Epidemiology of Syphilis among IDUs in Tijuana, Mexico

说明（由申请方提供）：本提案的目的是从个人、社会网络以及环境和结构因素方面描述蒂华纳注射吸毒者中梅毒的流行病学特征，并采用流行病学、地理和网络方法相结合的方法，以宣传和制定结构层面和/或基于同伴的减少性风险干预措施。这涉及到NIDA的流行病学、服务和预防研究司的使命声明，即"通过促进理解和解决个人与环境之间的相互作用的综合方法来改善国家的公共健康，这些相互作用有助于与药物使用有关的连续问题。“在该项目的前两年辅导期间，申请人将进行课程和独立研究，以建立她在社会网络分析，多层次建模和地理信息系统（GIS）领域的知识基础和技能。这些技能的实际应用将通过对蒂华纳注射吸毒者中梅毒传播的个人、网络和地理方面进行建模来获得，该注射吸毒者参加了由主要导师Steffanie Strathdee博士建立的注射吸毒者前瞻性队列"Proyecto El Cuete"。在该项目的独立阶段，申请人将应用通过这些方法获得的信息，以告知和制定结构层面的性风险降低干预措施。干预措施将侧重于第一阶段确定的高风险群体，并将侧重于结构层面的因素，根据第一阶段的结果以及社区对这些方法的接受程度和可行性，采用基于场所和/或同行外联的方法。将利用感兴趣的社区内的初步重点小组来评估和制定不同的干预措施，并将使用干预前/后测试设计来测试干预措施的有效性。性传播感染仍然是全球的一个重要负担，这既是因为其本身的长期并发症，也是因为其对艾滋病毒传播的影响。除了在蒂华纳的高危人群中增加检测和治疗的直接好处外，通过扩展，在圣地亚哥的连接社区，该提案还提出了新的方法组合，以有效和高效地评估高危人群中的传播模式，并发现应用于干预措施开发的背景和结构因素。

DESCRIPTION (provided by applicant): The objectives of this proposal are to characterize the epidemiology of syphilis among IDUs in Tijuana, with respect to individual, social network and environmental and structural factors, and to apply a combination of epidemiological, geographical and network methods to inform and develop a structural-level and/or peer-based sexual risk reduction intervention. This addresses NIDA's Division of Epidemiology, Services and Prevention Research mission statement to "improve the nation's public health by promoting integrated approaches to understand and address interactions between individuals and environments that contribute to the continuum of problems related to drug use." During the first two mentored years of the project, the applicant will undertake coursework and independent studies to build her knowledge base and skills in the areas of social network analyses, multi-level modeling and geographic information systems (GIS). Practical application of these skills will be obtained through modeling individual, network and geographical aspects of syphilis transmission among IDUs in Tijuana participating in the 'Proyecto El Cuete', a prospective cohort of IDUs established by the primary mentor, Dr. Steffanie Strathdee. During the independent phase of the project, the applicant will apply the information gained through these methods to inform and develop a structural-level sexual risk reduction intervention. The intervention will focus on high risk groups identified during the first phase, and will focus on structural-level factors, applying either venue-based and/or peer-outreach methods, depending on the results from phase one and the level of acceptance and feasibility of these methods within the community. Initial focus groups within the community of interest will be used to assess and develop different ideas for the intervention, and the effectiveness of the intervention will be tested using a pre/post-intervention test design. STIs remain an important burden globally, both due to their own long-term complications, as well as their impact on HIV transmission. In addition to the immediate benefit of increased testing and treatment among the high risk populations in Tijuana and, by extension, the connected communities in San Diego, this proposal sets out to derive new combinations of methods to effectively and efficiently assess transmission patterns among high risk groups and uncover contextual and structural factors for application in the development of interventions.