Optimizing HIV Prevention Among Opioid-Dependent Persons

摘要 修订后的K24将使我能够通过三个广泛的， 相互关联的目标，包括：（1）通过康州大学的研究所指导更多的新的以病人为导向的研究人员， 健康，干预和政策合作（InCHIP）和耶鲁艾滋病计划，（2）扩大我的以病人为导向 研究（POR）计划包括几个高优先级的国内（例如，西弗吉尼亚州/俄亥俄州）和国际环境 (e.g.,乌干达、马来西亚和乌克兰），以及（3）就围绕 在国家和国际临床环境中实施循证艾滋病毒预防， 我的POR技能美国动荡的阿片类药物流行病造成了难以想象的损失，210万美国人 阿片类药物使用障碍（OUD）和过量死亡仅在2017年就达到70，200人，比15年增加了400%以上。 1与此同时，一些注射吸毒者（PWID）2中的艾滋病毒爆发扭转了这一下降趋势。 组，1反映了需要更有效地预防艾滋病毒在这一组，特别是作为患者与OUD过渡， 因此，疾病预防控制中心加大了努力，以减少新的 通过以下方式更有效地针对PWID感染艾滋病毒：1）减少艾滋病毒风险行为，2）增加依从性 3）促进有益于个人和公众健康的健康行为。虽然药物-和 与性有关的艾滋病毒风险降低和坚持是很容易改变的行为，干预措施必须谨慎， 在美国和国际上设计并位于一系列以患者为导向的环境中。4 -8我正在扩大 我的POR将重点放在更好地识别，理解和制定多层次的战略，以适应这些 患者，以便他们可以通过下一代干预措施（例如，mHealth）. 9 这些战略将需要加强遵守PrEP和其他生物医学预防（例如，阿片类激动剂治疗[OAT] 和注射器服务计划[SSP]）以及行为风险降低。这将是特别重要的，因为国内优先 和国际社会的斗争，他们无力克服政策因素，限制或限制充分获得 艾滋病毒预防工具包（即，PrEP、OAT、SSP、行为干预）用于PWID。我正在进行的（R 01 DA 044867;吉利德 ISR-US-19-10641），最近完成（R 01 DA 032290; R 01 DA 022122），未来的艾滋病毒预防项目构成了 我的POR和指导计划以及未来的国内和国际研究合作。每个目标将 提供广泛的机会，以扩大我的POR，并为我的学员发展他们需要成为的技能 下一代艾滋病预防科学家

Abstract This revised K24 will enable me to optimize HIV prevention among opioid-dependent persons through three broad and interrelated aims that include: (1) Mentoring a greater number of new patient-oriented researchers via UConn’s Institute for Collaboration on Health, Intervention, and Policy (InCHIP) and the Yale AIDS Program, (2) Expanding my patient-oriented research (POR) program to include several high priority domestic (e.g., rural West Virginia/Ohio) and international settings (e.g., Uganda, Malaysia, and Ukraine), and (3) Engaging in structured training on critical issues surrounding the implementation of evidence-based HIV prevention within clinical settings nationally and internationally that will complement my POR skill set. The volatile opioid epidemic in the U.S. has taken an unimaginable toll, with 2.1 million Americans having an opioid use disorder (OUD) and overdose deaths reaching 70,200 in 2017 alone, representing over a 400% increase in 15 years.1 In parallel, a number of HIV outbreaks among people who inject drugs (PWID)2 reversed a downward trend in this group,1 reflecting the need to more effectively prevent HIV in this group, especially as patients with OUD transition from prescription pain killers to injectable opioids.3 Consequently, the CDC has intensified efforts to reduce the number of new HIV infections by more effectively and efficiently targeting PWID via: 1) reduced HIV risk behaviors, 2) increased adherence and retention in treatment; and 3) promotion of health behaviors that benefit individual and public health. Although drug- and sex-related HIV risk reduction and adherence are behaviors that are readily modifiable, interventions must be carefully designed and situated in a range of patient-oriented settings in the US and internationally.4-8 I am in the process of expanding my POR to focus on better identifying, understanding, and developing strategies at multiple levels to accommodate such patients so that they can derive optimal HIV prevention benefits via the next generation of interventions (e.g., mHealth).9 Such strategies will need to reinforce adherence to PrEP and other biomedical prevention (e.g., opioid agonist therapies [OAT] and syringe services programs [SSP]) alongside behavioral risk reduction. This will be especially important as priority domestic and international communities struggle with their inability to overcome policy factors that limit or restrict access to the full toolkit of HIV prevention (i.e., PrEP, OAT, SSP, behavioral interventions) for PWID. My ongoing (R01DA044867; Gilead ISR-US-19-10641), recently completed (R01DA032290; R01DA022122), and future HIV prevention projects form the basis of my POR and mentoring program as well as future domestic and international research collaborations. Each of the aims will provide a wide range of opportunities for expanding my POR and for my mentees to develop the skill set they need to become the next generation of HIV prevention scientists.