Optimizing HIV Prevention Among Opioid-Dependent Persons

摘要 修订后的K24将使我能够通过三个广泛的和 相互关联的目标包括：(1)通过康涅狄格州大学研究所指导更多面向患者的新研究人员 健康、干预和政策合作(INCHIP)和耶鲁大学艾滋病项目，(2)扩大我的以患者为中心 研究(POR)计划，包括几个高度优先的国内(例如，西弗吉尼亚州/俄亥俄州农村)和国际环境 (例如，乌干达、马来西亚和乌克兰)，以及(3)参与有关关键问题的系统培训 在国内和国际临床环境中实施循证艾滋病毒预防，这将补充 我的战俘技能。美国动荡的阿片类药物流行造成了难以想象的损失，210万美国人 仅在2017年，阿片类药物使用障碍(OUD)和过量死亡就达到了70,200人，15年增长了400%以上 1同时，在注射吸毒者中爆发的若干艾滋病毒(PWID)2扭转了这方面的下降趋势 第1组，反映了在这一组中需要更有效地预防艾滋病毒，特别是当患者从 处方止痛药改为可注射阿片类药物。3因此，疾病预防控制中心加紧努力，减少新的 通过更有效和高效地针对PWID进行艾滋病毒感染：1)减少艾滋病毒危险行为，2)增加依从性 以及3)促进有益于个人和公共健康的健康行为。尽管毒品和 与性有关的艾滋病毒风险降低和遵守是很容易改变的行为，干预必须谨慎 在美国和国际上设计并定位于一系列以病人为中心的环境中。4-8我正在扩展过程中 我的POR将重点放在更好地识别、理解和制定多个层面的战略，以适应这些 使患者能够通过下一代干预措施(例如，移动保健)获得最佳艾滋病毒预防惠益。 这种战略将需要加强对PrEP和其他生物医学预防的坚持(例如，阿片类激动剂疗法[燕麦片])。 和注射器服务计划[SSP])，同时降低行为风险。作为国内的优先事项，这一点尤为重要 国际社会正在努力克服限制或限制充分利用的政策因素 艾滋病预防工具包(即PrEP、OAT、SSP、行为干预)。我正在进行中(R01DA044867；吉列德 ISR-US-19-10641)，最近完成(R01DA032290；R01DA022122)，以及未来的艾滋病毒预防项目构成了 我的POR和指导计划以及未来的国内和国际研究合作。每一个目标都将 提供广泛的机会来扩展我的POR，并让我的学员发展他们需要的技能集 下一代艾滋病毒预防科学家。

Abstract This revised K24 will enable me to optimize HIV prevention among opioid-dependent persons through three broad and interrelated aims that include: (1) Mentoring a greater number of new patient-oriented researchers via UConn’s Institute for Collaboration on Health, Intervention, and Policy (InCHIP) and the Yale AIDS Program, (2) Expanding my patient-oriented research (POR) program to include several high priority domestic (e.g., rural West Virginia/Ohio) and international settings (e.g., Uganda, Malaysia, and Ukraine), and (3) Engaging in structured training on critical issues surrounding the implementation of evidence-based HIV prevention within clinical settings nationally and internationally that will complement my POR skill set. The volatile opioid epidemic in the U.S. has taken an unimaginable toll, with 2.1 million Americans having an opioid use disorder (OUD) and overdose deaths reaching 70,200 in 2017 alone, representing over a 400% increase in 15 years.1 In parallel, a number of HIV outbreaks among people who inject drugs (PWID)2 reversed a downward trend in this group,1 reflecting the need to more effectively prevent HIV in this group, especially as patients with OUD transition from prescription pain killers to injectable opioids.3 Consequently, the CDC has intensified efforts to reduce the number of new HIV infections by more effectively and efficiently targeting PWID via: 1) reduced HIV risk behaviors, 2) increased adherence and retention in treatment; and 3) promotion of health behaviors that benefit individual and public health. Although drug- and sex-related HIV risk reduction and adherence are behaviors that are readily modifiable, interventions must be carefully designed and situated in a range of patient-oriented settings in the US and internationally.4-8 I am in the process of expanding my POR to focus on better identifying, understanding, and developing strategies at multiple levels to accommodate such patients so that they can derive optimal HIV prevention benefits via the next generation of interventions (e.g., mHealth).9 Such strategies will need to reinforce adherence to PrEP and other biomedical prevention (e.g., opioid agonist therapies [OAT] and syringe services programs [SSP]) alongside behavioral risk reduction. This will be especially important as priority domestic and international communities struggle with their inability to overcome policy factors that limit or restrict access to the full toolkit of HIV prevention (i.e., PrEP, OAT, SSP, behavioral interventions) for PWID. My ongoing (R01DA044867; Gilead ISR-US-19-10641), recently completed (R01DA032290; R01DA022122), and future HIV prevention projects form the basis of my POR and mentoring program as well as future domestic and international research collaborations. Each of the aims will provide a wide range of opportunities for expanding my POR and for my mentees to develop the skill set they need to become the next generation of HIV prevention scientists.