Drug tourism to Mexico: Impact of Mexicos new drug law on HIV-HCV-TB in US IDUs

墨西哥毒品旅游：墨西哥新毒品法对美国注射吸毒者 HIV-HCV-TB 的影响

• 批准号: 8452218
• 负责人: Richard S Garfein
• 金额: $ 3.26万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8452218
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adult; Affect; Area; Attitude; Behavior; Behavior assessment; Biological Assay; Border Crossings; California; Cannabis; Charge; Cities; Cocaine; Cohort Studies; Collaborations; Communities; Comorbidity; Complement; Country; Crime; Data; Data Collection; Diffusion of Innovation; Disease; Disease Progression; Drug Legislation; Drug usage; Drug user; Epidemic; Epidemiologic Studies; Evaluation; Frequencies; Fright; Funding; Future; Goals; Gold; HIV; HIV Antibodies; HIV Infections; Health Status; Health behavior; Health behavior outcomes; Hepatitis C; Hepatitis C Antibodies; Hepatitis C Prevalence; Hepatitis C virus; Heroin; High Prevalence; Home environment; Illicit Drugs; Incidence; Infection; Injecting drug user; Intervention; Interview; Knowledge; Laws; Lead; Legal; Location; Marijuana; Measures; Methamphetamine; Methods; Mexican; Mexico; Modeling; Mycobacterium tuberculosis; Narcotics; National Institute of Drug Abuse; Natural experiment; New Mexico; Participant; Perception; Persons; Pharmaceutical Preparations; Policies; Prevalence; Process; Production; Qualitative Methods; Recruitment Activity; Reporting; Research; Respondent; Risk; Risk Behaviors; Risk Factors; Role; Sampling; Serologic tests; Serum; Sister; Specific qualifier value; Statutes and Laws; Testing; Time; Travel; Tuberculosis; United States National Institutes of Health; Universities; Visit; Vulnerable Populations; base; behavioral health; cohort; design; disorder risk; effective intervention; experience; follow-up; insight; instrument; male; meetings; novel; peer; response; risk perception; theories; transmission process

DESCRIPTION (provided by applicant): The goal of the proposed 5-year epidemiologic study is to assess the impact of Mexico's new drug laws on behaviors and disease incidence among injection drug users (IDUs) in the U.S. In August, 2009, Mexico enacted a controversial law decriminalizing possession of personal-sized quantities of drugs including heroin, cocaine, methamphetamine and cannabis. The sister-cities of San Diego, CA, USA and Tijuana, BC, Mexico share the world's busiest land border crossing and are home to nearly 4 million residents. Through research collaborations with the University of California, San Diego and partners in Tijuana, we found: i) increasing drug use and HIV prevalence in Tijuana; ii) dramatically higher prevalence of hepatitis C virus (HCV) and M. tuberculosis (Mtb) infections among IDUs in Tijuana versus San Diego; and, iii) injecting in Mexico reported by 21% of IDUs in San Diego. "Drug tourism" to Mexico among San Diegan IDUs may be an unintended consequence of Mexico's relaxed drug laws and could increase their risk for HCV, Mtb and HIV infections. This epidemiologic study aims to: 1) identify sociodemographic, behavioral, and health status differences between IDUs in San Diego who do and do not inject in Mexico; 2) describe changes in San Diegan IDUs' knowledge, attitudes, and experiences related to Mexican drug policies and assess their influences on decisions about injecting in Mexico; and 3) determine whether San Diegan IDUs who inject in Mexico are at increased risk for incident HCV and Mtb infection and identify risk factors for infection. To achieve these aims, we will use a mixed-methods design involving quantitative and qualitative data collection. Quantitative methods include recruiting a cohort of 750 IDUs in San Diego via respondent driven sampling for semi-annual behavioral assessments and serologic testing for HIV, HCV, and Mtb infections over 24 months of follow-up. HIV and HCV antibody testing will be performed on serum using standard practices; Mtb infection will be detected by QuantiFERON TB-Gold assay. Qualitative methods involve selecting 20 participants after each assessment visit (total=100) for in-depth interviews that will be used to: i) explore novel findings that emerge in preliminary analysis of the quantitative data; ii) identify new areas of inquiry for addition to the quantitative assessments; and iii) assess the validity of quantitative findings by presenting them for interpretation to study participants in qualitative interviews. The iterative process of using qualitative and quantitative data to inform methods and interpret findings of each approach facilitates a comprehensive understanding of the conceptual model describing how Mexico's new law will impact the behaviors and health outcomes of IDUs in San Diego. This study meets NIDA priorities supporting epidemiologic research on HIV/AIDS co-morbidities including HCV and tuberculosis, and the prevention of HIV among vulnerable populations. This study exploits a rare natural experiment to evaluate the impact of opposing drug policies on interconnected, bordering communities, and will provide important insights for future policies.

描述（由申请人提供）：拟议的5年流行病学研究的目的是评估墨西哥新药法对注射吸毒者（IDU）（IDU）在2009年8月在墨西哥颁布的有争议的毒品含量的墨西哥，包括海洛因，cocaine，cachampis ancabiS的个人大小量子的量子，墨西哥在2009年8月颁布了墨西哥注射吸毒者（IDU）的影响。美国加利福尼亚州圣地亚哥的姊妹城市和墨西哥不列颠哥伦比亚省蒂华纳州共享世界上最繁忙的土地过境点，并拥有近400万居民的家园。通过与加利福尼亚大学，圣地亚哥分校和蒂华纳合作伙伴的研究合作，我们发现：i）提高蒂华纳的药物使用和艾滋病毒的患病率增加； ii）在蒂华纳与圣地亚哥的IDU中，丙型肝炎病毒（HCV）和结核分枝杆菌（MTB）感染的患病率显着更高； iii）在墨西哥注射的21％在圣地亚哥报告。在圣戴甘（San Diegan Idus）中前往墨西哥的“吸毒旅游业”可能是墨西哥放松的毒品法律的意外结果，并可能增加其HCV，MTB和HIV感染的风险。这项流行病学研究的目的是：1）确定圣地亚哥IDU之间的社会人口统计学，行为和健康状况差异，他们在墨西哥进行和不注射； 2）描述与墨西哥毒品政策有关的圣丹格·伊迪斯（San Diegan Idus）知识，态度和经验的变化，并评估他们对墨西哥注射的决策的影响； 3）确定在墨西哥注射的San Diegan Idus是否处于发生HCV和MTB感染的风险增加，并确定感染的危险因素。为了实现这些目标，我们将使用涉及定量和定性数据收集的混合方法设计。定量方法包括在24个月的随访中，通过受访者驱动的采样招募了圣地亚哥的750个IDU，并通过受访者驱动的采样对HIV，HCV和MTB感染的血清学测试进行招募。 HIV和HCV抗体测试将使用标准实践在血清上进行； MTB感染将通过Quantiferon TB-Gold分析检测。定性方法涉及在每次评估访问（总计= 100）之后选择20名参与者，以进行深入的访谈：i）探索在定量数据初步分析中出现的新发现； ii）确定添加定量评估的新调查领域； iii）通过向定量访谈中研究参与者的解释来评估定量发现的有效性。使用定性和定量数据为方法提供信息和解释每种方法发现的迭代过程，促进了对概念模型的全面理解，描述了墨西哥的新法律将如何影响圣地亚哥IDU的行为和健康成果。这项研究符合NIDA的优先级，支持有关HIV/AIDS合并症的流行病学研究，包括HCV和结核病，以及预防脆弱人群中的HIV。这项研究利用了一个罕见的自然实验，以评估相反的药物政策对互连，与社区接壤的社区的影响，并将为未来的政策提供重要的见解。