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

说明(申请人提供)：这项研究的主要目标是探索墨西哥/危地马拉边境毒品使用上升的背景，并确定其与艾滋病毒和性传播感染(STI)的当地流行病学和自然地理的关系。贩毒路线的改变、糟糕的经济条件以及硬性毒品在年轻人中越来越受欢迎，可能是导致吸毒的一些因素。许多通过该地区的区域和国际移民可能助长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。在此基础上，本项目的具体目标是：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使用模式；2)确定吸毒者中艾滋病毒、丙型肝炎病毒(丙型肝炎病毒)和性传播感染的流行率和相关性；3)探讨高危人群中艾滋病毒-1感染的自然地理和分子流行病学。为了实现目标1，将对墨西哥塔帕丘拉/希达尔戈市的20名药物使用者和危地马拉的Teczn Uman/Quetzaltenango地区的20名吸毒者进行深入访谈，以提供有关危险行为的背景数据，并帮助改进研究工具和方法。此外，还将开展与男男性行为者(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的药物使用情况的焦点小组。为了实现目标2，将使用受访者驱动抽样(RDS)招募三个连续的横断面队列(边界两侧各400,200人)。面对面的访谈将收集有关社会人口学、艾滋病毒/性传播感染知识、危险行为和获得卫生服务的信息。所有患者都将接受艾滋病毒、梅毒、单纯疱疹病毒-2和丙型肝炎病毒检测，并根据需要进行治疗。第一轮将包括使用FSWs的实质内容；第二轮将侧重于男男性接触者人口；第三轮将从“流动”人员--包括卡车司机、被驱逐出境的人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。对于目标3，我们将对HIV感染者的HIV-1Poll基因进行测序，包括逆转录酶，这将使我们能够评估该区域是否出现了HIV-1重组体或抗药性毒株，以及高危人群之间的混合程度。由于迁徙路线已被确定为其他环境中疾病传播的重要走廊，它们可能是第一批确定新的艾滋病毒亚型的地方之一。该项目将建立和扩大墨西哥、危地马拉和美国的研究人员之间的联系，并提高地区研究能力。这些发现将有助于制定后续的艾滋病毒干预和预防计划，在危险物质使用行为变得更加根深蒂固之前对其进行干预。由于艾滋病毒在拉丁美洲大部分地区的流行仍然集中，因此有一个关键的机会之窗，可以防止向普遍流行的过渡。与公共卫生相关：毒品使用，特别是可卡因的使用，在墨西哥/危地马拉边境变得越来越流行--许多区域和国际移民都通过这一边界。这项拟议的研究将收集关于毒品使用模式和背景的信息，以及药物使用如何与艾滋病毒、丙型肝炎病毒和性传播感染的传播有关。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，并帮助制定艾滋病毒干预和预防计划，在危险物质使用行为进一步确立之前对其进行干预。

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.