Evaluating the natural history of injection drug use

描述(由申请人提供)：本竞争续签申请的目的是评估不断变化的药物使用模式以及一系列社会、结构和环境因素对加拿大温哥华艾滋病毒阴性注射吸毒者(IDU)的艾滋病毒发病率、发病率和死亡率的影响。我们建议在甲基苯丙胺注射的稳步增长日益令人担忧的情况下开展这项工作。拟议的研究涉及温哥华注射吸毒者研究(VIDUS)的继续，该研究是北美历史最悠久的队列研究之一。自1997年以来，这项研究在公共卫生、艾滋病毒/艾滋病和注射吸毒领域出版了120多份经同行审查的出版物。加拿大的温哥华在北美是独一无二的，由于几个原因，它非常适合所提出的研究问题。首先，该市是发达国家注射吸毒者中有史以来最具爆炸性的艾滋病毒流行之一，艾滋病毒发病率在1997年达到每100人年18人的峰值，并持续上升到2007年。其次，像许多西海岸城市一样，温哥华的甲基苯丙胺使用量正在大幅增长，注射甲基苯丙胺的数量也在急剧增加。第三，温哥华的独特之处在于，它拥有一个特别大和明显的街头毒品市场，以及一个庞大的单间酒店网络(SRO)。我们试图通过调查各种社会、结构和环境因素对注射吸毒者的艾滋病毒危险行为、艾滋病毒发病率、发病率、死亡率和医院利用的影响，在过去专注于个人风险因素和卫生服务利用的基础上再接再厉。在此，我们建议继续我们以队列为基础的方法，每半年对1000名艾滋病毒阴性注射吸毒者进行一次随访。我们还建议通过将参与者数据链接到一系列医疗数据库，继续利用不列颠哥伦比亚省的全民医疗系统和集中的医疗数据。我们建议继续进行基于队列的研究提供了一个理想的机会来研究药物使用模式演变的影响，以及各种社会、结构和环境因素对注射药物使用自然历史的影响。鉴于甲基苯丙胺的使用出现在西海岸，我们对甲基苯丙胺注射上升的调查可能会为其他北美地区提供重要的信息和早期警告。总之，通过VIDUS的继续，我们的目标是应对几个紧迫的全球卫生挑战，并为一系列政策和干预措施的制定提供信息。 公共卫生相关性：这一竞争性续签申请的目的是评估在甲基苯丙胺注射稳步上升已成为紧迫问题的背景下，不断演变的药物使用模式以及一系列社会、结构和环境因素对艾滋病毒阴性注射吸毒者的艾滋病毒发病率、发病率和死亡率的影响。通过继续温哥华注射吸毒者研究，我们的目标是应对几个紧迫的全球卫生挑战，并为制定一系列政策和干预措施提供信息。

DESCRIPTION (provided by applicant): The purpose of this competing renewal application is to evaluate the impact of evolving drug use patterns, as well as a range of social, structural, and environmental factors, on HIV incidence, morbidity, and mortality among a cohort of HIV-negative injection drug users (IDU) in Vancouver, Canada. We propose to undertake this work in a setting where a steady growth in methamphetamine injection has become an increasing concern. The proposed research involves the continuation of the Vancouver Injection Drug Users Study (VIDUS), which is among the longest-standing cohort studies in North America. Since 1997, this study has led to more than 120 peer-reviewed publications in the area of public health, HIV/AIDS, and injection drug use. Vancouver, Canada, is unique in North America and is ideally suited to the proposed research questions for several reasons. First, the city is home to one of the most explosive HIV epidemics ever documented among IDU in the developed world, with HIV incidence peaking at 18 per 100 person-years in 1997 and persistently elevated HIV rates continuing up to 2007. Second, like many West Coast cities, Vancouver is in the midst of a massive growth in the use of methamphetamine and is also seeing a dramatic increase in methamphetamine injection. Third, Vancouver is unique in having an exceptionally large and visible street-based drug market and a large network of single-room occupancy hotels (SROs). We seek to build upon our past work focused on individual risk factors and health service use by investigating the impact of various social, structural, and environmental factors on HIV risk behavior, HIV incidence, morbidity, mortality, and hospital utilization among IDU. Herein we propose to continue our cohort-based approach involving semi-annual follow-up of 1000 HIV-negative IDU. We also propose to continue taking advantage of the universal healthcare system and centralized health data in British Columbia by linking participant data to a range of healthcare databases. Our proposed continuation of cohort-based research offers an ideal opportunity to examine the impact of evolving drug use patterns, as well as the impact of various social, structural, and environmental factors on the natural history of injection drug use. Given that methamphetamine use emerged on the West Coast, our investigation of rising methamphetamine injection could provide important information and early warning to other North American settings. In sum, through the continuation of VIDUS, we aim to address several urgent global health challenges and inform the development of a range of policies and interventions. PUBLIC HEALTH RELEVANCE: The purpose of this competing renewal application is to evaluate the impact of evolving drug use patterns, as well as a range of social, structural, and environmental factors on HIV incidence, morbidity and mortality among a cohort of HIV-negative injection drug users in a setting where a steady rise in methamphetamine injection has become an urgent concern. Through the continuation of the Vancouver Injection Drug Users Study, we aim to address several urgent global health challenges and inform the development of a range of policies and interventions.