Impacts of universal access to HIV/AIDS care among HIV+ injection drug users

艾滋病毒注射吸毒者普遍获得艾滋病毒/艾滋病护理的影响

• 批准号: 8849408
• 负责人: M-J Milloy
• 金额: $ 47.76万
• 依托单位: UNIVERSITY OF BRITISH COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-17 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8849408
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Antiretroviral drug resistance; Antiretroviral resistance; Attention; British Columbia; Canada; Caring; Characteristics; Charge; Cities; Clinical; Clinical Research; Clinical Trials; Cohort Studies; Communities; Companions; Consensus; Cost Savings; Data; Disease Progression; Drug user; Economics; Environment; Epidemic; Epidemiologic Studies; Epidemiology; Evaluation; Funding; Generations; Geographic Information Systems; Geographic state; HIV; HIV Infections; HIV Seropositivity; HIV risk; Health; Health Services; Healthcare; Healthcare Systems; Highly Active Antiretroviral Therapy; Home environment; Homelessness; Imprisonment; Incidence; Individual; Infection; Injecting drug user; Injection of therapeutic agent; International; Investigation; Knowledge; Laboratories; Light; Link; Marshal; Measures; Medical; Methods; Modeling; Molecular; Molecular Genetics; Monitor; Morbidity - disease rate; National Institute of Drug Abuse; Outcome; Pathogenesis; Pattern; Persons; Pharmaceutical Preparations; Phylogenetic Analysis; Plasma; Policies; Population; Prevalence; Prevention; Province; Public Health; Publications; RNA; Records; Research; Research Activity; Research Infrastructure; Resistance; Risk; Role; Running; Scientific Advances and Accomplishments; Shapes; Social Policies; State Government; Structure; Sum; Testing; Time; Treatment outcome; United States National Institutes of Health; Viral Load result; Vulnerable Populations; addiction; base; cohort; experience; health care service utilization; injection drug use; innovation; interest; mathematical model; member; mortality; prevent; programs; prospective; public health emergency; response; sex; transmission process; uptake

DESCRIPTION (provided by applicant): The purpose of this application is to seek renewed funding for a long-running prospective cohort of HIV- infected individuals who use injection drugs (IDU) linked to comprehensive HIV clinical monitoring to examine the impacts of individual, social, policy, economic, and physical exposures on HIV treatment outcomes. We seek to analyse the effects of these contextual determinants, including incarceration, homelessness, and involvement in the sex trade, on HIV RNA plasma viral load at both the individual and community levels. We will augment our ongoing epidemiologic and clinical research activities with molecular genetics and geographic information systems (GIS) based methods to model the effect of these exposures on community-level plasma viral load, HIV incidence, and the generation of antiretroviral drug resistance. In recognition of the increasing international attention to the HIV "risk environment," a conceptual framework modeling the effect of exogenous and endogenous characteristics on the risk of HIV infection, we will employ this structure to integrate data from individual and community levels in analyses of HIV treatment outcomes. This proposal comes at a time of broad international consensus on the need to respond urgently to persistently elevated levels of HIV-related morbidity and mortality among IDU. Emerging evidence from mathematical modeling, observational cohorts and clinical trials has revealed the close link between the HIV RNA viral load within individuals and at the community level and the risk of HIV transmission between individuals, resulting in lower rates of infection in populations with higher levels of coverage of highly active antiretroviral therapy (HAART.) This observation has led to renewed HIV prevention efforts to seek out members of vulnerable populations, test them for HIV infection, and engage them in healthcare, including treatment for HIV infection, in order to reduce HIV-related morbidity and mortality and lower the incidence of HIV seroconversion. Our proposed study will be conducted during a province-wide "Seek, Test, and Treat" campaign. Given the study infrastructure established to date and our track record evaluating barriers to HAART access and adherence, we are uniquely well placed to prospectively assess second-generation questions regarding the treatment as prevention campaign's impacts on community-level plasma viral loads, HAART resistance, and HIV incidence. In this regard, evaluations of treatment as prevention are an urgent priority in the FY 2012 Trans-NIH Plan for HIV-Related Research. In addition to the "Seek, Test, and Treat" campaign, our study setting of Vancouver, Canada, is ideally suited to our study aims. The universal healthcare system provides all medical care, including HAART, free of charge. Confidential record linkages allow the accurate attainment of all key measures, including health service utilization and HIV clinical outcomes. This application proposes a program of rigorous and innovative study that will marshal epidemiologic, geographic, and phylogenetic approaches to critically inform efforts to respond to HIV transmission and pathogenesis among IDU.

描述（由申请人提供）：本申请的目的是为使用注射药物（IDU）（IDU）寻求新的资金，这些艾滋病毒感染者（IDU）与全面的HIV临床监测相关，以检查个人，社会，政策，经济和身体曝光对艾滋病毒治疗的影响。我们试图分析这些上下文决定因素的影响，包括监禁，无家可归和对性贸易的参与，对个人和社区层面上的HIV RNA血浆病毒负荷。我们将使用基于分子遗传学和地理信息系统（GIS）的方法来扩大我们正在进行的流行病学和临床研究活动，以模拟这些暴露对社区水平血浆病毒载量，HIV发病率以及抗逆转录病毒耐药性的影响。为了认识到越来越多的国际对艾滋病毒“风险环境”的关注，这是一个概念框架，建模了外源性和内源性特征对艾滋病毒感染风险的影响，我们将利用这种结构来整合个人和社区水平的数据，以在HIV治疗结果分析中。这项提议是在国际上达成广泛共识的时候，就必须紧急做出反应，以持续提高IDU的HIV相关发病率和死亡率。来自数学模型，观察群体和临床试验的新兴证据揭示了个人内部和在社区水平上的HIV RNA病毒负荷与个体之间的HIV传播风险之间的紧密联系，导致人群的感染率较低，较低的人群的感染率较低，较高的覆盖率较高，覆盖高度活跃的抗逆转录病毒疗法（HAART）的范围是HAART的范围，HAART对HART的范围进行了侵害。感染并参与医疗保健，包括治疗HIV感染，以降低与HIV相关的发病率和死亡率，并降低HIV血清转化的发生率。我们提出的研究将在范围内的“寻求，测试和治疗”运动中进行。鉴于迄今为止建立的研究基础设施以及我们的往绩记录评估了HAART的访问和依从性的障碍，因此我们在预防运动对社区水平的血浆病毒载荷，HAART抗性和HIV的影响方面的影响方面非常适合评估有关治疗的第二代问题。在这方面，对预防治疗的评估是2012财年NIH与HIV相关研究计划的紧急优先事项。除了“寻求，测试和治疗”运动之外，我们在加拿大温哥华的研究设置非常适合我们的研究目标。普遍的医疗保健系统提供了免费的所有医疗服务，包括Haart，免费。机密的记录联系可以准确地达到所有关键措施，包括健康服务利用和HIV临床结果。该应用程序提出了一项严格和创新的研究计划，该计划将统一流行病学，地理和系统发育方法，以批判性地告知IDU中艾滋病毒传播和发病机理的努力。