Crossing Borders: HIV and Substance use at the Gateway to North America

描述（由申请人提供）：本研究的总体目标是探讨墨西哥/危地马拉边境不断上升的毒品使用背景，并确定其与当地艾滋病毒和性传播感染（STIs）的流行病学和进化地理学的关系。毒品贩运路线的改变、恶劣的经济条件和年轻人越来越多地使用硬性毒品可能是促使吸毒的一些因素。通过该地区的众多区域和国际移民可能助长了艾滋病毒和性传播感染的传播。然而，该区域缺乏关于吸毒与艾滋病毒/性传播感染之间关系的数据。基于上述，该项目的具体目标是：1)描述影响墨西哥/危地马拉边境高危人群吸毒的背景因素和吸毒模式；2)确定药物使用者中艾滋病毒、丙型肝炎病毒（HCV）和性传播感染的患病率及其相关因素；3)探讨高危人群HIV-1感染的进化地理学和分子流行病学。为了实现目标1，将在墨西哥的塔帕丘拉/伊达尔戈城和危地马拉的Teczn Uman/Quetzaltenango地区对不同样本的药物使用者进行20次深入访谈，以提供有关风险行为的背景数据，并帮助改进研究工具和方法。此外，还将对使用药物的男男性行为者（MSM）、女性性工作者（FSW）和移民以及为艾滋病毒高危人群提供服务的组织进行焦点小组讨论。为了满足目标2，将使用受访者驱动抽样（RDS）招募三个连续的横断面队列（n= 400,200在边界两侧）。面对面访谈将收集有关社会人口统计学、艾滋病毒/性传播感染知识、风险行为和获得卫生服务的信息。所有人都将接受艾滋病毒、梅毒、单纯疱疹病毒-2和丙型肝炎病毒的检测，并根据需要进行治疗。第1轮将包括使用fsw的物质；第二轮将重点关注男同性恋人群；第三轮将从“流动”人员（包括卡车司机、被驱逐者以及区域和国际移民）中抽取同行招聘人员（“种子”）开始。我们预计并将能够衡量这些风险群体之间的重叠。在Aim 3中，我们将对HIV-1 pol基因（包括逆转录酶）进行测序，这将使我们能够评估该地区是否出现了HIV-1的重组或耐药菌株，以及高危人群之间的混合程度。由于移徙路线已被确定为其他环境中疾病传播的重要通道，它们可能是发现新的艾滋病毒亚型的首批地点之一。该项目将在墨西哥、危地马拉和美国的研究人员之间建立和扩大联系，并提高区域研究能力。研究结果将有助于制定后续的艾滋病毒干预措施和预防规划，在危险物质使用行为进一步根深蒂固之前对其进行干预。由于艾滋病毒的流行在大多数拉丁美洲国家仍然是集中的，因此存在一个防止过渡到普遍流行的关键机会窗口。与公共卫生有关：在墨西哥/危地马拉边境，吸毒，特别是可卡因的使用越来越普遍，许多区域和国际移民都要经过这一边境。拟议的研究将收集有关药物使用模式和背景的信息，以及药物使用与艾滋病毒、丙型肝炎病毒和性传播感染的传播之间的关系。这一合作项目将加强危地马拉、墨西哥和美国研究人员之间的区域合作，并为艾滋病毒干预和预防项目的制定提供信息，在危险物质使用行为进一步形成之前对其进行干预。

DESCRIPTION (provided by applicant): The overarching goal of this study is to explore the context of rising drug use along the Mexico/Guatemala border and define its relationship to the local epidemiology and phylo-geography of HIV and sexually transmitted infections (STIs). Shifting drug trafficking routes, poor economic conditions, and increasing popularity of hard drugs among youth may be some of the factors driving substance use. Numerous regional and international migrants passing through the area likely contribute to the spread of HIV and STIs. However, data is lacking on the relationship between drug use and HIV/STIs in the region. Based on the above, the specific aims of this project are to: 1) describe the contextual factors affecting drug use and patterns of use in high risk populations along the Mexico/Guatemala border; 2) determine the prevalence and correlates of HIV, hepatitis C virus (HCV), and STIs among substance users; and 3) explore the phylo-geography and molecular epidemiology of HIV-1 infection in at-risk groups. To meet Aim 1, 20 in-depth interviews with a diverse sample of substance users in Tapachula/Ciudad Hidalgo, Mexico and 20 in the Teczn Uman/Quetzaltenango area of Guatemala will be conducted to provide contextual data on risk behaviors and help refine study instruments and methods. Additionally, focus groups with substance using men who have sex with men (MSM), female sex workers (FSW), and migrants, as well as with organizations serving those at-risk for HIV will be conducted. To meet Aim 2, three consecutive cross-sectional cohorts (n=400, 200 on each side of the border) will be recruited using respondent-driven sampling (RDS). Face-to-face interviews will collect information on sociodemographics, HIV/STI knowledge, risk behaviors, and access to health services. All will be tested for HIV, syphilis, herpes simplex virus-2, and HCV, and treated as needed. Round 1 will comprise substance using FSWs; Round 2 will focus on the MSM population; and Round 3 will begin with peer recruiters ("seeds") drawn from "mobile" persons- including truck drivers, deportees and regional and international migrants. We anticipate and will be able to measure the overlap between these risk groups. For Aim 3, we will sequence the HIV-1 pol gene, including reverse transcriptase, from those infected with HIV which will enable us to assess if recombinants or drug resistant strains of HIV-1 have emerged in this region and the extent to which there is mixing between at-risk groups. As migration routes have been identified as important corridors of disease transmission in other settings, they may be one of the first places new HIV subtypes will be identified. This project will create and expand ties among investigators in Mexico, Guatemala, and the U.S. and increase regional research capacity. Findings will help inform the development of subsequent HIV interventions and prevention programs that intervene upon risky substance use behaviors before they become further entrenched. Since the HIV epidemic in most of Latin America is still concentrated, there is a critical window of opportunity to prevent transition to a generalized epidemic. PUBLIC HEALTH RELEVANCE: Drug use, especially the use of cocaine, is becoming more popular at the Mexico/Guatemala border - through which many regional and international migrants pass. The proposed study will collect information on the patterns and context of drug use and how substance use is related to the spread of HIV, HCV, and sexually transmitted infections. This collaborative project will strength regional cooperation between researchers in Guatemala, Mexico, and the U.S. and help inform the development of HIV interventions and prevention programs that intervene upon risky substance use behaviors before they become further established.