Addiction, HIV and Tuberculosis in Malaysian Criminal Justice Settings

马来西亚刑事司法环境中的成瘾、艾滋病毒和结核病

• 批准号: 9693695
• 负责人: FREDERICK LEWIS ALTICE
• 金额: $ 62.89万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-15 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9693695
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Asia; Attitude; Back; Buprenorphine; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Chest; Clinical Trials; Collaborations; Communicable Diseases; Communities; Continuity of Patient Care; Cost Effectiveness Analysis; Country; Criminal Justice; Crowding; Data; Diagnostic; Disease; Disease Outbreaks; Drug resistance in tuberculosis; Drug usage; Education; Effectiveness; Environment; Evidence based intervention; Faculty; Female; Funding; General Population; Genes; HIV; HIV/TB; Hepatitis C Prevalence; Hepatitis C virus; Hepatotoxicity; High Prevalence; Human Resources; Imprisonment; Incidence; Individual; Injecting drug user; Injections; Malaysia; Malaysian; Methadone; Modeling; Morbidity - disease rate; NCI Scholars Program; National Institute of Drug Abuse; Opiate Addiction; Opioid; Outcome; Patients; Pharmaceutical Preparations; Physicians; Policies; Population; Postdoctoral Fellow; Prevalence; Prevention; Prevention strategy; Prisoner; Prisons; Randomized; Randomized Controlled Trials; Readiness; Recommendation; Research; Research Activity; Research Personnel; Research Project Grants; Risk; Risk Behaviors; Role; Scholarship; Science; Sexually Transmitted Diseases; Sputum; Substance abuse problem; Symptoms; System; Testing; Thoracic Radiography; Time; Tuberculin Test; Tuberculosis; United States National Institutes of Health; Universities; Work; addiction; antiretroviral therapy; arm; base; co-infection; community setting; comparative cost effectiveness; comparative effectiveness; cost effective; cost effectiveness; doctoral student; drug development; evidence base; global health; health equity; health training; high risk; improved; innovation; insight; isoniazid; low and middle-income countries; mathematical model; member; men who have sex with men; mortality; multidisciplinary; next generation; opioid agonist therapy; pandemic disease; pre-doctoral; preference; programs; public health relevance; rifapentine; screening; sex; success; transgender; transmission process; treatment comparison; treatment strategy; trial comparing; tuberculosis diagnostics

 DESCRIPTION (provided by applicant): The syndemics of addiction, HIV and TB are concentrated in criminal justice settings (CJS). HIV and TB contribute most to mortality among the ~50-60 million people who transition through prisons annually. Malaysia has the highest HIV prevalence among people who inject drugs (PWIDs) in Asia where criminalization of drugs is harsh, resulting in the highest HIV prevalence among prisoners and the second highest incarceration rate in Asia. While mortality decreased 39% in Asia, it has increased in Malaysia where treatment of HIV and TB are inadequately treated among PWIDs, especially in prisoners. Over the past 10 years, researchers at Yale University and the University of Malaya have continuously collaborated on research involving key populations, including PWIDs, prisoners, MSM and both female and transgender sex workers. Our research has multidisciplinary at the interface of addiction and infectious diseases like HIV, TB, HCV and sexually transmitted infections. Our research has been supported through funding for a number of pre- and post-doctoral students and junior faculty members through our Fogarty-sponsored Global Health Equity Scholars program, Doris Duke Charitable Global Health Training, Fulbright scholarships and through NIDA-sponsored research grants. Central to our research activities have been a number of findings from our prison-based studies that inform the current R01 submission, including: Accomplishments from these aims that support the next generation of research questions include: 1) extraordinary mortality among HIV+ prisoners, primarily form TB; 2) high prevalence of latent TB infection (LTBI) among HIV+ and HIV- prisoners and prison personnel alike; 3) the emerging role of prisoners as high risk environments contributing to onward TB transmission among prisoners transitioning to the community; 4) effectiveness of opioid agonist therapies (OAT) like methadone and buprenorphine in promoting retention in care and improved HIV and TB outcomes in community settings, including among released prisoners; 5) despite these promising findings from OAT, negative attitudes by prisoners and correctional staff toward their use undermine their potential benefits; and 6) preliminary studies challenging existing recommendations for TB screening, diagnostics and prevention strategies in prisons that are central to the two related and sequential specific aims in this proposal: 1) To conduct empiric studies of TB, including: a) TB diagnostics (symptoms, CXR, TST, AFB smear, Gene Xpert, and sputum culture) to optimize TB screening; b) a RCT of TB prevention strategies among HIV+ and HIV- prisoners comparing a 12-week short-course of once-weekly isoniazid/rifapentine vs a standard 40-week course of daily isoniazid in a population with high HCV prevalence and potential for hepatotoxicity; and c) a RCT of HIV= and HIV- prisoners with TB who have insufficient time to complete treatment within prison and comparing treatment completion rates for those who refuse OAT with those who accept it, but who are randomized to methadone or buprenorphine therapy to facilitate continuity of care post-release; and 2) To use data from aim 1 combined with publically available TB data to conduct agent-based modeling for comparative and cost- effectiveness analyses of TB screening, prevention and treatment strategies among prisoners with and without HIV, incorporating the contribution of latent TB infection and prevalent TB disease on community transmission post-release.

 描述（由申请人证明）：成瘾，艾滋病毒和结核病的集中在刑事司法环境中（CJ）。在亚洲，亚洲注射crugs的药物（PWID），亚洲的第二高，而死亡率降低了39％，在马来西亚的HIV A A AV A A TB中，它在PWID中造成不足。 Malaya的肤色与ER性工作者合作。通过我们的Fogarty赞助的全球卫生学者计划，Doris Duke Charitable Global Health Training，Fulbright奖学金和提供巨大的研究赠款，包括：支持下一项研究的成就，包括：问题包括：1）ISONER，主要TB； 2）艾滋病毒+和艾滋病毒培训者和hiv prsonnel的高度流行率； 3） 4）阿片类药物疗法（如美沙酮和丁丙诺啡）在社区环境中促进和改善艾滋病毒和结核病的成果，包括释放的囚犯中的有前途的发现； ）初步研究在监狱中挑战出来，以征求TB筛查，诊断和ention策略，这是该提案中两个相关和连续的特定目的的核心：1）进行TB的经验研究，a）TB Diagnostosto MS，CXR，CXR，TST，TST，TST ，AFB涂片，Gene Xpert和Putum Cruitat HCV患病率高的人群和肝毒性的潜力； 2）使用AIM 1的数据与公开可用的结核病数据结合到基于行为的G，以进行TB筛查，预防和治疗策略的比较和成本效益。在释放的情况下进行炎症的TB疾病。