Ending HIV/AIDS among People Who Use Drugs: Overcoming Challenges

这是一项延长药物使用和艾滋病毒研究中心(CDUHR)21年资金的提案- 25.艾滋病毒生物医学和行为科学的最新进展已被证明可以降低艾滋病毒发病率和 允许艾滋病毒阳性者达到接近正常寿命。这些成就使联合国艾滋病规划署、美国和 几个地方政府提出了“结束艾滋病毒流行”的战略。尽管如此， 要在吸毒者中实现这一目标(PWUD)，将需要解决一些问题 重要的现有障碍。这次更新的总主题是“在吸毒者中消灭艾滋病毒/艾滋病”。 毒品：克服挑战“。我们将结束艾滋病毒/艾滋病定义为减少新的感染和增加 病毒抑制的PWUD的比例。为了实现这一点，我们确定了这些研究 直接应对最重大挑战的优先事项：(1)制定新的战略以克服 在残障人士中消除艾滋病毒/艾滋病的新出现的和持久的障碍。障碍包括最近增加的 处方阿片类药物滥用，导致新一代海洛因吸毒者和注射者，以及缺乏 注意物质使用在男男性行为者和异性恋者新感染中的关键作用。 艾滋病毒阳性的PWUD在艾滋病毒护理的整个过程中也经历了差异，包括延迟 确诊、较低的护理保留率、延迟启动抗逆转录病毒治疗和较差的疾病结局。(2)品行 研究广泛实施循证干预的有效途径。艾滋病毒预防和护理 在美国的许多地区和世界其他有需要的地区，没有针对PWUD的计划 大多数，而且很少在公共卫生规模上实施。(三)发展新的创新模式 预防和治疗干预措施，以解决艾滋病毒感染和药物使用方面的差异 考虑到PWUD中艾滋病毒的复杂、多层次性质的治疗结果。 我们已经在这次续订的范围和结构方面做出了重大改变，我们将实现我们的 旨在通过五个核心、一个管理核心和四个研究支持核心：(1)传染病 流行病学和理论，(2)跨学科研究方法，(3)传播和实施， (4)试点项目和辅导。这些核心支持我们的研究基地和附属调查人员 开展尖端科学研究，增强来自多个学科的研究人员之间的协同作用，从而 这导致对该领域的贡献超出了单个项目所能达到的水平。在……里面 除了在CDUHR历史上制定的许多成功的倡议之外，新的活动 是为了满足我们调查人员不断变化的需求而增加的。此外，除了我们正在进行的承诺之外 为了培训新的调查人员进行高影响力的研究，我们将在以下领域与调查人员合作 艾滋病毒在PWUD中流行(在美国农村和中部，以及东欧和亚洲)， 以我们的集体知识和专门知识为基础，推动在这些地区消灭艾滋病毒/艾滋病。

This is a proposal to renew funding of the Center for Drug Use and HIV Research (CDUHR) for years 21- 25. Recent advances in HIV biomedical and behavioral science have been shown to reduce HIV incidence and allow HIV-positive persons to reach near-normal lifespans. These achievements have led UNAIDS, the US and several local governments to propose strategies for “Ending the HIV Epidemic”. Notwithstanding these successes, attaining this goal among people who use drugs (PWUD) will require addressing a number of important existing barriers. The overall theme of this renewal is “Ending HIV/AIDS among People who use Drugs: Overcoming Challenges”. We define Ending HIV/AIDS as reducing new infections and increasing the proportion of PWUD who are virally suppressed. To accomplish this, we have identified these research priorities, which directly address the most significant challenges: (1) Devise new strategies to overcome emerging and persistent barriers to ending HIV/AIDS among PWUD. Barriers include recent increases in prescription opioid misuse, which have given rise to a new generation of heroin user and injectors, and lack of attention to the key role of substance use in new infections in men who have sex with men and heterosexuals. HIV-positive PWUD also experience disparities all along the continuum of HIV care, including delayed diagnosis, lower retention in care, delayed initiation of ART and poorer disease outcomes. (2) Conduct research on effective ways to broadly implement evidence-based interventions. HIV prevention and care programs for PWUD do not exist in many regions of the US and the rest of the world where they are needed most, and they are rarely implemented at public-health scale. (3) Develop new, innovative models of prevention and treatment interventions to address substance-use related disparities in HIV infection and treatment outcomes that take into account the complex, multilevel nature of HIV among PWUD. We have made significant changes in our scope and structure for this renewal, and we will achieve our aims through five Cores, an Administrative Core and four Research Support Cores: (1) Infectious Disease Epidemiology and Theory, (2) Transdisciplinary Research Methods, (3) Dissemination and Implementation, and (4) Pilot Projects and Mentoring. These Cores support our research base and affiliated investigators to conduct cutting-edge science and enhance synergy across investigators from multiple disciplines, thereby leading to contributions to the field that are beyond what the individual projects could have achieved. In addition to the many successful initiatives that have been developed over CDUHR's history, new activities were added to respond to the evolving needs of our investigators. Also, in addition to our ongoing commitment to train new investigators to conduct high-impact research, we will collaborate with investigators in areas where HIV epidemics are occurring among PWUD (in rural and middle America, and in eastern Europe and Asia), building on our collective knowledge and expertise to advance toward Ending HIV/AIDS in those regions.