Ethno-epidemiology of HCV, HIV and Overdose associated with Drug Markets and Drug Tourism

这一竞争性修订旨在增加COVID-19检测和疫苗接种的可及性和使用率 在注射毒品者（PWID）中，这是一个极易感染COVID-19的人群。拟议 RADxUP项目，LinkUP，将嵌套在我们的母基金，洛杉矶圣地亚哥组成部分 Frontera，由NIDA于04/20资助。到目前为止，31%的拉弗龙特拉PWID已经测试了SARS- CoV-2抗体+，其中65%此前未接受过COVID-19检测。只有3%的人 到2021年5月接种疫苗，45%的人对疫苗犹豫不决。我们的具体目标是：目标1。前瞻性 评估PWID中COVID-19检测的患病率、预测因素和障碍。AIM 2.到 前瞻性评估PWID中COVID-19疫苗接种的发病率、预测因素和障碍。AIM 3. 调整和试行移动的注射器服务项目（SSP）提供的干预措施， 在残疾人中开展COVID-19检测和疫苗接种。AIM 4.为了比较COVID检测和 国家引入a）COVID-19快速检测和B）COVID-19之前和之后的疫苗接种率 在SSP接种疫苗，这是一个自然的实验。AIM 5.前瞻性评估 COVID-19检测和疫苗接种对PWID行为的影响。为了实现目标1和2，我们将 在拉弗龙特拉对400名PWID进行采访，结果将于2021年秋季公布。基于 这些调查结果和我们的社区和科学咨询委员会（CSAB）的投入，我们将选择和 调整简短干预措施，以改善PWID中的COVID-19检测和疫苗接种率 我们的社区合作伙伴OnPoint的移动的货车。LinkUP干预措施随后将在 150名La Frontera PWID的亚组，他们没有接受COVID-19疫苗或检测， 由OnPoint同伴辅导员实施，他们还将提供现场快速COVID-19抗原检测 以及确认性PCR和转诊至最近的COVID-19疫苗接种中心（直至提供疫苗 在国家）。我们将通过正在进行的La Frontera研究访视，包括自我报告的访谈数据，电子健康记录的链接 圣地亚哥县COVID-19数据库，并通过分析SARSCoV-2抗体模式， 区分自然感染和疫苗诱导的免疫。结果将用于估计 未来疗效试验的效应量，并与RADxUP联盟、政策制定者和 节目策划人由于全国有185个SSP，我们的研究将为努力实现 SSP将成为接触边缘化PWID的重要“接触点”，加强国家的 大流行准备基础设施，以减少COVID-19健康差距。

This competitive revision aims to increase access and uptake of COVID-19 testing and vaccination among people who inject drugs (PWID), a population highly vulnerable to COVID-19. The proposed RADxUP project, LinkUP, will be nested within the San Diego component of our parent grant, La Frontera, which was funded by NIDA in 04/20. To date, 31% of La Frontera PWID have tested SARS- CoV-2 antibody+, of whom 65% had not previously been tested for COVID-19. Only 3% had been vaccinated by 05/2021 and 45% were vaccine hesitant. Our specific aims are: AIM 1. To prospectively evaluate the prevalence, predictors and barriers to COVID-19 testing among PWID. AIM 2. To prospectively assess incidence, predictors and barriers to COVID-19 vaccination among PWID. AIM 3. To adapt and pilot an intervention offered at a mobile syringe services program (SSP) to improve uptake of COVID-19 testing and vaccination among PWID. AIM 4. To compare COVID testing and vaccination rates before and after the state introduces a) COVID-19 rapid testing and b) COVID-19 vaccination at the SSP, which represents a natural experiment. AIM 5. To prospectively assess the impact of COVID-19 testing and vaccination on PWIDs’ behaviors. To meet Aim 1 and 2, we will conduct interviews with 400 PWID in La Frontera, results which will be available in Fall 2021. Based on these findings and input from our Community and Scientific Advisory Board (CSAB), we will select and adapt a brief intervention to improve COVID-19 testing and vaccination uptake among PWID at the mobile van of our community partner, OnPoint. The LinkUP intervention will then be piloted among a subgroup of 150 La Frontera PWID who have not received COVID-19 vaccine or testing and will be implemented by OnPoint peer counsellors, who will also offer on-site rapid COVID-19 antigen testing and confirmatory PCR and referrals to the closest COVID-19 vaccination center (until vaccine is offered at OnPoint by the state). We will evaluate COVID-19 vaccine uptake independently through ongoing La Frontera study visits that will include self-reported interview data, linkage of electronic health records with the San Diego County COVID-19 database, and by analyzing SARSCoV-2 antibody patterns to differentiate between natural infection and vaccine-induced immunity. Results will be used to estimate effect sizes for a future efficacy trial and shared with the RADxUP consortium, policymakers and program planners. Since there are 185 SSPs across the country, our study will inform efforts to enable SSPs to become important ‘touchpoints’ to reach marginalized PWID, strengthening the nation’s pandemic preparedness infrastructure to reduce COVID-19 health disparities.