区的竣工。目标1将评估阿片类药物的关联性 存在丙型肝炎病毒感染的阿片类药物和兴奋剂的使用、兴奋剂使用和多物质使用 PWID。目标2将测量阿片类药物、兴奋剂和多物质(阿片类药物和兴奋剂)的使用之间的关系 关于丙型肝炎病毒检测和治疗完成情况。AIM 3将确定针对丙型肝炎病毒检测和 在ROI基础设施内的PWID社区中的治疗。该项目的结果将确定 需要丙型肝炎病毒检测和治疗支持以遏制丙型肝炎病毒和相关疾病传播的农村社区 PWID患者的死亡率。该项目将加强申请人在流行病学方面的专门知识和应用 方法解决物质使用和传染病领域的公共卫生问题。申请者将会 获得研究、合作和传播经验，为独立的流行病学研究做好准备 调查员的职业。这个项目和申请者得到了流行病学杰出教师的支持， 物质使用、传染病、行为健康、地理、人口健康和公共健康 信息学。

PROJECT SUMMARY The number of acute hepatitis C virus (HCV) infections has risen steadily in the U.S. due to increased injection drug use (IDU). The growth of IDU has disproportionately contributed to acute HCV infections in rural communities as their incidence rates are more than twice those of urban areas. HCV management is described using the HCV cascade of care (CoC) and includes testing and treatment completion. There is a critical need to increase HCV testing among people who inject drugs (PWID). The annual HCV testing rate is only 7.7% among those clinically identified as PWID in the U.S. Among rural PWID who tested positive for HCV, 59% contacted a healthcare provider within 18 months of their results, 14% reported seeking HCV treatment, and only 8% reported receiving HCV treatment. Further, stimulant use, defined as methamphetamine, amphetamine, or cocaine use, is resurging. Polysubstance use of opioids and stimulants is increasing among rural PWID and is associated with increased factors for HCV transmission, such as syringe sharing. Yet, the effect of stimulant and polysubstance use on HCV testing and treatment remains unclear. The proposed research aims to reduce the morbidity and mortality associated with HCV among PWID in rural communities. The proposed project will leverage data collected in eight NIH-funded studies of the Rural Opioid Initiative (ROI) (NIDA U24DA048538). We will use this comprehensive collection of data and the integration of epidemiological and spatial methods to determine the effect of opioids, stimulants (methamphetamine, amphetamine, cocaine), and their simultaneous and concurrent use on HCV infection, testing, and treatment completion in rural communities included in the ROI infrastructure. Aim 1 will estimate the association of opioid use, stimulant use, and polysubstance use of opioids and stimulants with the presence of HCV infection among PWID. Aim 2 will measure the association of opioid, stimulant, and polysubstance (opioid and stimulant) use on HCV testing and treatment completion. Aim 3 will identify high-priority locations to target HCV testing and treatment among PWID communities within the ROI infrastructure. The results from this project will identify rural communities that require HCV testing and treatment support to curtail the spread of HCV and associated mortalities among PWID. This project will enhance the applicant’s expertise and application of epidemiological methods to solve public health issues in the fields of substance use and infectious diseases. The applicant will gain research, collaboration, and dissemination experience to prepare her for an independent epidemiological investigator career. This project and applicant are supported by distinguished faculty in epidemiology, substance use, infectious diseases, behavioral health, geography, population health, and public health informatics.