The role of depression in HIV transmission among people who inject drugs in Vietnam

摘要 在越南，注射毒品者（PWID）的艾滋病毒感染率超过30%。迫切需要 预防计划旨在减缓持续传播并为大量艾滋病毒人群提供治疗服务- PWID阳性。大量共用针头和有限的抗逆转录病毒疗法导致 艾滋病毒在艾滋病感染者中的发病率居高不下。减少危险行为并使这一人群感染艾滋病毒 护理提出了重大挑战，PWID中抑郁症的高负担可能是其根源。 这些挑战。越南高达50%的PWID被发现患有严重抑郁症 大量研究表明，共病抑郁症一贯导致艾滋病毒感染率较低， 治疗结果。然而，抑郁症在艾滋病毒传播中的作用仍不清楚。拟议 一项研究假设，PWID中的抑郁症会增加注射和性风险行为， 参与艾滋病毒护理和坚持抗逆转录病毒疗法，导致艾滋病毒载量不受控制。通过便利 风险行为和生物传染性，抑郁症被假设为导致增加的向前 传染给易感的伴侣。这项研究首次同时研究了 抑郁症通过行为和生物途径传播艾滋病毒感染， 数学建模，以量化潜在的艾滋病毒预防效益的可能干预措施，在这一关键 人口本研究将使用从阮泰336名新诊断的HIV阳性PWID中收集的数据， 越南艾滋病毒诊断前和诊断后两年内。本研究的目标1和2将 估计抑郁症与传播风险行为（Aim 1）和HIV病毒载量（Aim 2）的关联， 艾滋病诊断前后Aim 3将建立一个数学模型， 越南的PWID量化了抑郁症对新发艾滋病毒感染的贡献。该模型将是第一个 估计越南艾滋病毒阳性PWID中的二次传播事件，并量化艾滋病毒感染， 可以避免使用当前的预防策略（抗逆转录病毒疗法，针交换，美沙酮维持 项目）和潜在的未来干预措施（抑郁症筛查和治疗）。拟议的研究是一项 创新的方法，将传统的流行病学方法与数学建模相结合， 了解艾滋病毒流行情况，指导越南艾滋病感染者的控制工作。这项研究的重点是一个 药物滥用的重要后果，艾滋病毒传播，并旨在减少这种危害，这是研究 被NIDA确定为高度优先的领域。抑郁症筛查和治疗可能对降低风险至关重要 行为，实现病毒抑制，并最终减缓关键人群的向前传播， 导致了艾滋病的流行

ABSTRACT HIV prevalence is above 30% among people who inject drugs (PWID) in Vietnam. There is an urgent need for prevention programs to slow ongoing transmission and provide treatment services for large populations of HIV- positive PWID. High levels of needle-sharing and limited uptake of antiretroviral therapy (ART) result in persistently high HIV incidence among PWID. Reducing risk behaviors and engaging this population in HIV care present significant challenges, and the high burden of depression among PWID may be at the root of those challenges. Up to 50% of PWID in Vietnam have been found to suffer from severe depressive symptoms, and a large body of research shows that comorbid depression consistently results in poorer HIV treatment outcomes. However, the role of depression in forward HIV transmission is still unclear. The proposed study hypothesizes that depression among PWID increases injecting and sexual risk behaviors and reduces engagement in HIV care and adherence to ART, resulting in uncontrolled HIV viral load. Through facilitating both risk behaviors and biological infectiousness, depression is hypothesized to result in increased forward transmission to susceptible partners. The proposed study is the first to simultaneously investigate the role of depression in forward spread of HIV infection through both behavioral and biological pathways and to use mathematical modeling to quantify the potential HIV prevention benefits of possible interventions in this key population. This study will use data collected from 336 newly diagnosed HIV-positive PWID in Thai Nguyen, Vietnam prior to HIV diagnosis and during the two years after diagnosis. Aims 1 and 2 of this study will estimate the association of depression with transmission risk behaviors (Aim 1) and HIV viral load (Aim 2), both before and after HIV diagnosis. Aim 3 will then develop a mathematical model of forward transmission among PWID in Vietnam to quantify the contribution of depression to new HIV infections. This model will be the first to estimate secondary transmission events among HIV-positive PWID in Vietnam and quantify HIV infections that could be averted using current prevention strategies (ART, needle exchanges, methadone maintenance programs) and potential future interventions (depression screening and treatment). The proposed study is an innovative approach, combining traditional epidemiologic methods with mathematical modeling to better understand the HIV epidemic and guide control efforts among PWID in Vietnam. This study focuses on an important consequence of drug abuse, HIV transmission, and aims to reduce this harm, which are research areas identified by NIDA as high priority. Depression screening and treatment may be critical to reducing risky behaviors, achieving viral suppression, and ultimately, slowing forward transmission in a key population that drives the HIV epidemic.