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.

项目概要/摘要 尽管注射吸毒者 (PWID) 的艾滋病毒感染率数十年来一直呈下降趋势， 由于 COVID-19 大流行以及应对措施可能导致的不稳定，值得警惕， 特别是在弱势群体中。 COVID-19 将扰乱对干预措施的获取，而正是这些干预措施导致了 减少吸毒者中的艾滋病毒感染率，包括减少伤害服务和抗逆转录病毒治疗（ART）。作为一个 结果，COVID-19 可能会导致美国结束艾滋病毒流行的努力付诸东流。近期多起艾滋病毒疫情爆发 由于合成阿片类药物的使用和接触增加而导致的美国突显了 COVID-19 这场大流行病与美国现有的公共卫生紧急情况有关，这种情况不成比例 影响吸毒者人群。目前尚不清楚阿片类药物危机与 COVID-19 大流行的交叉点将如何 相互作用以在短期内影响吸毒者的健康，以及是否会创造足够的条件 吸毒者群体的不稳定足以导致艾滋病毒的死灰复燃。因此迫切需要研究 研究 COVID-19 对注射吸毒者的直接影响和下游后果。此举的目的 因此，建议确定由于吸毒者的影响而导致艾滋病毒复发的可能性。 COVID-19 大流行对个人和网络因素的影响。我们的中心假设是 COVID-19 将会增加 个人和社会网络的不稳定足以促进吸毒者人群中艾滋病毒的爆发。我们 提出以下三个具体目标： 1) 审查对心理社会、经济和行为的威胁 COVID-19 大流行期间现有吸毒者群体的稳定性和艾滋病毒控制； 2) 理解 COVID-19 大流行期间和之后的社会和吸毒网络稳定性； 3) 估计 由于 COVID-19 大流行，吸毒者中艾滋病毒可能会卷土重来。为了实现这些目标，我们 将利用艾滋病相关的持续行为、实验室和临床数据收集 静脉内体验 (ALIVE) 队列并收集新的纵向社交网络数据和定性数据 描述 COVID-19 造成的破坏的特征。重要的是，我们将加深对个人如何 物质使用、与艾滋病毒相关的危险行为和社交网络特征都因以下原因而发生了变化： COVID-19，完全没有特征的关系。从该提议中产生的证据 研究将为当前针对吸毒者的干预措施设计提供信息，不仅是为了预防新出现的艾滋病毒 疫情爆发，但支持在护理和吸毒者中断的情况下改善吸毒者健康的努力 服务。鉴于 COVID-19 大流行可能会对注射吸毒者产生长期影响，因为持续的 SARS-CoV-2 在城市地区的传播和非药物干预措施 (NPI) 的持续循环 在出现更有效的预防和治疗策略之前，这里提出的研究将 对实践产生直接而重大的影响。