Impacts of universal access to HIV/AIDS care among HIV+ injection drug users

对感染艾滋病毒的注射吸毒者（IDU）进行适当的艾滋病毒治疗和护理的障碍越来越多， 关心国际社会努力改进向注射吸毒者提供高效抗逆转录病毒疗法， 诸如世卫组织的三五计划等，迫切需要关于如何解决这些障碍的数据。 虽然对艾滋病毒阴性的注射吸毒者的艾滋病毒预防一直很重视，但最近有一项研究表明， 越来越多的人认识到，打破艾滋病毒传播的循环需要重新关注行为， 感染艾滋病毒的注射吸毒者的预防需要。这一建议旨在填补北方存在的信息空白， 美国和其他地方通过以下具体目标： 1.评价艾滋病毒/艾滋病服务的接受率（例如，抗逆转录病毒疗法）和相关因素 在注射吸毒者中 2.评价HIV感染者对抗逆转录病毒药物耐药的发生率， 独特的抗逆转录病毒治疗模式对抗逆转录病毒耐药时间的影响 3.评估艾滋病毒疾病进展的趋势和因素，如医疗服务和中学 预防服务的使用可能与减少IDU中的疾病进展有关 4.确定与持续的艾滋病毒风险行为相关的因素（例如，注射器借贷）， 针对艾滋病毒感染者的综合循证艾滋病毒预防策略 这些目标将通过对艾滋病毒感染的注射吸毒者进行一项新的前瞻性队列研究来实现， 加拿大温哥华。这种情况是独一无二的，因为所有的医疗保健和抗逆转录病毒药物都是免费提供的。 通过全民医疗保健系统收费，使研究计划能够专注于非金融领域。 护理障碍。该队列将包括一系列血液采样，以评估抗逆转录病毒耐药模式， 评估非法药物使用和相关行为的详细调查表，以及正在进行的行政联系 到该省的集中医疗保健和社会服务数据库，以评估获得抗逆转录病毒药物 以及获得其他艾滋病毒/艾滋病护理和预防服务。通过帮助填补关键信息缺口， 这项研究有可能为制定针对注射吸毒者的公共卫生政策做出重大贡献。

Barriers to appropriate HIV treatment and care for HIV-infected injection drug users (IDU) are a growing concern. International efforts to improve the delivery of highly active antiretroviral therapy (HAART) toIDU, such as the WHO'S 3 by 5 Initiative, are in urgent need of data on how these barriers can be addressed. While there has been much focus on HIV prevention for HIV-negative IDU, there has recently been a growing recognition that breaking the cycle of HIV transmission will require renewed focus on behaviors and prevention needs of HIV-infected IDU. This proposal seeks to fill the information gap existing in North America and elsewhere through the following specific aims: 1. To evaluate the incidence of HIV/AIDS service uptake (e.g., antiretroviral therapy) and factors associated with uptake among IDU 2. To evaluate the incidence of HIV antiretroviral drug resistance among HIV-infected IDU and the role of unique antiretroviral delivery models on the time to antiretroviral resistance 3. To evaluate trends in HIV disease progression and factors such as medical service and secondary prevention service use that may be associated with reduced disease progression among IDU 4. To determine factors associated with persistent HIV risk behaviors (e.g., syringe lending) in a setting with comprehensive evidence-based HIV prevention strategies for HIV-infected IDU These aims will be met through the development of a new prospective cohort study of HIV-infected IDU in Vancouver, Canada. This setting is unique, since all medical care and antiretrovirals are provided free of charge through a universal healthcare system, allowing the research program to focus on non-financial barriers to care. The cohort will involve serial blood sampling to evaluate antiretroviral resistance patterns, a detailed questionnaire to evaluate illicit drug use and related behaviors, and ongoing administrative linkages to the province's centralized medical care and social service databases to evaluate access to antiretrovirals and access to other HIV/AIDS care and prevention services. By helping to fill a critical information gap, this study has the potential to make a major contribution to public health policies forIDU.