Injection Risk Networks in Rural Puerto Rico

摘要 从2014年11月到2017年5月，我们的团队在346个当前PWID中进行了多波数据收集。 波多黎各内陆农村地区通过NIH资助R 01 DA 037117支持的项目。这项研究是由 围绕四个具体目标：1）使用基于网络的抽样、民族志实地调查以及艾滋病毒和丙型肝炎病毒检测， 确定影响人群中HIV和HCV发病率和流行率的行为和结构因素 波多黎各农村地区注射毒品者（PWID）; 2）估计艾滋病毒和丙型肝炎病毒的流行范围， 使用网络结构的基于代理的波多黎各农村5年、10年和20年时间跨度的发病率 模拟; 3）模拟旨在预防动态风险中的HIV和HCV感染的常见干预措施 网络环境，以确定哪些干预措施（或干预措施的组合）是最适当的 预防艾滋病毒和丙型肝炎病毒在波多黎各农村地区的艾滋病感染者中传播; 4）与我们的 传播咨询委员会，采用与目标受众进行知识交流的综合办法 （波多黎各和纽约的政策制定者、公共卫生官员和减少危害的提供者， 农村注射者成为艾滋病毒阳性者后会去哪里）。2017年9月，飓风玛丽亚摧毁了波多黎各的 基础设施演进这场灾难对与毒品有关的发病率和死亡率的影响可能很大。目前， 除了最近的研究之外，人们对灾后与毒品有关的感染或过量风险的模式知之甚少 在经济结构调整下。有哪些证据表明，艾滋病毒感染的风险在全面上升 和丙型肝炎感染情况。虽然玛丽亚造成的破坏相对来说是前所未有的，但大规模的自然灾害 社会灾害日益普遍。从规划和干预的角度来看， 了解此类事件对（短期）用药过量率和（长期）HIV/HCV感染的影响 流行是关键。这一相互竞争的修订允许一个最初没有预料到的灾后浪潮 与波多黎各农村PWID一起收集数据，将重复用于建立PWID风险网络的策略 在2016年和2017年两波数据收集期间的拓扑结构和流行病学动态。飓风后 数据收集将使人们更好地了解大规模社会和生态破坏的影响 与目标1-3有关的各种因素。这也将使我们的团队能够重新建立综合 与我们的传播咨询委员会进行知识交流，该委员会对 波多黎各的局势可能已经发生了巨大的变化。虽然我们的具体目标保持不变， 将通过纳入有史以来第一个灾前/灾后网络数据， 收集PWID。

ABSTRACT From November 2014 to May 2017, our team conducted multi-wave data collection with 346 current PWID in the rural interior of Puerto Rico via project supported by NIH grant R01DA037117. This research was organized around four specific aims: 1) Use network-based sampling, ethnographic fieldwork, and HIV and HCV testing to determine behavioral and structural factors affecting HIV and HCV incidence and prevalence rates among people who inject drugs (PWID) in rural areas of Puerto Rico; 2) Estimate the range of HIV and HCV prevalence and incidence rates in rural Puerto Rico for 5, 10, and 20 year time spans using network-structured, agent based simulation; 3) Simulate common interventions aimed at preventing HIV and HCV infection in a dynamic risk network environment to determine which interventions (or combinations of interventions) are most appropriate for preventing the spread of HIV and HCV among PWID in rural Puerto Rico; 4) In collaboration with our Dissemination Advisory Board, apply an integrated knowledge-exchange approach with our target audiences (policymakers, public health officials, and harm reduction providers in Puerto Rico and in New York, where many rural injectors go when they become HIV+). In September 2017, hurricane Maria devastated Puerto Rico's infrastructure. The impact of the disaster on drug-related morbidity and mortality are likely to be large. Currently, little is known about post-disaster patterns of drug-related risk of infection or overdose, outside of recent research under economic restructuring. What evidence exists points to an escalation of risk across the full range of HIV and hepatitis C infection scenarios. While the damage from Maria is relatively unprecedented, large scale natural and social disasters are increasingly common. From a planning and intervention perspective, greater understanding of the impacts of such events on (short term) overdose rates and (long-term) HIV/HCV infection prevalence are critical. This competing revision allows for an originally unanticipated wave of post-disaster data collection with rural PWID in Puerto Rico that will repeat strategies used to establish PWID risk network topologies and epidemiological dynamics during two waves of data collection in 2016 and 2017. Post-hurricane data collection will provide greater understanding of the impact of large scale social and ecological destruction on the range of factors associated with Aims 1-3. It will also allow our team to re-establish the integrated knowledge exchange with our Dissemination Advisory Board, whose understanding of the situation on the ground in Puerto Rico is likely to have shifted dramatically. While our specific aims remain the same, the impact of the overall project will be significantly expanded by the inclusion of a first-ever pre-/post-disaster network data collection among PWID.