Harnessing big data to arrest the HIV/HCV/opioid syndemic in the rural and urban South

项目总结/摘要 艾滋病毒、丙型肝炎病毒和阿片类药物流行病对美国不同地区的人口产生了严重影响， 更高的负担（占美国新诊断艾滋病毒的51%）和更差的结果（美国艾滋病毒死亡率最高， 6-10在南方，特别是主要是农村各州，艾滋病毒/艾滋病感染者的死亡率为每1 000人。南部各州也排名 在急性和慢性丙型肝炎病毒（HCV）感染率最高的人群中， 2006年田纳西州、肯塔基州、弗吉尼亚州和西弗吉尼亚州因注射阿片类药物导致的HCV感染 和2012年（从每10万人1人增加到近4人）。该区域的过量死亡率也急剧上升 在COVID-19大流行期间（西弗吉尼亚州和田纳西州分别在美国排名第一和第三， ≥50例死亡/100，000），阿片类药物滥用是区域HIV/HCV综合征的持续驱动因素。 考虑到最近在印第安纳州斯科特县爆发的艾滋病毒/丙型肝炎病毒，疾病预防控制中心评估说， 县一级对基于急性HCV感染的艾滋病毒爆发的脆弱性。急性HCV感染 作为艾滋病毒高风险的代表，由于共享注射毒品的近端原因， 在阿片类药物使用率和过量使用率高的地区采取这种做法。该研究直接告知了 田纳西州处方药过量计划的启动，CDC资助的监测系统，以监测 致命和非致命的药物过量。报告要求也已修改， 已经建立了信息学基础设施，以适应病毒性肝炎的自动化实验室上传 抗体，抗原和核酸检测，以确定急性丙型肝炎病毒感染，除了国家已经 强有力的艾滋病毒监测计划。类似的计划目前在32个州实施。此外，在过去几年中， 年，注射器服务计划和扩大获得非处方纳洛酮是法律的下， 公共章413和596在田纳西州，而国家的“胎儿攻击”的法律，沿着类似的， 直到最近，亚拉巴马和南卡罗来纳州才开始惩罚阿片类药物成瘾的准妈妈。 因此，拟议的研究将协调、链接和分析现成的“大数据”来源 加强艾滋病毒、艾滋病毒/HCV合并感染和阿片类药物过量死亡率结果的流行病学， 通过提高对最高风险人群的针对性，为艾滋病毒/HCV和过量用药预防和治疗活动提供信息， 风险/回报最高的人群（目标1和2）。评估个人行为的影响 和环境背景（邻里特征，如结构性贫困和混乱，缺乏 运输等）以及对这些结果的政策变化将是对文献的重要补充， 同样重要的是，数据传播平台（例如，仪表板），这将改善 在南部各州开展预防和治疗活动（目标1、2和3）。利用流行病学研究， 为政策提供信息，同时建立传播平台， 区域大流行防范工作意味着这项工作在未来几年仍将是一项宝贵的资源。

Project Summary / Abstract The HIV, HCV, and opioid epidemics disparately impact populations in different regions of the US, with higher burden (51% of new HIV diagnoses in the US) and poorer outcomes (highest HIV mortality in the US, at 6-10 per 1,000 persons with HIV) in the South, particularly largely rural states. Southern states also rank among those with the highest rates of acute and chronic Hepatitis C virus (HCV), with massive increases in HCV infections due to injected opioid use in Tennessee, Kentucky, Virginia, and West Virginia between 2006 and 2012 (from 1 to nearly 4 per 100,000). The region has also seen a dramatic increase in overdose mortality during the COVID-19 pandemic (West Virginia and Tennessee ranked 1st and 3rd in the US, respectively, with ≥50 deaths per 100,000), with opioid abuse a continued driver of the regional HIV/HCV syndemic. With the relatively recent HIV/HCV outbreak in Scott County, Indiana in mind, the CDC assessed county-level vulnerabilities to an HIV outbreak based on acute HCV infection. Acute HCV infection was used as a proxy of high HIV risk due to the proximal cause of shared injection drug use, an increasingly common practice in areas afflicted with high rates of opioid use and overdose. The research directly informed the initiation of the Tennessee Prescription Drug Overdose Program, a CDC-funded surveillance system to monitor both fatal and non-fatal drug overdoses. Reporting requirements have also been revamped and a new informatics infrastructure has been created to accommodate automated laboratory uploads of viral hepatide antibody, antigen, and nucleic acid testing to ascertain acute HCV infection, alongside the state’s already robust HIV surveillance program. Similar programs now exist in 32 states. In addition, over the past several years, syringe service programs and expanded access to non-prescription naloxone were made legal under Public Chapters 413 and 596 in Tennessee, while the state’s “fetal assault” law, along with similar ones in Alabama and South Carolina, penalized expectant mothers with opioid addictions until recently. The proposed research will therefore harmonize, link, and analyze readily available “big data” sources to enhance the epidemiology of HIV, HIV/HCV co-infection, and opioid overdose mortality outcomes which will inform HIV/HCV and overdose prevention and treatment activities by improving the targeting of highest- risk/highest-reward populations for their receipt (Aims 1 and 2). Assessing the impact of individual behavior and environmental context (neighborhood characteristics such as structural poverty and disorder, lack of transportation, etc.) as well as policy changes on these outcomes will be an essential addition to the literature, and as importantly, to data dissemination platforms (e.g., dashboards) which will improve deployment of prevention and treatment activities in southern states (Aims 1, 2, and 3). Using epidemiologic research to inform policy, while creating dissemination platforms which may be updated and re-deployed in future for regional pandemic preparedness, means this work will remain a valuable resource for years to come.