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
基本信息
- 批准号:10513372
- 负责人:
- 金额:$ 54.21万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2007
- 资助国家:美国
- 起止时间:2007-09-17 至 2025-04-30
- 项目状态:未结题
- 来源:
- 关键词:AIDS preventionAIDS/HIV problemAchievementAddressAdherenceAgonistAreaBasic ScienceBioinformaticsBiologicalCanadaCaringChronicClinicalClinical DataClinical ManagementCohort StudiesCommunitiesDataDevelopmentDiseaseDisease OutbreaksDisease OutcomeDisease ProgressionDrug usageDrug userEconomic FactorsEconomicsEnvironmentEpidemicEpidemiologyEvaluationEvolutionFormulationFundingGenerationsGeneticHIVHIV InfectionsHIV SeropositivityHIV diagnosisHIV-1Harm ReductionHealthcare SystemsHepatitis CHepatitis C co-infectionHomelessnessIllicit DrugsImmune System DiseasesImmunologicsImprisonmentIncomeIndividualInequalityInflammationInjectableInjecting drug userInterventionInterviewInvestigationLife ExpectancyLinkLongitudinal StudiesMaintenanceMarshalMeasuresMedicalMedical Care CostsMedicineMethodsMonitorMorbidity - disease rateNational Institute of Drug AbuseOutcomePainPain managementParticipantPathogenesisPatternPersonsPharmaceutical PreparationsPhylogenetic AnalysisPlasmaPoliciesPositioning AttributePremature aging syndromePrimary Health CareProspective cohortProspective cohort studyRNARecording of previous eventsRecordsRegimenResearchResearch PriorityResistanceRoleSeverity of illnessSiteSocial SciencesSpecimenStudy modelsTherapeuticTimeTreatment outcomeUnited StatesViral Load resultWorkaddictionantagonistantiretroviral therapybasechronic painclinical biomarkersclinical epidemiologyco-infectioncohortcomorbiditycostcost effectivenessdisparity reductioneconomic determinanteffective therapyexperienceillicit drug useimprovedinnovationmortalitymultidisciplinarymultiple drug usenext generationnon-opioid analgesicnovelnovel strategiesopioid useopioid use disorderprescription opioid misuseprogramsrecruitsocial exclusionsocial stigmasocial structuresocioeconomicsstimulant usestimulant use disordertransmission processtreatment guidelinesuptakevirology
项目摘要
PROJECT SUMMARY / ABSTRACT
Two decades since the development of effective antiretroviral therapy (ART) for HIV infection, HIV-positive
people who use illicit drugs (PWUD) continue to experience persistent disparities in HIV treatment outcomes.
Although the deleterious impact of high-intensity illicit drug use on access and adherence to ART is clear, the
social, structural and economic barriers to engagement and retention in HIV care remain incompletely
described, and there is an urgent need to identify aspects of treatment for HIV and addiction that promote
optimal HIV treatment outcomes.
At the same time, there is an increasing appreciation of the importance of HIV-associated comorbidities,
coinfections and complications—especially immunologic dysfunction, chronic inflammation and premature
aging—on HIV disease outcomes, even among HIV-positive individuals optimally engaged in ART. Although
the impact of some comorbidities, such as hepatitis C virus co-infection, on HIV-positive PWUD are well
described, we are unaware of any longitudinal study using a validated measure incorporating HIV- and non-
HIV-related clinical biomarkers to systematically investigate HIV disease severity, and the impact of illicit drug
use and related social, structural and economic factors, among HIV-positive PWUD in a setting of no-cost
universal medical care including all ART and medications for addiction treatment.
Thus, in this application, we propose novel and significant investigations into the individual, social,
structural and economic determinants of HIV treatment and disease outcomes among PWUD. Specifically,
through the renewal of funding for a longstanding community-recruited prospective cohort of more than 1000
HIV-positive PWUD linked to comprehensive clinical monitoring data in Vancouver, Canada, we propose to:
analyze the implementation, uptake and impact of new and emerging treatment for HIV and addiction on the
achievement and maintenance of optimal HIV treatment and disease outcomes; investigate the impacts of
established and emerging illicit drug use patterns and evolving approaches to addiction treatment on HIV
treatment and disease outcomes; explore the interrelationships between social, structural and economic forces
and illicit drug use patterns on HIV disease outcomes; and continue to serve as a NIDA-funded cohort that is a
platform for a range of epidemiological, phylogenetic/bioinformatic and basic research into HIV acquisition,
transmission and pathogenesis among people who use illicit drugs.
This proposal to renew our research program exploits several established and emerging facets of the
local environment, including: a centralized program of universal access to no-cost medical care, allowing for
the complete ascertainment of clinical data free of the confounding influence of financial ability; the ongoing
development of a range of innovative HIV and addiction programs for PWUD, including initiation of ART upon
HIV diagnosis, harm-reduction-based HIV prevention and treatment supports; and novel approaches to
manage opioid and stimulant use disorders. Our proposal is well aligned with recent calls for high-priority
research to reduce disparities in HIV treatment and disease outcomes among HIV-positive PWUD through
evidence to promote engagement and retention in HIV care and reduce the effect of comorbidities,
complications and coinfections.
项目概要/摘要
自开发有效的抗逆转录病毒疗法(ART)治疗艾滋病毒感染以来二十年,艾滋病毒阳性者
非法药物使用者 (PWUD) 在艾滋病毒治疗结果方面仍然存在持续的差异。
尽管高强度非法药物使用对获得和坚持接受抗逆转录病毒疗法的有害影响是显而易见的,但
参与和保留艾滋病毒护理的社会、结构和经济障碍仍然不完全
描述,并且迫切需要确定艾滋病毒和成瘾治疗的各个方面,以促进
最佳的艾滋病毒治疗结果。
与此同时,人们越来越认识到艾滋病毒相关合并症的重要性,
合并感染和并发症——尤其是免疫功能障碍、慢性炎症和早产
老龄化对艾滋病毒疾病结果的影响,即使是在最佳参与抗逆转录病毒治疗的艾滋病毒阳性个体中也是如此。
一些合并症(例如丙型肝炎病毒合并感染)对 HIV 阳性 PWUD 的影响很明显
描述,我们不知道有任何纵向研究使用经过验证的措施纳入艾滋病毒和非艾滋病毒
与 HIV 相关的临床生物标志物可系统地研究 HIV 疾病的严重程度以及非法药物的影响
在免费环境中艾滋病毒呈阳性的残疾人士中的使用情况以及相关的社会、结构和经济因素
全民医疗保健,包括所有抗逆转录病毒治疗和成瘾治疗药物。
因此,在本申请中,我们提出了对个人、社会、
残疾人艾滋病毒治疗和疾病结果的结构和经济决定因素具体来说,
通过为长期社区招募的超过 1000 名前瞻性队列提供资助
HIV 阳性 PWUD 与加拿大温哥华的综合临床监测数据相关,我们建议:
分析新出现的艾滋病毒和成瘾治疗方法的实施、采用和影响
实现并维持最佳的艾滋病毒治疗和疾病结果;调查以下因素的影响:
已建立和新出现的非法药物使用模式以及不断发展的艾滋病毒成瘾治疗方法
治疗和疾病结果;探索社会、结构和经济力量之间的相互关系
和非法药物使用模式对艾滋病毒疾病结果的影响;并继续作为 NIDA 资助的队列
针对艾滋病毒感染进行一系列流行病学、系统发育/生物信息学和基础研究的平台,
使用非法药物的人之间的传播和发病机制。
这项更新我们的研究计划的提议利用了该研究的几个既定和新兴的方面。
当地环境,包括: 普遍获得免费医疗服务的中央计划,允许
临床数据的完整确定,不受财务能力的持续影响;
为残疾人士制定一系列创新的艾滋病毒和成瘾方案,包括在
艾滋病毒诊断、基于减少危害的艾滋病毒预防和治疗支持以及新方法;
我们的建议与最近提出的高度优先的呼吁非常一致。
研究旨在通过以下方式减少艾滋病毒阳性残疾人之间艾滋病毒治疗和疾病结果的差异
促进艾滋病毒护理的参与和保留并减少合并症影响的证据,
并发症和合并感染。
项目成果
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M-J Milloy其他文献
M-J Milloy的其他文献
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{{ truncateString('M-J Milloy', 18)}}的其他基金
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:
9089024 - 财政年份:2007
- 资助金额:
$ 54.21万 - 项目类别:
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:
9897499 - 财政年份:2007
- 资助金额:
$ 54.21万 - 项目类别:
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 - 财政年份:2007
- 资助金额:
$ 54.21万 - 项目类别:
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:
10662562 - 财政年份:2007
- 资助金额:
$ 54.21万 - 项目类别:
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