When pandemics collide: The intersection of the opioid crisis, COVID-19 and HIV pandemics among people who inject drugs in the United States

当流行病发生冲突时：阿片类药物危机、COVID-19 和艾滋病毒流行病在美国注射吸毒者中的交叉点

• 批准号: 10468132
• 负责人: Becky Lynn Genberg
• 金额: $ 78.89万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10468132
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Affect; Anxiety; Baltimore; Behavior; Behavioral; COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; Caring; Characteristics; China; Clinical Data; Communities; Data; Data Collection; Disease; Disease Outbreaks; Drug usage; Drug user; Economics; Enrollment; Epidemic; Equation; Equipment; Etiology; Exposure to; Failure; Frequencies; Future; Geography; Goals; HIV; HIV risk; Harm Reduction; Health; Health Services Accessibility; Hepatitis C; Heroin; Homelessness; Incidence; Individual; Injecting drug user; Injections; Interruption; Intervention; Interview; Intravenous; Kentucky; Laboratories; Lead; Link; Massachusetts; Measures; Mental Depression; Mental Health; Methods; Modeling; National Institute of Drug Abuse; Needle Sharing; Overdose; Participant; Pathogenesis; Pennsylvania; Persons; Pharmacotherapy; Play; Population; Prevention strategy; Prospective cohort; Public Health; Relapse; Research; Research Priority; Resources; Risk; Risk Behaviors; Risk Factors; Role; Running; Rural; SARS-CoV-2 transmission; Sampling; Services; Signal Transduction; Social Network; Social isolation; Social support; Sterility; Stress; Syringes; United States; Viral; Vulnerable Populations; Washington; West Virginia; antiretroviral therapy; base; care systems; cohort; disorder prevention; experience; follow-up; high risk behavior; improved; injection drug use; mortality; operation; opioid epidemic; opioid use; opioid use disorder; pandemic disease; prevent; prevention service; psychosocial; public health emergency; response; social; substance use; suburb; synthetic opioid; therapy design; transmission process; treatment strategy; trend; urban area

Project Summary/Abstract Despite the more than decades long downward trend in HIV incidence among people who inject drugs (PWID), there is cause for alarm due to the COVID-19 pandemic and the instability the response will likely cause, particularly among vulnerable populations. COVID-19 will disrupt access to the very interventions that led to declining HIV incidence among PWID, including harm reduction services and antiretroviral therapy (ART). As a result, COVID-19 threatens to undo efforts to end the HIV epidemic in the US. Several recent HIV outbreaks in the US that resulted from increasing use and exposure to synthetic opioids highlights how the COVID-19 pandemic is being layered onto an existing public health emergency in the US that is disproportionately affecting PWID populations. It is unknown how the intersection of the opioid crisis and COVID-19 pandemic will interact to impact the health of PWID in the short term and whether it will create conditions sufficient to destabilize PWID populations enough to support the resurgence of HIV. Research is therefore urgently needed to examine the immediate impact and downstream consequences of COVID-19 on PWID. The objective of this proposal is therefore to determine the potential of HIV resurgence among PWID due to the impact of the COVID-19 pandemic on individual and network factors. Our central hypothesis is that COVID-19 will increase individual and social network instability sufficiently to promote HIV outbreaks among PWID populations. We propose the following three specific aims: 1) To examine threats to psychosocial, economic and behavioral stability and HIV control among an existing cohort of PWID during the COVID-19 pandemic; 2) To understand social and drug-use network stability during and following the COVID-19 pandemic; and 3) To estimate the potential for HIV resurgence among PWID as a result of the COVID-19 pandemic. To achieve these aims, we will leverage ongoing behavioral, laboratory and clinical data collection within the AIDS Linked to the IntraVenous Experience (ALIVE) cohort and collect new longitudinal social network data and qualitative data to characterize the disruption due to COVID-19. Importantly, we will advance our understanding of how individual substance use, HIV-related risk behaviors, and social network characteristics have changed as a result of COVID-19, relationships that are entirely uncharacterized. The evidence generated from this proposed research will inform the ongoing design of interventions targeted to PWID, not only to prevent emerging HIV outbreaks, but to support efforts to improve the health of PWID in the context of disruptions to care and services. Given that the COVID-19 pandemic will likely have prolonged impacts on PWID due to continued SARS-CoV-2 transmission in urban areas and continual cycling of non-pharmaceutical interventions (NPIs) until more effective prevention and treatment strategies are available, the research proposed here will have immediate and substantial impact on practice.

项目摘要/摘要 尽管注射毒品的人（PWID）中的艾滋病毒发病率数十多年，但 由于联想19的大流行而引起警报，并且反应可能引起的不稳定性， 特别是在弱势群体中。 COVID-19将破坏对导致的干预措施的访问 PWID的HIV发病率下降，包括减少危害服务和抗逆转录病毒疗法（ART）。作为 结果，Covid-19可能会撤消努力，以结束美国的艾滋病毒流行。最近发生的几次艾滋病毒爆发 由于使用和暴露于合成阿片类药物而产生的美国，该美国互相指示如何如何 大流行正在美国现有的公共卫生紧急情况下，这是不成比例的 影响pWID人群。尚不清楚阿片类药物危机与共同危机的交集将如何 互动以在短期内影响PWID的健康状况，以及它是否会创造足够的条件 使PWID人群不足，足以支持艾滋病毒的复兴。因此，迫切需要研究 检查Covid-19对PWID的直接影响和下游后果。这个目的 因此，提案是为了确定由于影响艾滋病毒的潜力 COVID-19关于个人和网络因素的大流行。我们的中心假设是Covid-19将增加 个人和社交网络不稳定足以促进PWID人群中的艾滋病毒爆发。我们 提出以下三个特定目的：1）检查对社会心理，经济和行为的威胁 在Covid-19大流行期间，现有的PWID队列之间的稳定性和HIV控制； 2）理解 社会和毒品使用网络稳定性在Covid-19-19大流行期间和之后； 3）估计 CoVID-19大流行期间，PWID之间HIV复活的潜力。为了实现这些目标，我们 将利用与艾滋病相关的艾滋病中正在进行的行为，实验室和临床数据收集 静脉经历（活着）队列并收集新的纵向社交网络数据和定性数据 特征是由于COVID-19引起的破坏。重要的是，我们将提高我们对个人的理解 随着药物使用，与HIV相关的风险行为和社交网络特征的变化 COVID-19，完全没有特色的关系。该提议产生的证据 研究将告知针对PWID的干预措施的持续设计，不仅是为了防止新兴的艾滋病毒 爆发，但要支持在干扰和护理和 服务。鉴于Covid-19-大流行可能会因继续对PWID产生延长的影响 城市地区的SARS-COV-2传播以及非药物干预措施的持续循环（NPI） 在提供更有效的预防和治疗策略之前，此处提出的研究将有 对实践的直接和实质性影响。