Harnessing big data to arrest the HIV/HCV/opioid syndemic in the rural and urban South

利用大数据遏制南方农村和城市的艾滋病毒/丙型肝炎/阿片类药物流行病

基本信息

批准号：
10696612
负责人：
Peter F Rebeiro
金额：
$ 37.19万
依托单位：
VANDERBILT UNIVERSITY MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-06-01 至 2028-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10696612
关键词：
Acquired Immunodeficiency Syndrome Acute Hepatitis Acute Hepatitis C Address Affect Alabama Antibodies Antigens Area Behavior Behavioral Big Data COVID-19 COVID-19 pandemic Centers for Disease Control and Prevention (U.S.)Cessation of life Characteristics Chronic Hepatitis C Classification Collaborations County Data Disease Disease Outbreaks Epidemic Epidemiologist Epidemiology Event Funding Future HIV HIV diagnosis HIV risk HIV/AIDS HIV/HCV Health Hepatitis C Hepatitis C Incidence Hepatitis C Transmission Hepatitis C co-infection Hepatitis C virus Incidence Indiana Individual Intervention Kentucky Laboratories Laws Legal Link Literature Methods Mind Modeling Monitor Naloxone Needle-Exchange Programs Neighborhoods Nucleic Acid Amplification Tests Opiate Addiction Opioid Outcome Overdose Pattern Persons Pharmaceutical Preparations Policies Population Populations at Risk Poverty Predisposition Pregnant Women Prescription drug overdose Prevention Prevention Research Probability Proxy Public Health Reporting Research Research Personnel Resources Risk Risk Behaviors Role Rural Rural Community Rural Population Scourge Source South Carolina Surveillance Program System Tennessee Territoriality Testing Time Translating Transportation United States National Institutes of Health Update Urban Community Viral Virginia West Virginia Work assault causal model co-infection comorbidity contextual factors dashboard data dissemination epidemiological model epidemiology study fetal heterogenous data high reward high risk improved indexing informatics infrastructure injection drug use interest mathematical model mortality novel opioid abuse opioid epidemic opioid injection opioid overdose opioid policy opioid use outcome disparities overdose death overdose prevention pandemic preparedness predictive modeling prescription opioid prevent programs public health intervention public health relevance rural area rural residence rural setting sharing platform social health determinants sociodemographics substance use syndemic transmission process urban area urban setting

项目摘要

Project Summary / Abstract The HIV, HCV, and opioid epidemics disparately impact populations in different regions of the US, with higher burden (51% of new HIV diagnoses in the US) and poorer outcomes (highest HIV mortality in the US, at 6-10 per 1,000 persons with HIV) in the South, particularly largely rural states. Southern states also rank among those with the highest rates of acute and chronic Hepatitis C virus (HCV), with massive increases in HCV infections due to injected opioid use in Tennessee, Kentucky, Virginia, and West Virginia between 2006 and 2012 (from 1 to nearly 4 per 100,000). The region has also seen a dramatic increase in overdose mortality during the COVID-19 pandemic (West Virginia and Tennessee ranked 1st and 3rd in the US, respectively, with ≥50 deaths per 100,000), with opioid abuse a continued driver of the regional HIV/HCV syndemic. With the relatively recent HIV/HCV outbreak in Scott County, Indiana in mind, the CDC assessed county-level vulnerabilities to an HIV outbreak based on acute HCV infection. Acute HCV infection was used as a proxy of high HIV risk due to the proximal cause of shared injection drug use, an increasingly common practice in areas afflicted with high rates of opioid use and overdose. The research directly informed the initiation of the Tennessee Prescription Drug Overdose Program, a CDC-funded surveillance system to monitor both fatal and non-fatal drug overdoses. Reporting requirements have also been revamped and a new informatics infrastructure has been created to accommodate automated laboratory uploads of viral hepatide antibody, antigen, and nucleic acid testing to ascertain acute HCV infection, alongside the state’s already robust HIV surveillance program. Similar programs now exist in 32 states. In addition, over the past several years, syringe service programs and expanded access to non-prescription naloxone were made legal under Public Chapters 413 and 596 in Tennessee, while the state’s “fetal assault” law, along with similar ones in Alabama and South Carolina, penalized expectant mothers with opioid addictions until recently. The proposed research will therefore harmonize, link, and analyze readily available “big data” sources to enhance the epidemiology of HIV, HIV/HCV co-infection, and opioid overdose mortality outcomes which will inform HIV/HCV and overdose prevention and treatment activities by improving the targeting of highest- risk/highest-reward populations for their receipt (Aims 1 and 2). Assessing the impact of individual behavior and environmental context (neighborhood characteristics such as structural poverty and disorder, lack of transportation, etc.) as well as policy changes on these outcomes will be an essential addition to the literature, and as importantly, to data dissemination platforms (e.g., dashboards) which will improve deployment of prevention and treatment activities in southern states (Aims 1, 2, and 3). Using epidemiologic research to inform policy, while creating dissemination platforms which may be updated and re-deployed in future for regional pandemic preparedness, means this work will remain a valuable resource for years to come.

项目概要/摘要 HIV、HCV 和阿片类药物流行病对美国不同地区的人口影响不同，其中更高的负担（美国新诊断出的艾滋病毒占 51%）和更差的结果（美国艾滋病毒死亡率最高，在南方，尤其是大部分农村州，每 1,000 名艾滋病毒感染者中就有 6-10 人感染艾滋病毒。急性和慢性丙型肝炎病毒 (HCV) 感染率最高的人群，其中感染率大幅上升 2006 年田纳西州、肯塔基州、弗吉尼亚州和西弗吉尼亚州因注射阿片类药物导致的 HCV 感染 2012 年（从每 10 万人 1 人增加到近 4 人）。在 COVID-19 大流行期间（西弗吉尼亚州和田纳西州分别在美国排名第一和第三，每 10 万人中有 50 人死亡），阿片类药物滥用是该地区艾滋病毒/丙型肝炎综合征的持续驱动因素。考虑到印第安纳州斯科特县最近爆发的艾滋病毒/丙型肝炎病毒，疾病预防控制中心评估使用了基于急性 HCV 感染的县级 HIV 爆发脆弱性。作为艾滋病毒高风险的一个指标，其最直接原因是共用注射吸毒，这是一种日益常见的现象该研究直接告知了阿片类药物使用率高和过量的地区的做法。启动田纳西州处方药过量计划，这是一个由疾病预防控制中心资助的监测系统，用于监测致命和非致命药物过量报告要求也已修订并制定了新的要求。已建立信息学基础设施，以适应病毒肝炎的自动化实验室上传抗体、抗原和核酸检测以确定急性丙肝病毒感染，以及该州已经此外，过去几个州现在也有类似的艾滋病毒监测计划。多年来，注射器服务计划和扩大非处方纳洛酮的获取渠道已成为合法田纳西州的公共章节 413 和 596，而该州的“胎儿攻击”法以及类似的法律阿拉巴马州和南卡罗来纳州直到最近才对阿片类药物成瘾的孕妇进行惩罚。因此，拟议的研究将协调、链接和分析现成的“大数据”来源加强艾滋病毒、艾滋病毒/丙型肝炎病毒合并感染和阿片类药物过量死亡率结果的流行病学研究通过提高最高目标的针对性，为艾滋病毒/丙型肝炎和药物过量预防和治疗活动提供信息接受风险/最高回报人群（目标 1 和 2）。和环境背景（邻里特征，如结构性贫困和混乱、缺乏交通等）以及对这些结果的政策变化将成为文献的重要补充，同样重要的是，数据传播平台（例如仪表板）将改善部署南部各州的预防和治疗活动（目标 1、2 和 3）。为政策提供信息，同时创建传播平台，这些平台将来可能会更新和重新部署区域大流行病防范意味着这项工作在未来几年仍将是宝贵的资源。