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

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.