The role of depression in HIV transmission among people who inject drugs in Vietnam

抑郁症在越南注射吸毒者艾滋病毒传播中的作用

• 批准号: 9750707
• 负责人: Sara Nicole Levintow
• 金额: $ 7.48万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9750707
• 关键词: AIDS prevention; Address; Adherence; Area; Asia; Awareness; Behavior; Behavioral; Biological; Blood; Blood specimen; Caring; Coitus; Country; Data; Depressed mood; Depression screen; Diagnosis; Disease; Drug abuse; Eastern Europe; Epidemic; Epidemiologic Methods; Event; Exposure to; Future; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Human immunodeficiency virus test; Incidence; Injecting drug user; Intervention; Link; Measures; Mental Depression; Mental Health; Modeling; National Institute of Drug Abuse; Needle Sharing; Needle-Exchange Programs; Newly Diagnosed; Outcome; Participant; Pathway interactions; Plant Roots; Population; Prevalence; Prevention program; Prevention strategy; Province; RNA; Recording of previous events; Reporting; Research; Risk Behaviors; Risk Reduction; Risk-Taking; Role; Sex Behavior; Sexual Partners; Stigmatization; Symptoms; Testing; Treatment outcome; Vietnam; Viral; Viral Load result; Viral load measurement; Viremia; Virus; Virus Replication; Visit; Vulnerable Populations; antiretroviral therapy; center for epidemiological studies depression scale; comorbid depression; condoms; depressive symptoms; improved; injection drug use; innovation; mathematical model; methadone treatment; sexual risk behavior; social exclusion; success; transmission process; treatment services; uptake

ABSTRACT HIV prevalence is above 30% among people who inject drugs (PWID) in Vietnam. There is an urgent need for prevention programs to slow ongoing transmission and provide treatment services for large populations of HIV- positive PWID. High levels of needle-sharing and limited uptake of antiretroviral therapy (ART) result in persistently high HIV incidence among PWID. Reducing risk behaviors and engaging this population in HIV care present significant challenges, and the high burden of depression among PWID may be at the root of those challenges. Up to 50% of PWID in Vietnam have been found to suffer from severe depressive symptoms, and a large body of research shows that comorbid depression consistently results in poorer HIV treatment outcomes. However, the role of depression in forward HIV transmission is still unclear. The proposed study hypothesizes that depression among PWID increases injecting and sexual risk behaviors and reduces engagement in HIV care and adherence to ART, resulting in uncontrolled HIV viral load. Through facilitating both risk behaviors and biological infectiousness, depression is hypothesized to result in increased forward transmission to susceptible partners. The proposed study is the first to simultaneously investigate the role of depression in forward spread of HIV infection through both behavioral and biological pathways and to use mathematical modeling to quantify the potential HIV prevention benefits of possible interventions in this key population. This study will use data collected from 336 newly diagnosed HIV-positive PWID in Thai Nguyen, Vietnam prior to HIV diagnosis and during the two years after diagnosis. Aims 1 and 2 of this study will estimate the association of depression with transmission risk behaviors (Aim 1) and HIV viral load (Aim 2), both before and after HIV diagnosis. Aim 3 will then develop a mathematical model of forward transmission among PWID in Vietnam to quantify the contribution of depression to new HIV infections. This model will be the first to estimate secondary transmission events among HIV-positive PWID in Vietnam and quantify HIV infections that could be averted using current prevention strategies (ART, needle exchanges, methadone maintenance programs) and potential future interventions (depression screening and treatment). The proposed study is an innovative approach, combining traditional epidemiologic methods with mathematical modeling to better understand the HIV epidemic and guide control efforts among PWID in Vietnam. This study focuses on an important consequence of drug abuse, HIV transmission, and aims to reduce this harm, which are research areas identified by NIDA as high priority. Depression screening and treatment may be critical to reducing risky behaviors, achieving viral suppression, and ultimately, slowing forward transmission in a key population that drives the HIV epidemic.

抽象的 在越南注射药物（PWID）的人中，艾滋病毒患病率超过30％。迫切需要 预防计划减慢正在进行的传播并为大量HIV人群提供治疗服务 正pwid。高水平的针头共享和抗逆转录病毒疗法（ART）的摄取有限导致 PWID之间持续高的艾滋病毒发病率。降低风险行为并使该人群参与艾滋病毒 护理提出了重大挑战，PWID之间的高抑郁负担可能是 这些挑战。发现越南多达50％的PWID患有严重抑郁症 症状和大量研究表明，合并症的抑郁症始终导致艾滋病毒较差 治疗结果。但是，抑郁症在正向HIV传播中的作用尚不清楚。提议 研究假设PWID之间的抑郁会增加注射和性风险行为，并减少 参与艾滋病毒护理和对艺术的依从性，导致不受控制的艾滋病毒病毒负荷。通过促进 风险行为和生物传染性都可以假设抑郁症会导致前进 传输到易感合作伙伴。拟议的研究是第一个同时研究的研究 艾滋病毒感染通过行为和生物学途径的抑郁症并使用 数学建模，以量化此密钥中可能干预措施的潜在HIV预防益处 人口。这项研究将使用从泰国Nguyen的336个新诊断的HIV阳性PWID收集的数据， 越南在HIV诊断之前以及诊断后的两年中。本研究的目标1和2将 估计抑郁症与传播风险行为（AIM 1）和HIV病毒负荷（AIM 2）的关联，两者均 HIV诊断前后。 AIM 3然后将开发一个数学模型的远期传输模型 越南的PWID量化抑郁症对新的HIV感染的贡献。该模型将是第一个 估计越南HIV阳性PWID之间的次要传播事件，并量化HIV感染 可以使用当前的预防策略（艺术，针交换，美沙酮维护 计划）和潜在的未来干预措施（抑郁筛查和治疗）。拟议的研究是 创新的方法，将传统流行病学方法与数学建模相结合以更好 了解越南PWID的HIV流行和指导控制工作。这项研究重点是 药物滥用，艾滋病毒传播的重要结果，旨在减少这种伤害，这是研究 NIDA确定为高优先级的领域。抑郁症筛查和治疗对于降低风险至关重要 行为，实现病毒抑制，最终，在关键人群中放缓前进的传播 驱动艾滋病毒流行。