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：
10662562
负责人：
M-J Milloy
金额：
$ 54.07万
依托单位：
UNIVERSITY OF BRITISH COLUMBIA
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：
https://reporter.nih.gov/project-details/10662562
关键词：
AIDS prevention Achievement Address Adherence Agonist Area Basic Science Bioinformatics Biological Canada Caring Chronic Clinical Clinical Data Clinical Management Cohort Studies Communities Data Development Disease Disease Outbreaks Disease Outcome Disease Progression Disparity Drug usage Drug user Economic Factors Economics Environment Epidemic Epidemiology Evaluation Evolution Formulation Funding Generations Genetic HIV HIV Infections HIV Seropositivity HIV diagnosis HIV disparities HIV-1 HIV/AIDS Harm Reduction Healthcare Systems Hepatitis C Hepatitis C co-infection Homelessness Illicit Drugs Immune System Diseases Immunologics Imprisonment Income Individual Inequality Inflammation Injectable Injecting drug user Intervention Investigation Life Expectancy Link Longitudinal Studies Maintenance Measures Medical Medical Care Costs Medicine Methods Monitor Morbidity - disease rate National Institute of Drug Abuse Outcome Pain Pain management Pathogenesis Pattern Persons Pharmaceutical Preparations Phylogenetic Analysis Plasma Policies Positioning Attribute Premature aging syndrome Primary Care Prospective cohort Prospective, cohort study RNA Recording of previous events Records Regimen Research Research Priority Resistance Role Severity of illness Site Social Sciences Specimen Study models Therapeutic Time Treatment outcome United States Viral Load result Work addiction antagonist antiretroviral therapy chronic pain clinical biomarkers clinical epidemiology co-infection cohort comorbidity cost cost effectiveness disparity reduction economic determinant effective therapy experience illicit drug use improved innovation marginalization mortality multidisciplinary multiple drug use next generation non-opioid analgesic novel novel strategies opioid use opioid use disorder participant interview prescription opioid misuse programs recruit social social determinants social factors social stigma socioeconomics stimulant use stimulant use disorder structural determinants transmission process treatment guidelines uptake virology

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.

项目摘要 /摘要自HIV感染，HIV阳性的有效抗逆转录病毒疗法（ART）以来的二十年使用非法药物（PWUD）的人继续经历艾滋病毒治疗结果中的持续分配。尽管高强度非法药物使用对进入和遵守艺术的有害影响很明确，但艾滋病毒护理中参与和保留的社会，结构和经济障碍仍然不完全描述的，迫切需要确定促进艾滋病毒和成瘾的治疗方面最佳HIV治疗结果。同时，人们对与HIV相关的合并症的重要性有所欣赏，共同感染和并发症 - 尤其是免疫功能障碍，慢性炎症和过早的衰老 - 艾滋病毒疾病的结果，即使在最佳从事艺术的艾滋病毒阳性个体中也是如此。虽然某些合并症（例如丙型肝炎病毒共感染）对HIV阳性PWUD的影响很好描述的是，我们没有意识到使用编码HIV和非 - 与HIV相关的临床生物标志物系统地研究HIV疾病的严重程度以及非法药物的影响在无成本的情况下，在HIV阳性的PWUD中使用及相关的社会，结构和经济因素全民医疗服务，包括所有成瘾治疗的艺术和药物。在此应用程序中，我们向个人，社会， PWUD中艾滋病毒治疗和疾病结果的结构和经济决定者。具体来说，通过续签资金，以超过1000多个社区招募的前瞻性队列 HIV阳性PWUD与加拿大温哥华的综合临床监测数据有关，我们建议：分析新的和新兴治疗艾滋病毒的实施，吸收和影响以及成瘾对实现和维持最佳的HIV治疗和疾病结果；调查建立和新兴的非法药物使用模式和艾滋病毒成瘾治疗的不断发展的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以及关于HIV疾病结局的非法药物使用模式；并继续充当NIDA资助的队列一系列流行病学，系统发育/生物信息学和基础研究的平台，使用非法药物的人的传播和发病机理。这项启动我们的研究计划的建议利用了几个已建立和新兴方面当地环境，包括：一项集中的通用访问无成本医疗服务的计划，允许完全确定临床数据没有财务能力的混杂影响；正在进行的开发一系列针对PWUD的创新艾滋病毒和成瘾计划，包括艺术计划 HIV诊断，基于减少损害的HIV预防和治疗支持；和新颖的方法管理阿片类药物和兴奋剂使用障碍。我们的建议与最近高优先级的呼吁非常一致通过减少HIV治疗和艾滋病毒阳性PWUD中疾病结局分布的研究促进艾滋病毒护理中参与和保留的证据，并降低合并症的影响，并发症和共同感染。

项目成果

期刊论文数量（353）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

The Veterans Aging Cohort Study (VACS) Index Predicts Mortality in a Community-recruited Cohort of People With Human Immunodeficiency Virus (HIV) Who Use Illicit Drugs.

退伍军人衰老队列研究 (VACS) 指数可预测社区招募的使用非法药物的人类免疫缺陷病毒 (HIV) 感染者队列的死亡率。

DOI：
10.1093/cid/ciaa1263
发表时间：
2021
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
0
作者：
Reddon,Hudson;Grant,Cameron;Nosova,Ekaterina;Fairbairn,Nadia;Barrios,Rolando;Justice,AmyC;Nolan,Seonaid;Socias,MEugenia;Milloy,M-J
通讯作者：
Milloy,M-J

Factors associated with initiation of antiretroviral therapy among HIV-positive people who use injection drugs in a Canadian setting.

DOI：
10.1097/qad.0000000000000989
发表时间：
2016-03-27
期刊：
AIDS (London, England)
影响因子：
0
作者：
Joseph B;Wood E;Hayashi K;Kerr T;Barrios R;Parashar S;Richardson L;Dobrer S;Guillemi S;Montaner J;Milloy MJ
通讯作者：
Milloy MJ

Methadone maintenance therapy promotes initiation of antiretroviral therapy among injection drug users.

DOI：
10.1111/j.1360-0443.2010.02905.x
发表时间：
2010-05
期刊：
Addiction (Abingdon, England)
影响因子：
0
作者：
Uhlmann S;Milloy MJ;Kerr T;Zhang R;Guillemi S;Marsh D;Hogg RS;Montaner JS;Wood E
通讯作者：
Wood E

Socioeconomic marginalisation in the structural production of vulnerability to violence among people who use illicit drugs.