Injection Risk Networks in Rural Puerto Rico

描述（由申请人提供）：尽管波多黎各存在艾滋病毒持续感染的流行病学现实，但该领土严重缺乏与艾滋病毒/艾滋病和药物滥用有关的公共卫生基础设施，这反映在注射吸毒者的发病率/死亡率高得惊人。因此，艾滋病毒继续对波多黎各的个人健康和医疗保健系统产生重大影响。波多黎各的艾滋病毒感染率在美国各州和地区中排名前5%，而圣胡安仅在大都市地区排名前20%。这种差异表明了一种不同类型的流行病，即农村社区对艾滋病毒流行率的贡献与城市地区相比不成比例。波多黎各农村的艾滋病患者感染艾滋病病毒的动态仍不为人所知，尽管人们知道艾滋病病毒的风险在移民到大陆后急剧增加——这一旅程已成为需要服务的艾滋病患者的常态。了解农村艾滋病毒感染的动态对于利用流行病学、预防和治疗方面的最新进展制定有效、成本效益高的预防策略至关重要。该项目采用定量和定性方法来描述和解决波多黎各中部农村PWID网络中的艾滋病毒传播动态。这是通过以下方式实现的：(i)通过分析受访者驱动的抽样调查，确定四个农村社区的人口统计学特征、疾病流行情况和高危人群的行为；（ii）通过人种学验证的网络微观分析，对农村社区内风险伙伴关系的动态结构进行建模；（iii）通过收集的真实世界数据模型，开发人工（但在统计上似是而非）动态风险网络的随机计算机模拟；（iv）通过对模拟结果的敏感性分析，确定哪些行为和结构变量对这些农村环境中HIV/HCV流行病学影响最大；(v)通过增强模拟，评估目标人群中一系列循证艾滋病毒控制战略的相对效率和成本效率。该项目通过(1)与所有四个城市的当地私人传染病医生建立工作关系，通过立即将艾滋病毒或丙型肝炎病毒检测呈阳性的研究参与者与服务联系起来，增加获得护理的机会，解决了艾滋病患者缺乏与护理联系的问题；(2)开发一个PWID护航系统，以确保在项目的整个生命周期内获得和治疗；(3)开发新的方法，利用基于同伴驱动的社区教育和倡导项目的社会网络方法，支持这一人群的检测和治疗登记，以减缓波多黎各农村地区HIV/HCV的传播；最后，与由当地利益攸关方组成的传播咨询委员会合作，(4)传播基于模拟的关于循证艾滋病毒最佳控制策略的研究结果，这些策略在解决波多黎各农村疾病传播问题方面最有可能是有效和具有成本效益的

DESCRIPTION (provided by applicant): Despite the epidemiological reality of ongoing HIV infection in Puerto Rico, the public health infrastructure related to HIV/AIDS and substance abuse in the territory is severely lacking, as reflected in alarmingly high rates of morbidity/mortality among people who inject drugs (PWID). Because of this, HIV continues to have substantial impact on individual health and the healthcare system in Puerto Rico. While Puerto Rico ranks in the top 5% of US states and territories with respect to HIV prevalence, San Juan ranks only in the top 20% of metropolitan areas. This discrepancy points to a different type of epidemic, where rural communities contribute disproportionately to HIV prevalence rates relative to urban areas. The dynamics of HIV among PWID in rural Puerto Rico remains largely unknown, though HIV risk is known to increase precipitously upon migration to the mainland-a journey that has become the norm for PWID in need of services. Understanding the dynamics of rural HIV infection is critical to developing effective cost-efficient prevention strategies using he most recent developments in epidemiology, prevention, and treatment. This project applies both quantitative and qualitative methods to characterize and address HIV propagation dynamics in rural PWID networks of Central Puerto Rico. This is achieved by: (i) characterizing demographics, disease prevalence, and behaviors of at-risk populations in four rural communities via analysis of respondent- driven sampling surveys; (ii) modeling the dynamic structure of risk partnerships within the rural communities via ethnographically validated network micro-assays, (iii) developing stochastic computer simulations of artificial (but statistically plausible) dynamic risk networks, via models of the real-world data collected; (iv) identifying which behavioral and structural variables most strongly impact HIV/HCV epidemiology in these rural settings, via sensitivity analysis of simulation outcomes; (v) evaluating the relative efficay and cost efficiency of a range of evidence-based HIV control strategies within the target population via augmented simulations. The project addresses lack of link-to-care for the PWID population by (1) developing a working relationship with local private infectious disease doctors in all four municipalities to enhance access to care by immediately linking study participants who test positive for HIV or HCV to services; (2) developing an PWID escort system to ensure access and treatment throughout the life of the project, (3) developing new ways to support testing and treatment enrollment for this population using a social network approach that builds upon peer-driven community education and advocacy programs to slow the spread of the HIV/HCV in rural Puerto Rico; and finally, in concert with a Dissemination Advisory Board comprised of local stakeholders, (4) disseminating the simulation-based findings concerning optimal evidence-based HIV control strategies that are most likely to be effective and cost-efficient in addressing disease propagation in rural Puerto Rico. 1