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The Diversion of Antiretroviral Medications to Street Markets

抗逆转录病毒药物转移到街头市场

基本信息

批准号：
7580136
负责人：
HILARY L SURRATT
金额：
$ 45.68万
依托单位：
UNIVERSITY OF DELAWARE
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-12-01 至 2012-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7580136
关键词：
AIDS/HIV problem Address Adherence Anti-Retroviral Agents Area Attitude Benzodiazepines Caring Combivir Communication County Deterioration Development Dimensions Drug Delivery Systems Drug Prescriptions Drug resistance Drug usage Drug user Economics Environmental Monitoring Environmental Risk Factor Exposure to Family Florida Foundations Fraud Frequencies Funding Gilead brand of tenofovir disoproxil fumarate Goals Government Agencies HIV HIV Infections HIV Seropositivity HIV drug resistance Health Health Personnel Healthcare Healthcare Systems Homelessness Indigent Individual Industry Injection of therapeutic agent Internet Intervention Interview Lamivudine Left Legal Literature Location Lopinavir/Ritonavir Marketing Medicaid Medical Medicare/Medicaid Mental Health Methods Modeling Motivation Narcotic Analgesics National Institute of Drug Abuse Nature Nelfinavir Monomethane Sulfonate Newly Diagnosed Opioid Oxycodone Patients Pattern Percocet Pharmaceutical Preparations Pharmacologic Substance Pharmacy facility Phase Physicians&apos Offices Policies Prevention Price Process Provider Public Health Published Comment Qualitative Research Recording of previous events Recruitment Activity Reporting Research Research Personnel Risk Management Ritonavir Sampling Site Source Stavudine Substance abuse problem Tenofovir Testing Tetrahydrocannabinol Time Treatment Protocols Trizivir Unsafe Sex Vulnerable Populations Waiting Lists Work Zidovudine abacavir abacavir sulfate base drug abuser drug resistant virus efavirenz effective therapy emtricitabine experience follow-up health care service utilization health organization pill prescription drug abuse pressure programs public health relevance resistant strain sustiva theories transmission process truvada viracept

项目摘要

DESCRIPTION (provided by applicant): Prescription drug "diversion" -- the unlawful channeling of regulated pharmaceuticals from legal sources to the illicit marketplace -- has been a topic of widespread commentary since the latter part of the 1990s, and a number of recent studies have addressed patterns of narcotic analgesic abuse and diversion. The scientific literature, however, has been virtually silent regarding the diversion of antiretroviral medications (ARV) for HIV. Nevertheless, pilot work conducted by the investigators of this application suggests that ARV diversion is a growing problem among drug-involved individuals in Miami, and is likely occurring in other large urban centers where rates of HIV infection are high. The ramifications of this diversion are potentially significant. Importantly, those prescribed ARV medications may not be consistently adhering to their treatment regimens, resulting in a deterioration of their own health and increasing the potential for the emergence of medication-resistant strains of HIV. From a public health perspective, the widespread transmission of drug-resistant HIV could leave newly-infected individuals with few viable treatments. Within this context, the overall goals of the proposed 4-year project are to examine the patterns and predictors of ARV diversion among drug-involved HIV-positive individuals in Miami (Dade County), Florida, and to describe the dynamics of ARV medication diversion to local street markets. The study will utilize a theory-driven, mixed method approach to achieve these goals. The specific aims of the qualitative component of the proposed research are to: 1) Describe the key individual, provider, and environmental factors that influence ARV diversion through formative qualitative research; and, 2) Adapt and refine the Andersen model of health services utilization to include the key dimensions of ARV diversion identified in the formative qualitative research phase. Aims 1 and 2 will be accomplished by: 1) Conducting baseline and follow-up in-depth interviews with 90 drug-involved, indigent, HIV positive ARV diverters and non-diverters to examine motivations for diversion and non-diversion over time; 2) Conducting baseline and follow-up in-depth interviews with 30 "pill brokers" to document their ARV diversion activities over time; and, 3) Conducting in-depth baseline and follow-up interviews with 45 HIV positive buyers of illicit ARVs to examine motivations for illicit ARV purchases over time. The primary specific aim of the quantitative component of the research is to: 3) Compare the key differences between ARV diverters and non-diverters on individual, provider, and environmental level factors described by the modified Andersen Model of health services utilization, and examine their effects on patterns of ARV medication diversion. Aim 3 will be accomplished by: 1) Recruiting a sample of 500 indigent, HIV positive individuals who are current drug users [250 of whom divert ARV medications and 250 who do not]; and, 2) assessing the constellation of individual, provider and environmental factors hypothesized to predict ARV diversion. PUBLIC HEALTH RELEVANCE: A comprehensive understanding of the nature, motivations for, and mechanisms of ARV medication diversion is critical for funding and regulatory agencies, industry, public health organizations, and health care providers as they attempt to develop appropriate prevention, risk management, treatment, and policy initiatives. Most importantly, this study will inform interventions targeting the significant health consequences of ARV diversion and non-adherence by highly vulnerable populations.

描述（由申请人提供）：处方药“转移”——将受监管的药品从合法来源非法输送到非法市场——自 20 世纪 90 年代后期以来一直是广泛评论的话题，最近的一些研究已经解决了麻醉镇痛药滥用和转移的模式。然而，科学文献对于转移抗逆转录病毒药物（ARV）治疗艾滋病毒的问题几乎保持沉默。然而，该应用程序的调查人员进行的试点工作表明，抗逆转录病毒药物转移是迈阿密吸毒者中一个日益严重的问题，并且很可能发生在艾滋病毒感染率较高的其他大城市中心。这种转移的影响可能是重大的。重要的是，那些服用抗逆转录病毒药物的人可能无法始终坚持治疗方案，从而导致自身健康状况恶化，并增加出现耐药性艾滋病毒株的可能性。从公共卫生的角度来看，耐药艾滋病毒的广泛传播可能使新感染者几乎没有可行的治疗方法。在此背景下，拟议的四年项目的总体目标是研究佛罗里达州迈阿密（戴德县）艾滋病毒阳性者中抗逆转录病毒药物转移的模式和预测因素，并描述抗逆转录病毒药物转移到当地街头市场的动态。该研究将利用理论驱动的混合方法来实现这些目标。拟议研究定性部分的具体目标是： 1) 通过形成性定性研究描述影响抗逆转录病毒药物转移的关键个人、提供者和环境因素； 2) 调整和完善安徒生卫生服务利用模型，以纳入在形成性定性研究阶段确定的抗逆转录病毒药物转移的关键维度。目标 1 和 2 将通过以下方式实现： 1) 对 90 名吸毒、贫困、艾滋病毒阳性的抗逆转录病毒药物转移者和非转移者进行基线和后续深入访谈，以检查随着时间的推移转移和不转移的动机； 2) 对 30 名“药品经纪人”进行基线和后续深度访谈，记录他们一段时间内的抗逆转录病毒药物转移活动； 3) 对 45 名非法抗逆转录病毒药物购买者进行深入的基线和后续访谈，以调查一段时间内非法购买抗逆转录病毒药物的动机。该研究定量部分的主要具体目标是： 3) 比较抗逆转录病毒药物转移者和非转移者在修正的安徒生卫生服务利用模型所描述的个人、提供者和环境水平因素上的主要差异，并检查它们对抗逆转录病毒药物转移模式的影响。目标 3 将通过以下方式实现： 1) 招募 500 名当前吸毒者的贫困 HIV 阳性个体作为样本 [其中 250 人转移抗逆转录病毒药物，250 人不转移]； 2) 评估预测抗逆转录病毒药物转移的假设的个人、提供者和环境因素。公共卫生相关性：全面了解抗逆转录病毒药物转移的性质、动机和机制对于资助和监管机构、行业、公共卫生组织和医疗保健提供者试图制定适当的预防、风险管理、治疗和政策举措至关重要。最重要的是，这项研究将为针对抗逆转录病毒药物转移和高度脆弱人群不遵守药物的重大健康后果的干预措施提供信息。