Epidemiology, Prevention and Treatment of HCV in Young Adult Persons who Inject Drugs in non-urban New Mexico

 描述（由申请人提供）：丙型肝炎病毒（HCV）在美国的流行集中在注射毒品（PWID）的人群中。越来越多的HCV报告，包括非城市地区年轻成人PWID中HCV的爆发，引发了对流行病扩大的担忧。一些调查表明，HCV感染的这些峰值与美国处方阿片类药物使用的急剧增加有关，这一趋势导致年轻人从处方阿片类药物过渡到注射使用，特别是海洛因。非城市地区的年轻成年PWID感染的风险可能会增加，这是由于注射群体中的高病毒感染性和高HCV流行率，以及缺乏有关感染途径和有效预防的知识。新墨西哥州是年轻人中HCV记录增加的州之一，在CDC的新发感染项目（EIP），肝炎监测示范点项目中，2011年报告的HCV病例数量和比率排名第二。海洛因、处方阿片类药物和其他药物也是该州过量服用率最高的原因之一。2013年10月至2014年3月间，新墨西哥州卫生部在一项试点监测研究中记录了211例年轻人中的HCV病例，证明了问题的严重性。为了解决这一人群对HCV的预防，护理和治疗服务的需求，我们建议在新墨西哥州的两个地区的流行病学和服务摄取研究，年轻的成年人PWID已受到药物使用和HCV的影响。我们将在新墨西哥州的两个卫生区招募并随访非城市年轻成年PWID患者，开展一项前瞻性队列研究（1）收集有关危险行为、药物使用模式、注射网络、预防需求和卫生服务利用的流行病学数据;（2）将年轻成年PWID转介到HCV护理服务以及其他预防和治疗机会，包括减少伤害和药物治疗，并评估成功联系的比率，包括级联护理;（3）检查可能导致慢性HCV感染的年轻成人PWID不接受治疗、依从性差和未能实现SVR的因素;（4）评估接受HCV治疗并实现SVR的年轻成人PWID的再感染事件。我们的建议，我们在本申请中称为新墨西哥州H-TIPS，也将包括艾滋病毒和HBV合并感染的检测和转诊。一个由公共卫生和临床专家组成的合作小组与新墨西哥州强大的预防和临床服务基础设施相联系，将确保这项研究的成功实施。这项拟议研究的结果将影响不成比例地处于HCV风险中的多样化年轻人口，并减少受药物使用和HCV高度影响的地区的健康差异。

 DESCRIPTION (provided by applicant): The hepatitis C virus (HCV) epidemic in the U.S. is concentrated in people who inject drugs (PWID). Increasing reports of HCV including outbreaks of HCV in young adult PWID in non-urban locales have prompted concerns about an expanding epidemic. Several investigations suggest that that these spikes in HCV infection are linked to sharp increases in prescription opiate use that has been trending in the U.S, and which have resulted in young adults transitioning from prescription opiates to injection use, particularly heroin. Young adult PWID in non-urban areas may be at increased risk of infection, from the combination of high viral infectivity and high prevalence of HCV in injecting groups, together with a lack of knowledge regarding infection routes and effective prevention. New Mexico is one of the states leading recorded increases in HCV in young adults, ranking 2nd in the CDC's Emerging Infections Program (EIP), Hepatitis Surveillance Demonstration Sites project, in 2011 for the number and rate of HCV cases reported. Heroin, prescription opioids, and other drugs are also accounting for this state having one of the highest overdose rates in the country. Between October 2013 and March 2014, the New Mexico Department of Health recorded 211 cases of HCV among young adults in a pilot surveillance study, demonstrating the gravity of the problem. To address the need for prevention, care and treatment services against HCV in this population, we propose epidemiological and service uptake research in two regions of New Mexico where young adult PWID have been impacted by drug use and HCV. We will initiate a prospective cohort study of young adult non-urban PWID who will be recruited and followed in two health regions of New Mexico (the South West and North East) to: (1) gather epidemiologic data on risk behaviors, drug use patterns, injection networks, prevention needs, and health service utilization; (2) to refer young adult PWID to HCV care services, as well as other prevention and treatment opportunities including harm reduction and drug treatment, and assess rates of successful linkage, including the cascade of care; (3) to examine factors that may contribute to non-treatment, poor adherence, and failure to achieve SVR among young adult PWID with chronic HCV infection; and (4) assess reinfection events among young adult PWID who are treated for HCV and achieve SVR. Our proposal, which we refer to in this application as New Mexico H-TIPS, will also include testing and referrals for HIV and HBV co-infections as well. A collaborative group of public health and clinical specialists linked with a strong prevention and clinical service infrastructure in New Mexico will ensure successful implementation of this research. Results from this proposed research will impact a diverse young population disproportionately at risk for HCV and reduce health disparities in a region highly impacted by drug use and HCV.