Quantifying health policy impacts on substance use and treatment among women with and at risk for HIV: a longitudinal multilevel analysis using the Women's Interagency HIV Study

量化卫生政策对感染艾滋病毒和有感染艾滋病毒风险的妇女的药物使用和治疗的影响：利用妇女机构间艾滋病毒研究进行纵向多层次分析

• 批准号: 10219745
• 负责人: Danielle Frances Haley
• 金额: $ 16.75万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-18 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10219745
• 关键词: Acquired Immunodeficiency Syndrome; Address; Alcohol abuse; Alcohol or Other Drugs use; Alcohols; Anti-Retroviral Agents; Behavioral; Breast Feeding; Clinical; Data; Directories; Dose; Drug Utilization; Drug abuse; Environment; Epidemiology; Faculty; Female; Fostering; Frequencies; Funding; Future; Goals; HIV; HIV Infections; HIV Seropositivity; Health; Health Insurance; Health Policy; Healthcare; Individual; Insurance; Intervention; K-Series Research Career Programs; Knowledge; Laws; Link; Liver diseases; Longitudinal cohort; Marijuana; Mediating; Medical; Medical Marijuana; Mentors; Monitor; Morbidity - disease rate; National Institute of Drug Abuse; North Carolina; Opioid; Opioid Analgesics; Outcome; Pain management; Participant; Pathway interactions; Pattern; Pharmaceutical Preparations; Pharmacotherapy; Policies; Policy Analysis; Population; Pregnancy; Principal Investigator; Race; Reporting; Research; Research Infrastructure; Risk; Role; Seminal; Sexual Health; Shapes; Social Environment; Strategic Planning; Structure; System; Target Populations; Time; Training; Training and Infrastructure; United States; United States National Institutes of Health; Universities; Viral; Woman; Women’s Interagency HIV Study; Work; alcohol abuse therapy; base; behavioral health; built environment; career; chronic pain; cohort; design; disease transmission; evidence base; hazardous drinking; health care availability; health care service utilization; marijuana legalization; marijuana use; misuse of prescription only drugs; mortality; multilevel analysis; novel strategies; opioid therapy; opioid use; overtreatment; parity; prescription drug abuse; prescription monitoring program; prescription opioid; reduced substance use; response; sex; social; therapy design; transmission process; treatment program; virology

PROJECT SUMMARY/ABSTRACT Substance use (SU), including hazardous alcohol use, is common among women with HIV in the United States (US) and rates exceed those of the general female population. Substance-using women with HIV are less likely to initiate and adhere to antiretroviral medications, which has important implications for morbidity, mortality, and HIV transmission. Drug and alcohol treatment mitigates these effects, but is underutilized. In addition, high-dose opioid pain therapy is prevalent among people with HIV, increasing their risk of prescription drug misuse. Marijuana may serve as an alternative for opioid-based pain management, but marijuana's effect on HIV clinical outcomes is unclear. Several policy initiatives have the potential to influence SU and drug and alcohol treatment in the US by: 1) curbing inappropriate prescribing practices for pain management (e.g., prescription drug monitoring programs [PDMPs]); 2) increasing access to drug and alcohol treatment (e.g., health parity laws [HPLs]); and 3) legalizing marijuana use for medical purposes (e.g., medical marijuana laws [MMLs]). Yet, little is known about how these health policies impact women with HIV. Studies suggest that these policies have benefits (e.g., HPLs associated with drug treatment). Others found negative or unintended consequences (e.g., MMLs associated with more alcohol, but less opioid use). This K01 leverages participant- level data from the NIH-funded Women's Interagency HIV Study by integrating cohort data with contextual data (e.g., Prescription Drug Abuse Policy System) capturing the policy and health care access environments where these women live. The proposed study will use a longitudinal, multilevel design to generate evidence on how health policies impact SU and drug and alcohol treatment among women with and without HIV in the US, and elucidate the pathways through which health policies shape HIV viral suppression among women with HIV. The specific aims are: Aim 1. Assess relationships between PDMPs and prescribed and non-prescribed opioid use over time, examining the modifying role of HIV status and race. Aim 2. Assess relationships between HPLs, access to drug and alcohol treatment, and treatment utilization over time, examining the modifying role of HIV status, health insurance, and patterns of SU. Aim 3: Assess relationships between MMLs, access to legalized marijuana, and marijuana use and hazardous drinking, examining the modifying role of HIV status and patterns of SU. Aim 4: Among women with HIV, assess the impact of PDMPS, HPLs, and MMLs on HIV viral suppression, examining the mediating or modifying role of SU and drug and alcohol treatment. To accomplish these aims the applicant will receive training in: 1) the epidemiology of SU, 2) empirical policy analysis, and 3) advanced longitudinal multilevel analysis, under the direction of University of North Carolina at Chapel Hill faculty Drs. Vivian Go, Adaora Adimora, Mark Holmes, and Daniel Bauer. These analyses will to inform future policy and structural interventions by generating causal evidence on how policies influence SU and alcohol and drug treatment over time among US women with and at risk of HIV.

项目概要/摘要 物质使用 (SU)，包括有害酒精的使用，在美国感染艾滋病毒的女性中很常见 州（美国）和比率超过了一般女性人口。患有艾滋病毒的吸毒女性 不太可能开始和坚持抗逆转录病毒药物，这对发病率有重要影响， 死亡率和艾滋病毒传播。药物和酒精治疗可以减轻这些影响，但尚未得到充分利用。在 此外，高剂量阿片类药物疼痛治疗在艾滋病毒感染者中很普遍，增加了他们服用处方药的风险 药物滥用。大麻可以作为基于阿片类药物的疼痛管理的替代品，但大麻的作用 HIV 临床结果的影响尚不清楚。多项政策举措有可能影响 SU 和毒品和 在美国，通过以下方式进行酒精治疗：1) 遏制用于疼痛管理的不当处方做法（例如， 处方药监测计划 [PDMP]）； 2) 增加获得药物和酒精治疗的机会（例如， 健康平等法[HPL]）； 3) 将大麻用于医疗目的合法化（例如医用大麻法 [MML]）。然而，人们对这些卫生政策如何影响感染艾滋病毒的女性知之甚少。研究表明 这些政策有好处（例如，与药物治疗相关的 HPL）。其他人发现负面或无意的 后果（例如，MML 与更多饮酒有关，但较少使用阿片类药物）。这个K01利用参与者- 通过将队列数据与背景数据相结合，获得 NIH 资助的妇女机构间艾滋病毒研究的水平数据 （例如，处方药滥用政策系统）捕获政策和医疗保健获取环境 这些女人活着。拟议的研究将使用纵向、多层次的设计来生成证据，说明如何 卫生政策影响美国感染和未感染艾滋病毒的女性的 SU 以及药物和酒精治疗，以及 阐明卫生政策在感染艾滋病毒的妇女中抑制艾滋病毒病毒的途径。 具体目标是： 目标 1. 评估 PDMP 与处方药和非处方药之间的关系 随着时间的推移阿片类药物的使用，检查艾滋病毒状况和种族的改变作用。目标 2. 评估关系 HPL 之间、获得药物和酒精治疗的机会以及随着时间的推移治疗的利用情况，检查 改变艾滋病毒状况、健康保险和 SU 模式的作用。目标 3：评估之间的关系 MML、获得合法大麻、大麻使用和危险饮酒、审查修改 HIV 状况和 SU 模式的作用。目标 4：在感染艾滋病毒的女性中，评估 PDMPS、HPL、 和 MMLs 关于 HIV 病毒抑制，检查 SU 以及药物和酒精的调节或调节作用 治疗。为了实现这些目标，申请人将接受以下方面的培训：1) SU 流行病学，2) 实证政策分析，3）高级纵向多层次分析，在大学的指导下 北卡罗来纳州教堂山教职人员博士。维维安·戈、阿多拉·阿迪莫拉、马克·霍姆斯和丹尼尔·鲍尔。这些 分析将通过生成有关政策如何实施的因果证据，为未来的政策和结构性干预措施提供信息 随着时间的推移，对患有艾滋病毒和有艾滋病毒风险的美国女性的 SU 以及酒精和药物治疗产生影响。