Individualized approaches to the HIV/TB epidemic among polysubstance users in Irkutsk

项目总结/摘要 人体免疫缺陷病毒（艾滋病毒）在西伯利亚伊尔库茨克地区的流行率高于任何其他地区， 俄罗斯联邦。结核病（TB）是全世界艾滋病毒感染者的主要杀手， 蹂躏伊尔库茨克多种药物滥用影响伊尔库茨克艾滋病毒/结核病护理连续体的多个方面 导致艾滋病毒/结核病死亡率居高不下。尽管患者开始接受抗逆转录病毒和抗结核治疗， 数据表明，艾滋病毒/结核病治疗失败代表了宿主不遵守复杂的 由于抗结核药物不佳但可纠正而导致的药物治疗方案和功能性耐药性 浓度的因此，本项目旨在了解物质使用的预期影响 在伊尔库茨克背景下，依从性、药代动力学和疾病进展的模式。我们已经开发 测量这些因素的创新方法，包括移动的电话（mHealth）增强的生态 依从性和物质使用的瞬时评估，基于尿液的药物浓度测定，以及 从尿液中检测分枝杆菌DNA作为疾病的非侵入性生物标志物。该项目建立在 我们之前的美国/俄罗斯研究合作，同时联合专家与互补和多学科 在行为科学、临床心理学、HIV医学、移动健康、药代动力学、HIV/TB方面的经验 共同感染、艾滋病毒和结核病耐药性以及结核病生物标志物。我们预计项目完成后， 有针对性的干预措施，以中断伊尔库茨克的药物使用、艾滋病毒和结核病的循环， 服务，并将艾滋病毒护理转向以患者为中心的模式。

PROJECT SUMMARY/ ABSTRACT The human immunodeficiency virus (HIV) prevalence in the Irkutsk, Siberia region is higher than any other in the Russian Federation. Tuberculosis (TB) is the leading killer worldwide of people living with HIV and is simply ravaging Irkutsk. Polysubstance abuse affects multiple aspects of the HIV/TB care continuum in Irkutsk contributing to overwhelming HIV/TB mortality. Despite patients initiating antiretroviral and anti-TB therapy, our data suggests that HIV/TB treatment failure represents the interplay of host nonadherence to complex medication regimens and functional drug-resistance due to suboptimal but correctable anti-TB medication concentrations. Therefore, this project seeks to understand the prospective influence of substance use patterns on adherence, pharmacokinetics and disease progression in the Irkutsk context. We have developed innovative methods for measurement of these factors including mobile phone (mHealth) enhanced ecological momentary assessment of adherence and substance use, urine based medication concentration assays, and mycobacterial DNA detection from the urine as a non-invasive biomarker of disease. This project builds upon our prior US/Russian research collaboration while uniting experts with complimentary and multidisciplinary experience in Behavioral Science, Clinical Psychology, HIV Medicine, mHealth, Pharmacokinetics, HIV/TB coinfection, HIV and TB Drug-Resistance and TB Biomarkers. We expect completion of the project to generate targeted interventions to interrupt the cycle of substance use, HIV and TB in Irkutsk, foster integration of services, and shift HIV care toward a patient-centered model.