An ethno-epidemiological study to advance HIV prevention and treatment for PWUD

项目摘要/摘要 在北美，先进的生物医学艾滋病毒预防和治疗技术(例如，暴露前 预防、简化的抗逆转录病毒治疗方案)、系统一级的创新(例如，艾滋病毒治疗作为 预防)，共同管理艾滋病毒/艾滋病和共病的干预措施(例如，综合艾滋病毒/艾滋病护理)是 按照结束和减少与以下方面有关的总体健康负担的目标加以利用 艾滋病毒/艾滋病。到目前为止，还缺乏关于可接受性、可行性和实施的研究 人群中正在出现的和预期的干预措施(例如，长效抗逆转录病毒疗法、艾滋病毒疫苗) 世卫组织使用毒品(PWUD)，尽管吸毒人群在艾滋病毒相关结果方面仍然存在差异。 因此，吸毒人群可能无法从艾滋病毒预防方面的进步中充分受益， 治疗和护理将是今后全球应对艾滋病毒/艾滋病工作的重要组成部分 十年。这项申请的目的是应用民族流行病学方法来检查个人， 社会、结构和环境对可接受性、可行性和实施的影响 预防和治疗的新兴和前瞻性生物医学、系统级和程序性干预 艾滋病毒/艾滋病，并管理残障人士的共病。拟议的研究嵌套在一个更大的计划中 这项研究包括三项由NIDA资助的纵向队列研究，包括艾滋病毒阴性和艾滋病毒- 在加拿大温哥华，阳性的PWUD和街头吸毒青年(SY)。因此，这种方法提供了一种 利用这些队列研究进行流行病学知情抽样的“增值”机会 和有针对性地招募PWUD，并收集人种学和定性数据，可以用三角测量 量化的临床和行为数据。扩展我们的民族流行病学研究以检查新出现的 和预期的艾滋病毒预防和治疗干预措施以及合并症的管理将 从而更全面地了解PWUD对这些干预措施的影响 仅通过流行病学研究。温哥华非常适合进行以下几项拟议的研究 理由。这座城市一直是关于新型和组合艾滋病毒的持续创新的地点 预防、治疗和护理干预措施，这里试行的方法通常在其他环境中实施 (例如，作为预防的艾滋病毒治疗)。此外，温哥华提供了开展研究的独特机会 调查新出现的和预期的干预措施的可接受性、可行性和实施情况 在“真实世界”中对艾滋病毒相关结果的后续影响(例如，抗逆转录病毒疗法的坚持、病毒学结果) 环境，没有医疗保险的混杂影响。这项拟议的研究与美国国立卫生研究院保持一致。 艾滋病研究优先事项和指导方针办公室(2015)和2017年艾滋病毒相关跨国立卫生研究院计划 研究，并将帮助在加拿大、美国和加拿大优化和扩大这些干预措施 州，以及其他高收入环境。

PROJECT SUMMARY/ABSTRACT In North America, advanced biomedical HIV prevention and treatment technologies (e.g., pre-exposure prophylaxis, simplified antiretroviral therapy regimens), systems-level innovations (e.g., HIV Treatment as Prevention), and interventions to co-manage HIV/AIDS and co-morbidities (e.g., integrated HIV/AIDS care) are being harnessed pursuant to the goal of both ending and reducing the overall health burden associated with HIV/AIDS. To date, there has been a lack of research into the acceptability, feasibility, and implementation of emerging and prospective (e.g., long-acting antiretroviral therapy, HIV vaccines) interventions among people who use drugs (PWUD), despite continuing disparities in HIV-related outcomes among drug-using populations. As a consequence, drug-using populations might not fully benefit from advancements in HIV prevention, treatment, and care that will represent a crucial component of the global response to HIV/AIDS over the next decade. The purpose of this application is to apply an ethno-epidemiological approach to examine individual, social, structural, and environmental influences on the acceptability, feasibility, and implementation of emerging and prospective biomedical, systems-level, and programmatic interventions to prevent and treat HIV/AIDS and manage co-morbidities among PWUD. The proposed study is nested within a larger program of research that includes three NIDA-funded, longitudinal cohort studies comprised of HIV-negative and HIV- positive PWUD and drug-using street-involved youth (SY) in Vancouver, Canada. Thus, this approach offers a `value-added' opportunity to harness these cohort studies to undertake epidemiologically-informed sampling and targeted recruitment of PWUD and collect ethnographic and qualitative data that can be triangulated with quantitative clinical and behavioral data. Extending our ethno-epidemiological research to examine emerging and prospective HIV prevention and treatment interventions, as well as the management of co-morbidities, will result in a more complete understanding of influences on these interventions among PWUD than is possible through epidemiological research alone. Vancouver is ideally suited for the proposed research for several reasons. The city has been the site of ongoing innovation with respect to novel and combination HIV prevention, treatment, and care interventions, with approaches piloted here often implemented in other settings (e.g., HIV Treatment as Prevention). Further, Vancouver presents unique opportunities to undertake research into the acceptability, feasibility, and implementation of emerging and prospective interventions and subsequent impacts on HIV-related outcomes (e.g., ART adherence, virological outcomes) in a `real world' setting, without the confounding influence of health insurance. The proposed research is aligned with the NIH Office of AIDS Research Priorities and Guidelines (2015) and the 2017 Trans-NIH Plan for HIV-Related Research, and will help inform the optimization and scale-up of these interventions in Canada, the United States, and other high-income settings.