Brief Longitudinal Incident Sentinel Surveillance (BLISS) to End the HIV Epidemic among Persons Who Inject Drugs (PWID)

摘要 随着传播的持续，消除艾滋病毒的终局将变得越来越困难 最被社会边缘化、最难预防的人群 项目，也是流行病学研究中最具挑战性的项目。虽然三 弗朗西斯科似乎有望在未来几年内实现零新增艾滋病毒感染 注射吸毒者(PWID)的发展轨迹落后。较慢的下降速度 PWID中的HIV可能是由于接触前的意识和接受程度较低所致 预防(PrEP)。与此同时，邻近的阿拉米达县(奥克兰的所在地)几乎没有看到 艾滋病毒流行率下降，并在黑人/非洲人中爆发 美国人或经历无家可归的人。除了艾滋病毒，美国的PWID正在经历一场 阿片类药物过量导致的死亡人数激增。结束艾滋病毒流行并缓解其他健康问题 对于PWID的差异，数据收集系统需要更快、更具代表性和 对这一高危人群做出反应。因此，我们建议创建一种新的流行病学 阿拉米达县和旧金山县的PWID数据收集系统称为Brief 纵向事件哨兵监视(BLISS)。我们将招聘600名PWID(每名300人 县)使用一种新的基于地点/同行推荐的混合方法，称为海星抽样 积累一个队列，并纵向跟踪他们。在艾滋病毒检测和基线之后 问卷，参与者将被招募每月向11名哨兵提供简要答复 对艾滋病毒和药物使用流行病具有高度重要性的事件(例如，PrEP摄取或 停药、减少伤害计划的使用、过量服药经历)。每月数据将为 通过智能手机和在线技术收集，并提供面对面选项作为备份。 精选的哨兵事件将通过生态瞬间触发数据收集 评估(EMA)。样本大小适合于检测在 社区作为早期预警信号，并获得足够的纵向数据来评估原因 艾滋病毒风险和预防行为的因素，特别是使用PrEP的障碍和促进者 和坚持不懈。BLISS数据将有助于识别和避免疫情、微目标干预、 优先处理高危人群，满足未得到满足的护理和预防需求，结束艾滋病毒流行。

ABSTRACT The endgame for eliminating HIV will become increasingly difficult as transmission persists in populations who are the most marginalized from society, the hardest to reach with prevention programs, and the most challenging to include in epidemiological studies. Although San Francisco appears on track to achieve zero new HIV infections within the next few years, the trajectory among people who inject drugs (PWID) lags behind. The slower rate of decrease in HIV among PWID may be due to lower levels of awareness and uptake of pre-exposure prophylaxis (PrEP). Meanwhile, neighboring Alameda County (home to Oakland) has seen little decrease in the HIV epidemic, and outbreaks occur among PWID who are Black/African American or experiencing homelessness. In addition to HIV, PWID in the US are experiencing a surge in deaths due opioid overdose. To end the HIV epidemic and mitigate other health disparities for PWID, data collection systems need to be more rapid, representative, and responsive to this population at high risk. We therefore propose to create a new epidemiological data collection system for PWID in Alameda and San Francisco counties called Brief Longitudinal Incident Sentinel Surveillance (BLISS). We will recruit 600 PWID (300 each in county) using a novel venue-based / peer-referral hybrid method called Starfish Sampling to accrue a cohort and follow them longitudinally. Following HIV testing and a baseline questionnaire, participants will be enlisted to provide monthly brief responses to 11 sentinel events of high significance to the HIV and substance use epidemics (e.g., PrEP uptake or discontinuation, harm reduction program utilization, overdose experiences). Monthly data will be collected through smart phone and online technologies with in-person options as back up. Selected sentinel events will trigger “deeper dive” data collection through ecological momentary assessments (EMAs). The sample size is geared to detect events occurring at low rates in the community as early warning signals and to obtain sufficient longitudinal data to assess causal factors for HIV risk and preventive behaviors, particularly barriers and facilitators to PrEP use and adherence. BLISS data will help identify and avert outbreaks, micro-target interventions, prioritize those at highest risk, fill unmet care and prevention needs, and end the HIV epidemic.