Neurocognitive Impulsivity and HIV Risk Behaviors in Bulgarian Heroin Users

描述（由申请人提供）：全球海洛因成瘾率正在上升，随之而来的是法律、健康和个人成本，包括艾滋病毒传播风险的增加。海洛因成瘾通常与冲动方面的神经认知缺陷有关，如决策能力受损、冒险行为增加和奖励折扣延迟。这种神经认知缺陷可能与从事危险的性行为和注射行为有关，这些行为是艾滋病毒传播的一些主要媒介。然而，相对于其他非法药物，关于慢性海洛因使用的神经认知后遗症及其与艾滋病毒风险行为的关系的研究要少得多。此外，大多数现有的研究包括多种物质使用者，这使得不可能将海洛因的神经认知效应与其他药物区分开来。我们建议制定一个研究计划，长期目标是了解冲动性的神经认知方面如何与海洛因使用者的艾滋病毒风险行为相关。该方案将在保加利亚制定。保加利亚是东南欧的一个中低收入国家，也是“巴尔干毒品路线”上的一个关键国家，“巴尔干毒品路线”是从西南亚到西欧的国际毒品贩运的主要路线之一。海洛因在该国很容易获得，海洛因成瘾已成为最严重的公共卫生问题之一。保加利亚海洛因成瘾的模式是独特的，因为对多种物质的依赖并不常见。此外，虽然目前保加利亚的艾滋病毒流行率仍然很低，但该国被认为处于艾滋病毒流行的边缘，因为它位于世界上艾滋病毒感染率增长最快的区域。因此，在一个保健资源非常有限的发展中国家进行这项研究，可以在艾滋病毒全面流行之前为艾滋病毒预防工作提供信息，从而对公共卫生产生重大影响。此外，在保加利亚进行这项研究提供了一个独特的机会，可以研究“纯”海洛因使用者群体的神经认知功能与艾滋病毒风险行为之间的关系，从而避免多种物质使用的混杂影响。我们的R21试点研究的具体目标是扩大我们已经建立的国际研究合作，并通过调整北美实验室冲动性神经认知任务和评估问卷，为保加利亚文化上适当的使用，开发物质依赖个体（sdi）冲动性和艾滋病毒风险行为的初始神经认知评估协议。我们还将探索在现有的50名非多物质海洛因依赖者中收集冲动性和艾滋病毒风险行为的不同神经认知指数之间关联的探索性数据的可行性。研究结果将提供试点数据，并用于设计sdi中神经认知和HIV风险行为的更大研究，最终目标是通过开发可作为sdi中HIV风险行为的“神经认知标记”的措施来帮助预防和干预计划。该项目的重点是冲动性的神经认知指数如何与物质依赖个体（sdi）的艾滋病毒风险行为相关，预计通过开发可作为sdi中艾滋病毒风险行为的“神经认知标记”的措施，对预防和干预计划具有重要意义。此外，该项目可以通过识别最容易参与艾滋病毒风险行为的个体，从而帮助降低当前预防和干预项目的成本，这些个体应该首先成为预防和干预项目的目标。

DESCRIPTION (provided by applicant): Rates of heroin addiction are increasing worldwide with concomitant legal, health, and personal costs, including increased risk of HIV transmission. Heroin addiction is commonly associated with neurocognitive deficits in impulsivity, such as impaired decision-making, increased risk-taking, and delayed reward discounting. Such neurocognitive deficits may be related to engagement in risky sexual and injection behaviors, some of the primary vectors for HIV transmission. However, relative to other illicit drugs, considerably less research exists on the neurocognitive sequelae of chronic heroin use and how they relate to HIV risk behaviors. Further, most existing studies include polysubstance users, which makes it impossible to distinguish the neurocognitive effects of heroin from those of other drugs. We propose to develop a program of studies with the long-term goal of understanding how neurocognitive aspects of impulsivity relate to HIV risk behaviors in heroin users. This program will be developed in Bulgaria, a low-middle income country in Southeastern Europe and a key country on the `Balkan Drug Route', one of the main routes for international drug traffic from South-West Asia to Western Europe. Heroin is easily available in the country and heroin addiction has become one of the most significant public health problems. Patterns of heroin addiction in Bulgaria are unique in that polysubstance dependence is uncommon. Moreover, although currently the prevalence of HIV in Bulgaria is still low, the country is considered to be at the brink of an HIV epidemic, as it is located in a region experiencing the world's fastest-growing rates of HIV infection. Therefore, conducting the study in a developing country with very limited health-care resources could have critical public health implications by informing HIV prevention efforts prior to onset of a full-fledged HIV epidemic. Furthermore, conducting the study in Bulgaria provides a unique opportunity to study how neurocognitive function relates to HIV risk behaviors in populations of "pure" heroin users, thereby avoiding the confounding effects of polysubstance use. Our specific aims for this R21 pilot study are to expand our already established international research collaboration and develop a protocol for initial neurocognitive assessment of impulsivity and HIV risk behaviors in substance dependent individuals (SDIs) by adapting North American laboratory neurocognitive tasks of impulsivity and assessment questionnaires for culturally-appropriate use in Bulgaria. We will also explore the feasibility of collecting exploratory data about the associations between different neurocognitive indices of impulsivity and HIV risk behaviors among an existing cohort of 50 non-polysubstance using heroin dependent subjects. Study results will provide pilot data and be used to design a larger study of neurocognition and HIV risk behaviors in SDIs with the ultimate goal of helping prevention and intervention programs by developing measures that could be used as "neurocognitive markers" of HIV risk behaviors in SDIs. RELEVANCE The focus of the project on how neurocognitive indices of impulsivity relate to HIV risk behaviors in substance dependent individuals (SDIs) is expected to have important implications for prevention and intervention programs by developing measures that could be used as "neurocognitive markers" of HIV risk behaviors in SDIs. Further, the project may help reduce the costs of current prevention and intervention programs by identifying individuals most vulnerable to engaging in HIV risk behaviors who should be targeted first by prevention and intervention programs.