ASTERISK: Alcohol and Substance use Treatment and Engagement Research on Intervention Studies among Key populations

项目总结 酒精和物质使用障碍(ASUD)与相当大的发病率和死亡率有关。全球范围 酒精使用障碍(AUD)被归因于9920万个伤残调整寿命年(DALY)，尽管这是非法的 物质使用障碍(SUD)被归因于2016年3180万DALY的损失。尽管迫切需要 减少ASUD对公共健康的影响，扩大有效的干预措施，在全球范围内采用治疗 仍然很低。心理社会和结构性因素是ASUD治疗和参与的主要障碍。为 例如，心理困扰、使用多种药物、无家可归、监禁和从事性工作 与ASUD治疗覆盖率和完成率较低有关。当这些因素同时出现时，它们 可能还会产生协同的负面影响，从而导致较不理想的健康结果和更大的 疾病负担(定义为综合征)。较少的研究经验性地检验了 心理社会和结构性障碍对ASUD治疗和治疗参与度的影响。优化ASUD的步骤 治疗和最大限度地参与，迫切需要研究这些因素之间的共同关系 条件，特别是在多项和不同的研究中。为了解决这些差距，桑托斯博士建议 扩大其以患者为中心的研究(POR)计划，并扩大其培训早期调查人员的能力 (Esis)，特别是来自代表人数不足的背景的人。桑托斯博士将提供体验式培训 在三个相辅相成的POR项目(项目A、B和C)中进行ESIS，这些项目将检查ASUD的障碍 获得和参与治疗，并探索ASUD患者的治疗偏好。项目A将 检查心理社会和结构条件对ASUD治疗使用的综合影响(目标1)， 以及这些影响的主持人(目标2)，利用五个国家艾滋病毒行为调查周期(累计 N=3848)使用综合数据分析(IDA)方法。项目B将研究以下方面的共同影响 心理社会和结构条件对ASUD治疗结果的影响(AIM 3)，以及这些因素的调节因素 效果(目标4)，利用10个ASUD药物治疗试验(累积n=722)，也使用IDA方法。 项目C将使用离散选择来检查ASUD患者的首选治疗属性 实验(DCE；目标5)，并检查250个个体在不同组之间的偏好差异(目标6 使用ASUD。最终，这项研究的结果将填补ASUD治疗实施方面的关键空白， 特别是对受艾滋病毒影响不成比例的关键人群。在这些研究项目的同时，Dr。 桑托斯将在三个关键支持领域为EIS提供结构化的指导和培训：工具性、 职业的和社交的。工具性支持将侧重于建设教育信息系统的独立能力 研究人员。专业支持将集中在职业发展技能上，以在研究中蓬勃发展。最后，社交 支持旨在通过网络机会、团体社交来增加他们的社会资本和韧性 活动和个人教练。

PROJECT SUMMARY Alcohol and substance use disorders (ASUD) are associated with substantial morbidity and mortality. Globally alcohol use disorders (AUD) were attributed to 99.2 million disability-adjusted life years (DALYs) while illicit substance use disorders (SUD) were attributed to 31.8 million DALYs lost in 2016. Despite the urgent need to reduce the public health impacts of ASUD and scale up efficacious interventions, treatment uptake worldwide remains low. Psychosocial and structural factors are major barriers to ASUD treatment and engagement. For example, psychological distress, polysubstance use, homelessness, incarceration, and engagement in sex work have been associated with lower ASUD treatment coverage and completion. When these factors co-occur, they may also generate synergistic negative effects that contribute to less optimal health outcomes and greater disease burden (defined as syndemics). Less research has empirically examined the syndemic effects of psychosocial and structural barriers on ASUD treatment and treatment engagement. To optimize ASUD treatments and maximize engagement, there’s an urgent need to examine the syndemic relationship of these conditions, especially across multiple and diverse studies. To address these gaps, Dr. Santos proposes to expand his patient oriented research (POR) program, and expand his capacity to train early stage investigators (ESIs), particularly those from underrepresented backgrounds. Dr. Santos will provide experiential training for ESIs in three complementary POR projects (Projects A, B, and C) that will examine the barriers to ASUD treatment access and engagement, and explore treatment preferences of individuals with ASUD. Project A will examine the syndemic effects of psychosocial and structural conditions on the use of ASUD treatment (AIM 1), and the moderators of those effects (AIM 2), leveraging five National HIV Behavioral Survey cycles (cumulative n=3848) using an Integrative Data Analysis (IDA) approach. Project B will examine the syndemic effects of psychosocial and structural conditions on ASUD treatment outcomes (AIM 3), and the moderators of those effects (AIM 4), leveraging 10 ASUD pharmacotherapy trials (cumulative n=722), also using an IDA approach. Project C will examine the preferred treatment attributes of individuals with ASUD using Discrete Choice Experiments (DCE; AIM 5) and examine how preferences differ between groups (AIM 6) among 250 individuals with ASUD. Ultimately, the findings from this study will be fill critical gaps in ASUD treatment implementation, particularly for key populations disproportionately impacted by HIV. In parallel to these research projects, Dr. Santos will provide structured mentoring and training to ESIs in three key areas of support: instrumental, professional and social. Instrumental support will focus on building ESIs capacity to become independent researchers. Professional support will focus on career development skills to thrive in research. Finally, social support aims to increase their social capital and resilience through networking opportunities, group social activities, and individual coaching.