Addiction, HIV and Tuberculosis in Malaysian Criminal Justice Settings

马来西亚刑事司法环境中的成瘾、艾滋病毒和结核病

• 批准号: 9323367
• 负责人: FREDERICK LEWIS ALTICE
• 金额: $ 72.72万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-15 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9323367
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Agonist; Asia; Attitude; Back; Buprenorphine; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Chest; Clinical Trials; Collaborations; Communicable Diseases; Communities; Continuity of Patient Care; Country; Criminal Justice; Crowding; Data; Diagnostic; Disease; Disease Outbreaks; Drug resistance in tuberculosis; Drug usage; Education; Effectiveness; Environment; Evidence based intervention; Faculty; Female; Funding; General Population; Genes; HIV; Hepatitis C; Hepatitis C Prevalence; Hepatotoxicity; High Prevalence; Human Resources; Imprisonment; Incidence; Individual; Infection; Infection prevention; Injectable; Injecting drug user; Injection of therapeutic agent; Malaysia; Malaysian; Methadone; Modeling; Morbidity - disease rate; NCI Scholars Program; National Institute of Drug Abuse; Opiate Addiction; Opioid; Outcome; Patients; Pharmaceutical Preparations; Physicians; Policies; Population; Postdoctoral Fellow; Prevalence; Prevention; Prevention strategy; Prisoner; Prisons; Randomized; Randomized Controlled Trials; Readiness; Recommendation; Research; Research Activity; Research Personnel; Research Project Grants; Resistance development; Risk; Risk Behaviors; Role; Scholarship; Science; Sexually Transmitted Diseases; Sputum; Substance abuse problem; Symptoms; System; Testing; Thoracic Radiography; Time; Tuberculin Test; Tuberculosis; United States National Institutes of Health; Universities; Work; addiction; antiretroviral therapy; arm; base; co-infection; community setting; comparative cost effectiveness; comparative effectiveness; cost effective; cost effectiveness; doctoral student; drug development; evidence base; global health; health equity; health training; high risk; improved; innovation; insight; isoniazid; low and middle-income countries; mathematical model; member; men who have sex with men; mortality; multidisciplinary; next generation; pandemic disease; preference; programs; public health relevance; rifapentine; screening; sex; success; transgender; transmission process; treatment strategy; trial comparing

 DESCRIPTION (provided by applicant): The syndemics of addiction, HIV and TB are concentrated in criminal justice settings (CJS). HIV and TB contribute most to mortality among the ~50-60 million people who transition through prisons annually. Malaysia has the highest HIV prevalence among people who inject drugs (PWIDs) in Asia where criminalization of drugs is harsh, resulting in the highest HIV prevalence among prisoners and the second highest incarceration rate in Asia. While mortality decreased 39% in Asia, it has increased in Malaysia where treatment of HIV and TB are inadequately treated among PWIDs, especially in prisoners. Over the past 10 years, researchers at Yale University and the University of Malaya have continuously collaborated on research involving key populations, including PWIDs, prisoners, MSM and both female and transgender sex workers. Our research has multidisciplinary at the interface of addiction and infectious diseases like HIV, TB, HCV and sexually transmitted infections. Our research has been supported through funding for a number of pre- and post-doctoral students and junior faculty members through our Fogarty-sponsored Global Health Equity Scholars program, Doris Duke Charitable Global Health Training, Fulbright scholarships and through NIDA-sponsored research grants. Central to our research activities have been a number of findings from our prison-based studies that inform the current R01 submission, including: Accomplishments from these aims that support the next generation of research questions include: 1) extraordinary mortality among HIV+ prisoners, primarily form TB; 2) high prevalence of latent TB infection (LTBI) among HIV+ and HIV- prisoners and prison personnel alike; 3) the emerging role of prisoners as high risk environments contributing to onward TB transmission among prisoners transitioning to the community; 4) effectiveness of opioid agonist therapies (OAT) like methadone and buprenorphine in promoting retention in care and improved HIV and TB outcomes in community settings, including among released prisoners; 5) despite these promising findings from OAT, negative attitudes by prisoners and correctional staff toward their use undermine their potential benefits; and 6) preliminary studies challenging existing recommendations for TB screening, diagnostics and prevention strategies in prisons that are central to the two related and sequential specific aims in this proposal: 1) To conduct empiric studies of TB, including: a) TB diagnostics (symptoms, CXR, TST, AFB smear, Gene Xpert, and sputum culture) to optimize TB screening; b) a RCT of TB prevention strategies among HIV+ and HIV- prisoners comparing a 12-week short-course of once-weekly isoniazid/rifapentine vs a standard 40-week course of daily isoniazid in a population with high HCV prevalence and potential for hepatotoxicity; and c) a RCT of HIV= and HIV- prisoners with TB who have insufficient time to complete treatment within prison and comparing treatment completion rates for those who refuse OAT with those who accept it, but who are randomized to methadone or buprenorphine therapy to facilitate continuity of care post-release; and 2) To use data from aim 1 combined with publically available TB data to conduct agent-based modeling for comparative and cost- effectiveness analyses of TB screening, prevention and treatment strategies among prisoners with and without HIV, incorporating the contribution of latent TB infection and prevalent TB disease on community transmission post-release.

 描述(申请人提供)：成瘾、艾滋病毒和结核病的综合症状集中在刑事司法环境(CJS)。艾滋病毒和结核病是每年约5,000万至6,000万囚犯死亡的主要原因。马来西亚是亚洲注射吸毒者中艾滋病毒感染率最高的国家，在那里，对毒品的刑事定罪非常严厉，导致囚犯中艾滋病毒感染率最高，监禁率在亚洲排名第二。虽然亚洲的死亡率下降了39%，但马来西亚的死亡率却有所上升，在那里，艾滋病毒和结核病的治疗在残疾人中没有得到充分的治疗，特别是在囚犯中。在过去的10年里，耶鲁大学和马来亚大学的研究人员不断合作进行涉及关键人群的研究，包括PWID、囚犯、MSM以及女性和变性性工作者。我们的研究在成瘾与艾滋病毒、结核病、丙型肝炎和性传播感染等传染病的界面上进行了多学科的研究。我们的研究通过Fogarty赞助的全球健康公平学者计划、Doris Duke慈善全球健康培训、富布赖特奖学金和NIDA赞助的研究基金资助了许多博士后和博士后学生和初级教职员工。我们的研究活动的中心是我们监狱研究的一些发现，这些发现为目前的R01提交提供了信息，包括：这些目标取得的成果支持下一代研究问题包括：1)艾滋病毒+囚犯中的异常死亡率，主要是结核病；2)艾滋病毒+和艾滋病毒-囚犯和监狱工作人员中潜在结核病感染(LTBI)的高流行率；3)囚犯作为高风险环境的新角色，导致过渡到社区的囚犯中继续传播结核病；4)阿片类激动剂疗法(OAT)，如美沙酮和丁丙诺啡，在促进社区环境中保留护理和改善艾滋病毒和结核病结果方面的有效性，包括在被释放的囚犯中；5)尽管审查处有这些令人振奋的发现，但囚犯和惩教人员对使用结核病的消极态度破坏了他们的潜在利益；以及6)对监狱中结核病筛查、诊断和预防战略的现有建议提出挑战的初步研究，这些建议对本提案中两个相关和顺序的具体目标至关重要：1)对结核病进行经验性研究，包括：a)结核病诊断(症状、CXR、TST、AFB涂片、基因Xpert和痰培养)，以优化结核病筛查；(B)艾滋病毒感染者和艾滋病毒感染者中结核病预防策略的随机对照试验，比较丙型肝炎病毒高流行率和潜在肝毒性人群中12周一周一次的短期异烟肼/利福喷丁疗程与标准的每日40周异烟肼疗程；以及c)艾滋病毒=和艾滋病毒-患有结核病的囚犯的随机对照试验，这些囚犯没有足够的时间在监狱内完成治疗，并比较拒绝接受燕麦片疗法的人和接受燕麦片疗法的人的治疗完成率，但这些人被随机接受美沙酮或丁丙诺啡治疗，以促进释放后继续治疗；2)使用AIM 1的数据和公共可获得的结核病数据进行基于代理的建模，对感染和不感染艾滋病毒的囚犯的结核病筛查、预防和治疗策略进行比较和成本效益分析，纳入潜在结核病感染和流行的结核病疾病在释放后对社区传播的贡献。