Cigarette Smoking and Tuberculosis among Injection Drug Users in Tijuana, Mexico

描述(由申请人提供)：拟议研究的目标是描述吸烟的流行病学及其与注射吸毒者中结核病的关系，同时考虑艾滋病毒感染的影响和非法药物使用的模式吸烟与多种结核病结果有关，包括活动性结核病疾病、复发和结核病死亡率。然而，尽管在注射吸毒者中吸烟的流行率很高，但尚不清楚吸烟是否与注射吸毒者中结核病感染的增加有关，因为许多注射吸毒者已经因为艾滋病毒感染和使用非法药物而处于结核病的高风险之中。此外，对注射吸毒者的吸烟行为模式和戒烟准备情况知之甚少。2010年10月，墨西哥颁布了一项新的药物改革法，将大大扩大对鸦片成瘾者的美沙酮维持治疗，这为在药物治疗方案中预防注射吸毒者中的结核病提供了一个及时的机会。这项拟议的研究旨在通过实现以下目标，将烟草依赖治疗纳入药物治疗计划：1)确定吸烟是否与墨西哥提华纳注射吸毒者中的结核病感染有关，独立于艾滋病毒状况和非法药物使用模式，包括注射非法药物和吸食大麻、强效可卡因和甲基苯丙胺；2)描述吸烟剂量和持续时间与结核病感染之间的关系，并评估是否存在剂量-反应关系；以及3)描述目前吸烟的注射吸毒者的吸烟行为和戒烟意愿。我们将通过使用墨西哥提华纳正在进行的关于注射吸毒者艾滋病毒风险和药物使用情况的大型队列研究的基线数据来实现这些目标(PI：Strathdee，NIH R37 DA019829)。母研究包括关于艾滋病毒状况的数据和关于非法药物使用模式的广泛问题，这将使我们能够审查吸烟和结核病感染之间的联系，同时根据艾滋病毒状况和非法药物的使用情况进行调整(目标1和2)。我们还将通过对350名参与者的子集采用吸烟(半定量尿可替宁检测)和结核病感染(干扰素伽马释放检测)的生物学方法，来解决以前关于吸烟和结核病感染研究的一个重要局限性。对于目标3，我们将利用父母研究的完整基线数据集(N=815)，成为第一批描述注射吸毒者中烟草依赖和戒烟准备情况的研究之一。PI将在他的论文委员会和其他导师的监督下，将拟议的研究作为他的博士论文的一部分。开展这项研究将有助于该研究所在毒品和烟草依赖与艾滋病毒和结核病等传染病之间的相互作用方面获得专业知识，并将为作为一名独立研究员的成功职业生涯奠定坚实的基础。此外，拟议的研究将提供必要的数据，为墨西哥和其他地方的注射吸毒者制定烟草依赖治疗方案提供信息。 公共卫生相关性：拟议的研究将描述墨西哥提华纳注射吸毒者中吸烟的流行病学及其与结核病的关系，同时说明艾滋病毒感染的影响和非法药物的模式。鉴于注射吸毒者感染艾滋病毒和结核病的风险很高，而且结核病仍然是低收入和中等收入国家艾滋病毒感染者死亡的主要原因，迫切需要提供有效的干预措施来预防注射吸毒者中的结核病。我们的研究将提供必要的数据，为墨西哥和其他地方的注射吸毒者制定烟草依赖治疗计划提供信息。

DESCRIPTION (provided by applicant): The goal of the proposed research is to describe the epidemiology of cigarette smoking and its association with tuberculosis (TB) among injection drug users (IDUs) while accounting for the effect of HIV infection and patterns of illicit drug use Cigarette smoking is associated with multiple TB outcomes, including active TB disease, relapse, and TB mortality. However, despite the high prevalence of cigarette smoking among IDUs, it is unknown whether cigarette smoking is associated with increased TB infection among IDUs, many of whom are already at high risk of TB due to HIV infection and the use of illicit drugs. Furthermore, little is known regarding the patterns of cigarette smoking behavior and readiness to quit smoking among IDUs. In October 2010, Mexico enacted a new drug reform law that will significantly expand methadone maintenance treatment for opiate-addicted persons, which presents a timely opportunity to prevent TB among IDUs in drug treatment programs. The proposed research seeks to inform the integration of tobacco dependence treatment into drug treatment programs by accomplishing the following aims: 1) determine whether cigarette smoking is associated with TB infection among IDUs in Tijuana, Mexico, independent of HIV status and patterns of illicit drug use, including injecting illicit drugs and smoking marijuana, crack cocaine, and methamphetamines; 2) describe the relationship between the dosage and duration of cigarette smoking and TB infection and to evaluate whether a dose-response relationship exists; and 3) describe cigarette smoking behavior and readiness to quit among IDUs who currently smoke cigarettes. We will accomplish these aims by using the baseline data of a large, ongoing cohort study of HIV risk and drug use among IDUs in Tijuana, Mexico (PI: Strathdee, NIH R37 DA019829). The parent study includes data on HIV status and extensive questions on illicit drug use patterns, which will allow us to examine the association between cigarette smoking and TB infection while adjusting for HIV status and the use of illicit drugs (Aims 1 and 2). We will also address an important limitation of previous studies of cigarette smoking and TB infection by employing biological measures for cigarette smoking (a semi- quantitative urinary cotinine assay) and TB infection (an interferon gamma release assay) for a subset of 350 participants. For Aim 3, we will take advantage of the full baseline dataset of the parent study (N=815) to be among the first to describe tobacco dependence and readiness to quit among IDUs. The PI will conduct the proposed research as part of his doctoral dissertation under the supervision of his dissertation committee and other mentors. Conducting this research will help the PI gain expertise in the interaction between drug and tobacco dependence and infectious diseases such as HIV and TB, and will provide a strong foundation for a successful career as an independent researcher. Furthermore, the proposed research will provide essential data to inform the development of tobacco dependence treatment programs for IDUs in Mexico and elsewhere. PUBLIC HEALTH RELEVANCE: The proposed research will describe the epidemiology of cigarette smoking and its association with tuberculosis (TB) among injection drug users (IDUs) in Tijuana, Mexico, while accounting for the effect of HIV infection and patterns of illicit drug ue. Given the high risk of HIV and TB among IDUs and that TB remains the leading cause of death among HIV-infected persons in low and middle income countries, there is an urgent need to provide effective interventions for preventing TB among IDUs. Our research will provide essential data to inform the development of tobacco dependence treatment programs for IDUs in Mexico and elsewhere.