Social networks and HIV risk among rural drug users

申请者描述(申请人提供)：本申请是对PA-06-478“农村精神卫生与药物滥用障碍研究”的回应。该局强调的研究领域之一是利用社会网络分析检查农村艾滋病毒传播情况。这项研究的总体目标是使用社会网络分析和多水平建模来检查阿巴拉契亚农村吸毒者中艾滋病毒和其他血液传播感染(BBI)的流行率、发病率和危险因素，如乙肝(乙肝)和丙型肝炎(丙型肝炎)。艾滋病毒仍然是美国的一个主要公共卫生问题，特别是在吸毒者中。然而，人们对农村地区的艾滋病毒知之甚少，因为在农村地区存在明显的健康差距。因此，鉴于在城市吸毒者中的研究发现，社会网络指标是艾滋病毒风险的有力预测指标，将衡量社会网络和个人特征与农村吸毒者艾滋病毒风险的关联。具体目标是：1)确定农村注射吸毒者和非注射吸毒者中艾滋病毒、丙型肝炎病毒和乙肝病毒的患病率和发病率；2)检查农村注射吸毒者和非注射吸毒者中艾滋病毒和其他BBI风险；以及3)在基线后6个月、12个月和18个月检查农村艾滋病毒、丙型肝炎和乙肝风险的纵向变化。为了实现这些目标，将使用受访者驱动抽样(RDS)招募500名农村注射吸毒者和非注射吸毒者。除了艾滋病毒、丙型肝炎病毒和乙肝病毒的生物测试外，农村参与者还将接受面试者管理的问卷，内容涉及他们的社交网络(毒品、性和支持网络)、社会人口统计学、药物使用、艾滋病毒危险行为、精神病学诊断、预防和规范。由于个人将嵌套在网络中，因此将使用多级随机效应回归来分析数据，该回归允许同时检查社会网络和个人级别的风险。与NIDA艾滋病研究计划的优先事项一致，这项建议将探索农村吸毒人群的社会网络结构，以便更好地了解网络因素如何通过创新的多层次方法影响农村地区的艾滋病毒风险。拟议研究的结果将为农村地区艾滋病毒干预措施的设计和实施提供信息，并帮助确定开展这类活动的适当人群，以减少与艾滋病毒和其他BBIS有关的发病率和死亡率。 尽管艾滋病毒在美国仍然是一个严重的公共卫生问题，特别是在吸毒者中，但人们对阿巴拉契亚等农村地区的艾滋病毒风险知之甚少。在城市人口中已经表明，吸毒者之间的关系，也称为社会网络，是艾滋病毒风险的重要预测因素。因此，本研究试图通过测量社会网络和个人行为来表征农村艾滋病毒风险，以便为卫生资源匮乏的农村地区的预防活动提供信息。

DESCRIPTION (provided by applicant): This application is in response to PA-06-478, "Research on Rural Mental Health and Drug Abuse Disorders". One of the research areas highlighted by this PA is the examination of rural HIV transmission using social network analysis. The overall goal of the study is to examine the prevalence, incidence, and risk factors for HIV and other blood borne infections (BBIs) such as hepatitis B (HBV) and C (HCV) among rural Appalachian drug users using social network analysis and multilevel modeling. HIV continues to be a major public health problem in the United States, especially among drug users. However, little is known about HIV in rural areas in which there are marked health disparities. Therefore, given that studies among urban drug users have found that social network indicators are robust predictors of HIV risk, both social network and individual characteristics will be measured for their association with HIV risk among rural drug users. The specific aims are: 1) To determine the prevalence and incidence of HIV, HCV and HBV among rural injection and non- injection drug users; 2) To examine HIV and other BBI risk among rural injection and non-injection drug users; and 3) To examine longitudinal changes in rural HIV, HCV and HBV risk at 6-months, 12-months and 18- months post-baseline. To meet these aims, a sample 500 rural injection and non-injection drug users will be recruited using respondent driven sampling (RDS). In addition to biologic testing for HIV, HCV and HBV, rural participants will be given an interviewer-administered questionnaire pertaining to their social networks (drug, sexual and support networks), sociodemographics, drug use, HIV risk behaviors, psychiatric diagnoses, intravention and norms. Since individuals will be nested within networks, data will be analyzed using multilevel random effects regression that allows for the simultaneous examination of social network and individual-level risk. Consistent with the priorities of the NIDA AIDS Research Program, this proposal will explore the social network structure in a rural drug using population in order to better understand how network factors may affect HIV risk in rural areas using an innovative multilevel approach. Results from the proposed study will inform the design and implementation of HIV interventions in rural areas and help to determine the appropriate population for which to target such activities in order to reduce the morbidity and mortality associated with HIV and other BBIs. Although HIV remains a significant public health problem in the United States, especially among drug users, little is known about HIV risk in rural areas such as Appalachia. It has been shown in urban populations that relationships among drug users, also known as social networks, are important predictors of HIV risk. Therefore, this study seeks to characterize rural HIV risk by measuring both social network and individual behaviors in order to inform prevention activities in health resource-deprived rural areas.