Making Better Decisions: Policy Modeling for AIDS and Drug Abuse

项目摘要/摘要 阿片类药物滥用、注射用药和吸毒过量已成为国家公共卫生危机，超过6万人 2016年美国吸毒过量死亡人数最多的是阿片类药物。我们的目标是进行基于模型的 评估使用阿片类药物对艾滋病毒和丙型肝炎病毒的流行病学后果的研究，包括益处， 阿片类药物预防和缓解战略的危害和资源利用。我们将评估如何最好地减少 与阿片类药物使用相关的艾滋病毒和丙型肝炎发病率，并改善与阿片类药物使用相关的患者的生活质量 发生艾滋病毒或丙型肝炎病毒和阿片类药物使用障碍。我们的目标是： 1.模拟阿片类药物流行对艾滋病毒和丙型肝炎病毒传播的影响。我们将为 阿片类药物流行对艾滋病毒和丙型肝炎发病率、流行率、亚群浓度的影响， 基于性别和种族的差异。 2.为预防和缓解艾滋病的个别战略的流行病学和人口影响建立模型 阿片类药物和注射毒品对艾滋病毒和丙型肝炎结局的危害。我们将评估预防策略 包括对艾滋病毒和丙型肝炎病毒的适应性筛查，以帮助爆发和热点识别，改变 处方做法和监测方案、艾滋病毒暴露前预防(PrEP)、重症艾滋病毒和丙型肝炎病毒 筛查和缓解策略，包括成瘾治疗药物、心理社会干预、 和纳洛酮的分布。 3.模拟各种战略组合对流行病学和人口的影响，以减轻 阿片类药物的使用和药物注射对艾滋病毒和丙型肝炎结果的影响。因为没有一种单一的策略可能会 为了对人口健康结果产生足够的影响，我们将审查目标2至 评估哪些组合可能对发病率和死亡率产生最大的流行病学影响。 4.建立有效战略和战略组合实施障碍的影响模型，以 减少阿片类药物使用对艾滋病毒和丙型肝炎病毒的危害。我们将对实施障碍的影响进行建模 目标2和目标3中确定的战略的步骤(例如，招聘、推荐、参与和保留)。 这项拟议的工作将为临床医生和政策制定者提供急需的指导，指导他们如何 战略的组合可以有效地缓解阿片类药物使用造成的国家公共健康危机以及如何 这些干预措施可以结合在一起，以减少艾滋病毒和丙型肝炎病毒的发病率，并改善长度和 艾滋病毒、丙型肝炎病毒感染者和阿片类药物使用者的生活质量。

Project Summary/Abstract Opioid overuse, injection drug use, and overdose have become a national public health crisis, with over 60,000 drug overdose deaths in 2016 in the US, most involving opioids. Our objective is to conduct model-based studies that estimate the epidemiologic consequences of opioid use on HIV and HCV, including the benefits, harms, and resource use of opioid prevention and mitigation strategies. We will assess how best to reduce the incidence of HIV and HCV associated with opioid use and to improve quality of life for people with co- occurring HIV or HCV and opioid use disorder. Our aims are to: 1. Model the effect of the opioid epidemic on transmission of HIV and HCV. We will model the implications of the opioid epidemic on HIV and HCV incidence, prevalence, concentration in subpopulations, gender- and race-based differences. 2. Model the epidemiologic and population impacts of individual strategies to prevent and mitigate the harms of opioids and drug injection on HIV and HCV outcomes. We will evaluate prevention strategies including adaptive screening for HIV and HCV to aid in outbreak and hotspot identification, changing prescribing practices and monitoring programs, HIV pre-exposure prophylaxis (PrEP), intensive HIV and HCV screening, and mitigation strategies including medications for addiction treatment, psychosocial interventions, and distribution of naloxone. 3. Model the epidemiologic and population impact of portfolios of strategies to mitigate the harms of opioid use and drug injection on HIV and HCV outcomes. Because no single strategy will likely have sufficient impact on population health outcomes, we will examine sets of the strategies described in Aim 2 to assess which combinations have the potential for the largest epidemiologic impact on morbidity and mortality. 4. Model the impact of barriers to implementation of effective strategies and portfolios of strategies to reduce the harms of opioid use on HIV and HCV. We will model the effects of barriers to implementation steps (e.g., recruitment, referral, participation, and retention) for strategies identified in Aims 2 and 3. The proposed work will provide clinicians and policymakers with critically needed guidance about how combinations of strategies can efficiently mitigate the national public health crisis from opioid use and how such interventions can be integrated to reduce incidence of HIV and HCV and to improve both length and quality of life for people with HIV, HCV, and opioid use.