Injection Risk Networks in Rural Puerto Rico

摘要 2014年11月至2017年5月，我们团队利用346个现有的PWID进行了多波数据采集 波多黎各农村内陆通过国家卫生研究院拨款支持的项目R01DA037117。这项研究是有组织的 围绕四个具体目标：1)使用基于网络的采样、人种学实地调查以及艾滋病毒和丙型肝炎病毒检测 确定影响人群中艾滋病毒和丙型肝炎发病率和流行率的行为和结构因素 世卫组织在波多黎各农村地区注射毒品(PWID)；2)估计艾滋病毒和丙型肝炎的流行范围和 波多黎各农村地区使用网络结构、基于代理的5年、10年和20年的发病率 模拟；3)模拟动态风险中预防艾滋病毒和丙型肝炎病毒感染的常见干预措施 网络环境，以确定哪些干预措施(或干预措施组合)最合适 防止艾滋病毒和丙型肝炎病毒在波多黎各农村地区的残疾人中传播；4)与我们的 传播咨询委员会，与我们的目标受众采用综合知识交流方法 (波多黎各和纽约的政策制定者、公共卫生官员和减少伤害的提供者，那里的许多人 农村注射器在变成艾滋病毒阳性时就会消失)。2017年9月，飓风玛丽亚摧毁了波多黎各的 基础设施。这场灾难对与毒品有关的发病率和死亡率的影响可能很大。目前， 除了最近的研究外，人们对灾后与药物相关的感染或过量风险的模式知之甚少 在经济结构调整下。现有的证据表明，所有艾滋病毒感染者的风险都在不断上升 以及丙型肝炎感染的情景。虽然玛丽亚造成的破坏是相对史无前例的，但大规模的自然 社会灾难也越来越普遍。从规划和干预的角度来看， 了解此类事件对(短期)过量服药率和(长期)艾滋病毒/丙型肝炎病毒感染的影响 流行率是至关重要的。这一相互竞争的修订考虑到了最初意想不到的灾后浪潮 波多黎各农村PWID的数据收集将重复用于建立PWID风险网络的策略 2016年和2017年两波数据收集期间的拓扑和流行病学动态。飓风过后 数据收集将有助于更好地了解大规模社会和生态破坏的影响 关于与目标1-3相关的因素范围。它还将使我们的团队重新建立集成的 与我们的传播咨询委员会进行知识交流，该委员会了解 波多黎各的情况很可能发生了戏剧性的变化。虽然我们的具体目标保持不变，但其影响 将通过纳入有史以来第一个灾前/灾后网络数据来显著扩大整个项目的 PWID中的集合。

ABSTRACT From November 2014 to May 2017, our team conducted multi-wave data collection with 346 current PWID in the rural interior of Puerto Rico via project supported by NIH grant R01DA037117. This research was organized around four specific aims: 1) Use network-based sampling, ethnographic fieldwork, and HIV and HCV testing to determine behavioral and structural factors affecting HIV and HCV incidence and prevalence rates among people who inject drugs (PWID) in rural areas of Puerto Rico; 2) Estimate the range of HIV and HCV prevalence and incidence rates in rural Puerto Rico for 5, 10, and 20 year time spans using network-structured, agent based simulation; 3) Simulate common interventions aimed at preventing HIV and HCV infection in a dynamic risk network environment to determine which interventions (or combinations of interventions) are most appropriate for preventing the spread of HIV and HCV among PWID in rural Puerto Rico; 4) In collaboration with our Dissemination Advisory Board, apply an integrated knowledge-exchange approach with our target audiences (policymakers, public health officials, and harm reduction providers in Puerto Rico and in New York, where many rural injectors go when they become HIV+). In September 2017, hurricane Maria devastated Puerto Rico's infrastructure. The impact of the disaster on drug-related morbidity and mortality are likely to be large. Currently, little is known about post-disaster patterns of drug-related risk of infection or overdose, outside of recent research under economic restructuring. What evidence exists points to an escalation of risk across the full range of HIV and hepatitis C infection scenarios. While the damage from Maria is relatively unprecedented, large scale natural and social disasters are increasingly common. From a planning and intervention perspective, greater understanding of the impacts of such events on (short term) overdose rates and (long-term) HIV/HCV infection prevalence are critical. This competing revision allows for an originally unanticipated wave of post-disaster data collection with rural PWID in Puerto Rico that will repeat strategies used to establish PWID risk network topologies and epidemiological dynamics during two waves of data collection in 2016 and 2017. Post-hurricane data collection will provide greater understanding of the impact of large scale social and ecological destruction on the range of factors associated with Aims 1-3. It will also allow our team to re-establish the integrated knowledge exchange with our Dissemination Advisory Board, whose understanding of the situation on the ground in Puerto Rico is likely to have shifted dramatically. While our specific aims remain the same, the impact of the overall project will be significantly expanded by the inclusion of a first-ever pre-/post-disaster network data collection among PWID.