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

阿片类药物危机期间的流行病冲突：COVID-19 大流行对注射吸毒者中 HIV 和 HCV 传播决定因素的影响

• 批准号: 10674038
• 负责人: Eshan Uday Patel
• 金额: $ 4.77万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10674038
• 关键词: Acquired Immunodeficiency Syndrome; Age; Antiviral Therapy; Anxiety; Area; Baltimore; Behavioral; Biological Factors; COVID-19 pandemic; COVID-19 pandemic effects; COVID-19 vaccination; Cities; Communities; Coupled; Data; Disease Outbreaks; Environment; Epidemic; Epidemiologist; Epidemiology; Equation; Equipment; Feeling; Frequencies; Future; Goals; HIV; HIV Infections; HIV/HCV; Harm Reduction; Health; Health Services Accessibility; Healthcare; Hepatitis C; Hepatitis C Incidence; Hepatitis C Prevalence; Hepatitis C Transmission; Hepatitis C Viremia; Hepatitis C co-infection; Hepatitis C virus; Individual; Injecting drug user; Injections; Interruption; Interview; Intravenous; Link; Measures; Mental Depression; Mentors; Methods; National Institute of Drug Abuse; Needle Sharing; Needle-Exchange Programs; Needles; Neighborhoods; Participant; Patient Self-Report; Pattern; Personal Satisfaction; Persons; Pharmaceutical Preparations; Phase; Population; Population Decreases; Prevalence; Psychosocial Factor; Public Health; Public Health Schools; Qualitative Research; Research; Research Training; Risk; Risk Factors; Running; Sampling; Series; Services; Social Distance; Social isolation; Stress; Subgroup; Time; Time Series Analysis; Time trend; Training Programs; Transportation; United States; United States Public Health Service; Vaccination; Viremia; antiretroviral therapy; cohort; doctoral student; effective therapy; experience; follow-up; future pandemic; health care availability; high risk; improved; injection drug use; long term consequences of COVID-19; medication for opioid use disorder; opioid epidemic; opioid injection; opioid overdose; pandemic disease; pandemic impact; pre-pandemic; prevention service; psychosocial; residence; response; scale up; service uptake; service utilization; social contact; sociodemographics; statistics; substance use; testing services; transmission process; treatment services; trend; uptake

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.

项目总结/摘要 美国计划到2030年结束艾滋病毒流行（EHE）并消除丙型肝炎病毒（HCV）感染。而 在许多群体中取得了进展，包括注射毒品的人（PWID），最近爆发的HCV 在美国，PWID和HIV感染已被记录，HCV发病率在全国范围内呈上升趋势 因为鸦片危机COVID-19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，并创造了一个允许使用药物的环境。事实上，COVID-19 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除EHE和HCV。 本研究的目的是评估COVID-19大流行对中国的短期和长期影响。 马里兰州巴尔的摩PWID人群中HIV和HCV传播的个人和社区决定因素 具体目标是：（1）确定PWID中高风险注射实践的个体水平预测因子 在COVID-19大流行期间，（2）检查减少危害利用的趋势，并确定相关的 在COVID-19大流行期间PWID之间的障碍和促进因素，以及（3）评估 2019冠状病毒病大流行对PWID人群HIV和HCV病毒血症患病率的影响。这些目标 将通过利用来自一个最大和运行时间最长的基于社区的队列的数据来实现 全球范围内的PWID-艾滋病与静脉注射经验（ALIVE）研究在巴尔的摩，MD。目标1将 确定大流行前与高风险相关的社会人口、行为、心理和生物因素， 在大流行期间使用广义估计的修正泊松回归的风险注入做法 方程目标2将使用混合方法顺序解释方法来检查 人口一级对针头/注射器交换服务和类阿片使用障碍药物的接受情况 在大流行的不同阶段（2015-2021年）。将与25-30名PWID进行深入访谈， 探索服务利用的新障碍和促进因素。目标3将使用中断的时间序列分析 估计大流行对HIV病毒血症和HCV病毒血症流行率影响的方法（2015- 2023年）。这项研究将告知大流行是否对地方和国家的EHE目标构成重大威胁 消除HCV感染。这项研究还将为监测和方案的实施提供信息。 在持续的大流行和阿片类药物危机期间以及 未来的动荡和不稳定。拟议的研究涵盖了NIDA的一个高度优先领域， 作为Eshan Patel先生的博士论文，Eshan Patel先生是纽约大学流行病学系的一名博士生， 约翰霍普金斯布隆伯格公共卫生学院。一个全面的培训计划，包括指导 来自艾滋病毒、丙型肝炎病毒和药物使用流行病学、心理社会统计学专家的研究培训， 定性研究和因果推理将为申请人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HIV和HCV做出贡献。

项目成果

A Mixture Model for Estimating SARS-CoV-2 Seroprevalence in Chennai, India.

• DOI: 10.1093/aje/kwad103
• 发表时间: 2023-09-01
• 期刊: American journal of epidemiology
• 影响因子: 5
• 作者: Hitchings MDT;Patel EU;Khan R;Srikrishnan AK;Anderson M;Kumar KS;Wesolowski AP;Iqbal SH;Rodgers MA;Mehta SH;Cloherty G;Cummings DAT;Solomon SS
• 通讯作者: Solomon SS

Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in Baltimore, Maryland.

• DOI: 10.1016/j.dadr.2023.100184
• 发表时间: 2023-09
• 期刊: Drug and alcohol dependence reports
• 作者: Patel, Eshan U;Mehta, Shruti H;Genberg, Becky L;Baker, Owen R;Schluth, Catherine G;Astemborski, Jacquie;Fernandez, Reinaldo E;Quinn, Thomas C;Kirk, Gregory D;Laeyendecker, Oliver
• 通讯作者: Laeyendecker, Oliver

Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Hospitalizations: National Inpatient Sample, 2016-2019.

耐甲氧西林和甲氧西林敏感金黄色葡萄球菌住院情况：2016-2019 年全国住院患者样本。

• DOI: 10.1093/ofid/ofab585
• 发表时间: 2022-01
• 期刊: Open forum infectious diseases
• 影响因子: 4.2
• 作者: Klein EY;Zhu X;Petersen M;Patel EU;Cosgrove SE;Tobian AAR
• 通讯作者: Tobian AAR

Molecular Screening of Blood Donors for Babesia in Tyrol, Austria.

• DOI: 10.1159/000528793
• 发表时间: 2023-08
• 期刊: Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie

Therapeutic plasma exchange in the management of stiff person syndrome spectrum disorders: a case series and review of the literature.

• DOI: 10.1177/17562864231180736
• 发表时间: 2023
• 期刊: THERAPEUTIC ADVANCES IN NEUROLOGICAL DISORDERS
• 影响因子: 5.9
• 作者: Mercure-Corriveau, Nicolas;Roy, Shuvro;Hu, Chen;Crowe, Elizabeth P. P.;Zhu, Xianming;Obando, Danielle;Patel, Eshan U. U.;Tobian, Aaron A. R.;Wang, Yujie;Bloch, Evan M. M.;Newsome, Scott D. D.
• 通讯作者: Newsome, Scott D. D.