Risk Factors for AIDS among Persons Who Inject Drugs: HIV and COVID-19

摘要 很难低估COVID-19大流行对公共卫生的潜在影响， 艾滋病毒在艾滋病感染者中的新爆发。在公共卫生规模化实施“预防为主、防治结合”的同时， 艾滋病毒感染者中的“艾滋病毒护理”已导致许多高收入国家的艾滋病毒传播大幅减少， 还发生了多起艾滋病毒爆发，例如，在美国、西欧、东欧和以色列。而 每一次爆发都有不同的特点，在爆发中注意到一些共同的特点， 包括：1）社区经济混乱，2）艾滋病毒预防服务不足或中断，3）当地 引进新的注射药物，和4）无家可归的PWID作为一个非常高的风险群体。的COVID-19 大流行及其相关的封锁/控制措施似乎正在重新创造 在2019冠状病毒病爆发前，FDA紧急使用 有效的SARS-CoV-2疫苗的授权提供了一个关键的机会，以减轻一些，但肯定 而不是艾滋病预防的所有威胁。然而，快速接种疫苗的重要潜在困难 存在多个PWID。我们建议研究艾滋病毒，COVID-19和种族/民族之间的关系 纽约市的PWID之间的差异，这个地方经历了世界上最大的艾滋病毒流行病， PWID是世界上最大的COVID-19本地疫情之一，通过四个具体目标： 1.评估COVID-19大流行对纽约市PWID中艾滋病毒风险的短期（3年内）影响， 包括关键生物行为风险的潜在增加（艾滋病毒传播的综合风险和 多人感染艾滋病毒的风险）。 2.监测纽约市PWID中SARS-CoV-2疫苗接种情况。确定与接收相关的因素 疫苗接种，包括“基础健康状况”、社会人口统计学，特别是种族/民族， 就业、疫苗认识和态度以及各种吸毒模式。检查同伴、家人和 “可信来源”对接受疫苗接种的影响。教育参与者关于SARS-CoV-2疫苗， 包括可用性、类型、副作用和时间安排。评估“群体免疫”在多大程度上被 在PWID中实现。 3.利用抗体检测来估计PWID中过去和事件的COVID-19感染，识别风险 感染的因素，包括种族/民族，以及是否采取保护行为与 血清阳性率较低。 4.使用主成分分析（PCA），检查多种健康问题之间的关系， 纽约市残疾人健康的社会决定因素，包括艾滋病毒、COVID-19、HCV、阿片类药物和兴奋剂的使用， 在COVID-19大流行期间，药物过量，无家可归，经济和粮食不安全。审查 健康和健康的社会决定因素群组之间的种族/族裔差异模式。

Abstract It is difficult to underestimate the potential public health significance of the COVID-19 pandemic for generating new outbreaks of HIV among PWID. While public health scale implementation of “combined prevention and care for HIV” among PWID has led to dramatic reductions in HIV transmission in many high-income countries, multiple outbreaks of HIV have also occurred, e.g., in the US, Western and Eastern Europe, and Israel. While there were distinct features of each outbreak, a number of common features were noted across the outbreaks, including: 1) community economic dislocations, 2) inadequate or interrupted HIV prevention services, 3) local introduction of new injectable drugs, and 4) homeless PWID as a very high-risk group. The COVID-19 pandemic and its associated lockdown/control measures appear to be re-creating the very conditions that generated HIV outbreaks among PWID in the pre- COVID-19 era. The recent FDA emergency use authorization of effective SARS-CoV-2 vaccines provides a critical opportunity to alleviate some—but certainly not all—of the threats to HIV prevention. However, important potential difficulties in rapidly vaccinating large numbers of PWID exist. We propose to examine relationships between HIV, COVID-19, and racial/ethnic disparities among PWID in NYC, a location that has experienced the world’s largest local HIV epidemic among PWID, and one of the world’s largest local COVID-19 epidemics, through four specific aims: 1. Assess short term (within 3 years) impact of the COVID-19 pandemic on HIV risk among PWID in NYC, including potential increases in critical bio-behavioral risks (composite risk for HIV transmission and composite multi-person risk for HIV acquisition). 2. Monitor SARS-CoV-2 vaccination over time among PWID in NYC. Identify factors associated with receiving vaccination, including ‘underlying health conditions,” socio-demographics, particularly race/ethnicity and employment, vaccine awareness and attitudes, and across patterns of drug use. Examine peer, family and “trusted sources” influences on receiving vaccination. Educate participants on SARS-CoV-2 vaccines, including availability, types, side effects and scheduling. Assess the extent to which “herd immunity” is being achieved among PWID. 3. Utilize antibody testing to estimate past and incident COVID-19 infection among PWID, identifying risk factors for infection, including race/ethnicity, and whether practicing protective behaviors is associated with lower seroprevalence. 4. Using principal component analysis (PCA), examine relationships between multiple health problems and social determinants of health among PWID in NYC, including HIV, COVID-19, HCV, opioid and stimulant use, drug overdose, homelessness, and economic and food insecurity, during the COVID-19 pandemic. Examine patterns of racial/ethnic disparities among the clusters of health and social determinants of health.