Evaluating the natural history of injection drug use

描述（由申请人提供）：本次竞争续期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HIV阴性注射吸毒者（IDU）队列中HIV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定增长日益引起关注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）的延续，这是北美最长期的队列研究之一。自1997年以来，这项研究已在公共卫生、艾滋病毒/艾滋病和注射吸毒领域发表了120多篇同行评议出版物。加拿大温哥华在北美是独一无二的，由于几个原因，它非常适合提出的研究问题。首先，该市是发达国家有记录以来在注射吸毒者中艾滋病毒流行最严重的城市之一，艾滋病毒发病率在1997年达到每100人年18例的高峰，并一直持续上升到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，它有一个特别大、特别显眼的街头毒品市场和一个庞大的单间酒店网络。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中艾滋病毒风险行为、艾滋病毒发病率、发病率、死亡率和医院使用率的影响，建立在我们过去的工作基础上，重点关注个人风险因素和卫生服务使用。在此，我们建议继续我们基于队列的方法，包括每半年随访1000例hiv阴性IDU。我们还建议继续利用不列颠哥伦比亚省的全民医疗保健系统和集中健康数据，将参与者数据与一系列医疗保健数据库联系起来。我们建议继续进行基于队列的研究，为研究不断演变的药物使用模式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史的影响提供了一个理想的机会。鉴于西海岸出现了甲基苯丙胺的使用，我们对甲基苯丙胺注射上升的调查可以为其他北美地区提供重要信息和早期预警。总而言之，通过继续开展艾滋病毒监测，我们的目标是应对若干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.