The impact of social networks on hepatitis C transmission and care access in people who inject drugs

项目摘要 丙型肝炎是一个重大的公共卫生挑战，特别是在注射毒品的艾滋病毒感染者（PWID）中。 尽管最近出现了新的口服、有效、副作用小、持续时间短的HCV疗法， PWID中的HCV治疗率仍然很低。HIV/HCV共感染者肝脏疾病进展的加速率 感染者使HIV感染的PWID中的HCV治疗成为优先事项。PWID社交网络具有 作为提高HCV治疗率和预防HCV再感染的工具的潜力。有 然而，对PWID社交网络知之甚少，因为它与HCV感染、护理获得和传播有关 美国内城人口的模式。这个项目的目标是填补这些知识空白，作为桥梁， 开发有效的生物医学和行为（生物行为）相结合的干预措施，以改善HCV 治疗和预防HIV感染者的HCV再感染。 我是一名接受过传染病培训的医生，受过流行病学培训， 为市中心HIV感染者提供HIV和HCV护理的分子方法和临床实践经验 PWID。我的长期目标是进行复杂的临床试验， 采取干预措施，改善HCV/HIV的医疗护理、治疗和预防，并了解其传播 预防HCV再感染。 拟议的研究嵌套在两个NIDA资助的PWID队列中，即预防和测试（灯塔） 研究和艾滋病与静脉注射经验（ALIVE）队列，均代表HIV感染者， 未受感染的巴尔的摩市中心PWID目标1利用来自索引HIV感染者PWID的社交网络的数据， 确定HCV是否在PWID社交网络内聚集。目标2将评估个人和网络层面的障碍 在口服DAA时代，HIV感染的PWID中的HCV护理的促进者。目标3将评估社交网络 通过使用互补的社会网络和系统发育分析来记录HCV传播。 拟议的职业发展计划将通过以下方面的额外专业知识来扩展我的技术技能：（1） 社会网络分析;（2）PWID社交网络的招募和社会决定因素的评估 PWID HCV/HIV相关的健康结果; 3）系统发育分析和4）生物行为的实施 干预措施。我将得到约翰霍普金斯大学医学系的大力支持， 受益于约翰霍普金斯大学灯塔和ALIVE研究的优秀研究基础设施。 随着最近全国流行的从口服类阿片过渡到注射吸毒以及随之而来的吸毒人数增加， 艾滋病毒和HCV感染率，制定可持续干预措施以提高HCV治疗率 艾滋病毒/丙型肝炎感染率已成为一个优先事项。这个奖项将有助于我 作为一名以患者为导向的临床研究者，致力于发展独立的职业生涯 在HIV感染的PWID中采取干预措施，以提高HCV治疗率并预防HCV再感染。

PROJECT ABSTRACT Hepatitis C is a major public health challenge particularly among HIV infected people who inject drugs (PWID). Despite recent availability of new oral, efficacious HCV therapies of short duration with minimal side effects, rates of HCV treatment in PWID remain low. Accelerated rates of liver disease progression in HIV/HCV co- infected individuals make HCV treatment among HIV infected PWID a priority. PWID social networks have the potential to serve as vehicles to increase rates of HCV treatment and prevent HCV reinfection. There is however little know about PWID social networks as it relates to HCV infection, care access and transmission patterns in inner city US populations. The goal of this project is to fill these knowledge gaps as a bridge to developing effective combined biomedical and behavioral (bio-behavioral) interventions to improve HCV treatment and prevent HCV reinfection among HIV infected PWID. I am an infectious disease trained physician with training in epidemiology, prior laboratory experience in molecular methods and practical clinical experience providing HIV and HCV care to inner-city HIV infected PWID. My long term goal is to conduct sophisticated clinical trials of combined biomedical and behavioral interventions to improve HCV/HIV medical care, treatment and prevention as well as understand transmission dynamics to prevent HCV reinfection. The proposed studies are nested in two NIDA funded PWID cohorts, the prevention and testing (Lighthouse) study and the AIDS Linked to the IntraVenous Experience (ALIVE) cohort, both representing HIV infected and uninfected inner-city Baltimore PWID. Aim 1 utilizes data from social networks of index HIV-infected PWID to determine if HCV clusters within PWID social networks. Aim 2 will assess individual- and network-level barriers and facilitators of HCV care among HIV infected PWID in the oral DAA era. Aim 3 will assess if social networks document HCV transmission through use of complementary social network and phylogenetic analyses. The proposed career development plan will expand my technical skills through additional expertise in: (1) social network analyses; (2) recruitment of PWID social networks and assessment of social determinants of PWID HCV/HIV related health outcomes; 3) phylogenetic analyses and 4) implementation of bio-behavioral interventions. I will be well supported within the Department of Medicine at Johns Hopkins University and will benefit from the excellent research infrastructure of the Lighthouse and ALIVE studies at Johns Hopkins. With the recent national epidemic of transition from oral opioid to injection drug use and attendant increase in HIV and HCV infection rates, development of sustainable interventions to increase rates of HCV treatment among PWID and reduce rates of HIV/HCV infection have become a priority. This award will facilitate my pathway to an independent career as a patient-oriented clinical investigator committed to developing interventions to increase rates of HCV treatment and prevent HCV reinfection among HIV infected PWID.