The Role of Dead Space Syringes in HIV Epidemics Amount IDU's - Drug Abuse Aspect

死亡空间注射器在艾滋病毒流行中的作用 注射吸毒者数量 - 药物滥用方面

• 批准号: 7682792
• 负责人: WILLIAM A ZULE
• 金额: $ 8.05万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-03-01 至 2011-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7682792
• 关键词: Accounting; Acute; Asia; Belief; Blood; China; Cities; Country; Data; Drug abuse; Eastern Europe; Epidemic; Epidemiologic Studies; Europe; General Population; HIV; HIV Infections; Hepatitis C; Incidence Study; India; Individual; Infection; Injecting drug user; Injection of therapeutic agent; Intervention; Investments; Knowledge; Lead; Link; Low Prevalence; Modeling; Needle Sharing; One-Step dentin bonding system; Play; Population; Prevalence; Process; Recording of previous events; Research Personnel; Resources; Risk; Role; Russia; Sexual Transmission; Site; Syringes; Testing; Time; Unsafe Sex; Virus; comparison group; experience; high risk; mathematical model; novel; premature; public health relevance; transmission process

DESCRIPTION (provided by applicant): HIV continues to spread among injecting drug users (IDUs) in many countries around the world. In recent years, cities in Eastern Europe, the Russian Federation, India, China, and other parts of Asia have experienced rapid increases in HIV prevalence among IDUs, while HIV prevalence has remained low and stable among IDUs in other cities despite high levels of injecting risk. Twenty-five years into the HIV epidemic among IDUs, researchers still do not really know why the virus spreads more in some places than others. Simple rates of syringe sharing and unprotected sex do not account for varying degrees of HIV transmission. One widely overlooked factor that could significantly contribute to these differences in HIV spread is the type of syringes that IDUs are using. The proposed study represents one step in the process of assessing the role of syringe type in HIV epidemics among IDUs. To date, we have established that it is biologically plausible that the type of syringe may play a role in HIV transmission by demonstrating that high dead-space syringes (HDSSs) retain over 1,000 times more blood after use and rinsing than low dead-space syringes (LDSSs) retain. We have linked a history of sharing HDSSs with prevalent HIV and HCV infection, and we have developed mathematical models that suggest injection-related HIV epidemics may not occur in cities, if fewer than 10% of IDUs are using HDSSs. The next step is to collect empirical data to test this finding. Large multisite longitudinal HIV incidence studies that collect data from individual IDUs on the types of syringes that they are using will be needed to establish a causal relationship between HDSSs and HIV infection among IDUs. However, these studies would require a considerable investment in time and money. Thus, we propose to conduct a small exploratory study to identify cities in Europe, Russia, and Asia where HIV prevalence among IDUs is high and cities where HIV prevalence among IDUs is low. We will seek to obtain information on the types of syringes that IDUs are using in these cities. The proposed study has the potential for yielding extremely valuable data for minimal investment. The specific aim of the proposed study is: To compare the types of syringes used by IDUs in cities where HIV prevalence among IDUs is high (>30%) or increasing (>5% per year for >3 years) with the types of syringes that IDUs are using in a matched comparison group of cities with low and stable HIV prevalence (<5% for >5 years). Should we find an ecological association between use of HDSSs and HIV prevalence, we will propose larger studies with the purpose of better delineating causal inference, including the role for sexual transmission. PUBLIC HEALTH RELEVANCE: The information obtained in this project may substantially increase our knowledge of HIV transmission among injecting drug users (IDUs). If we find that the types of syringes used by IDUs influence HIV transmission, this could lead to relatively straightforward interventions that could substantially reduce HIV transmission in this high risk group. This in turn could reduce sexual transmission of HIV from IDUs to the general population.

描述（由申请人提供）：HIV继续在全球许多国家注射吸毒者（IDU）之间传播。近年来，东欧，俄罗斯联邦，印度，中国和亚洲其他地区的城市在IDUS中的艾滋病毒患病率迅速增加，而艾滋病毒的患病率在其他城市的IDU中仍然较低和稳定，尽管风险很高。 IDU的艾滋病毒流行二十五年，研究人员仍然并不真正知道为什么该病毒在某些地方比其他地方传播更多。简单的注射器共享和不受保护的性别的速率不会考虑不同程度的艾滋病毒传播。 IDUS正在使用的注射器的类型是，可能会导致艾滋病毒传播的这些差异的一个广泛忽视的因素。拟议的研究代表了评估IDU中注射器类型在HIV流行病中的作用的过程中的一步。迄今为止，我们已经确定，在生物学上，注射器的类型可以通过证明高空空间注射器（HDSSS（HDSSS）在使用后保持超过1000倍的血液和冲洗比低死空间注射器（LDSSS）保留的血液多1000倍以上。我们已经将共享HDSS与普遍的HIV和HCV感染的历史联系起来，并且我们开发了数学模型，这表明在城市中可能不会发生与注射相关的HIV流行病，如果IDU的少于10％的IDU使用HDSSS。下一步是收集经验数据以测试这一发现。大型多站点纵向HIV发病率研究，从单个IDU中收集有关其使用的注射器类型的数据将需要建立HDSSS和IDU之间的HIV感染之间的因果关系。但是，这些研究将需要对时间和金钱进行大量投资。因此，我们建议进行一项小型探索性研究，以确定欧洲，俄罗斯和亚洲的城市，在IDU中，IDU中的HIV患病率很高，而IDU中HIV患病率较低的城市。我们将寻求获取有关IDUS在这些城市中使用的注射器类型的信息。拟议的研究有可能产生极为有价值的数据以最少投资。拟议研究的具体目的是：比较IDU在IDUS中使用的注射器类型，因为IDUS中的HIV患病率很高（> 30％）或增加（> 3年> 3年> 3年的每年5％）与IDUS在匹配的较低和稳定的HIV患者匹配的城市中使用的注射器类型（<5％）。如果我们发现使用HDSSS和HIV患病率之间的生态关联，我们将提出更大的研究，以更好地描述因果推断，包括性传播的作用。 公共卫生相关性：该项目中获得的信息可能会大大增加我们注射吸毒者（IDU）中艾滋病毒传播的了解。如果我们发现IDUS使用的注射器类型会影响HIV传播，这可能会导致相对直接的干预措施，从而可以大大减少该高风险组中的HIV传播。反过来，这可以减少艾滋病毒从IDU到普通人群的性传播。