Ethno-epidemiology of HCV, HIV and Overdose associated with Drug Markets and Drug Tourism

与毒品市场和毒品旅游相关的丙型肝炎病毒、艾滋病毒和药物过量的民族流行病学

基本信息

批准号：
10754696
负责人：
STEFFANIE A. STRATHDEE
金额：
$ 5.06万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-04-01 至 2025-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10754696
关键词：
Address Border Community Border Crossings Characteristics Cities Cocaine Country Coupled Data Data Collection Disease Outbreaks Disparity Drug Formulations Drug Prescriptions Epidemiology Ethnography Female Fentanyl Future Geography HIV HIV/HCV Half-Life Health Heating Helping to End Addiction Long-term Hepatitis C Incidence Hepatitis C virus Heroin Incidence Injecting drug user Injections Intervention Laws Lead Marketing Mediating Methamphetamine Mexico Modeling Molecular Epidemiology Monitor National Institute of Drug Abuse Needle Sharing Outcome Overdose Penetration Persons Pharmaceutical Preparations Powder dose form Price Relaxation Reporting Research Risk Behaviors Route Sampling Syringes Tars Testing Time United States National Institutes of Health Virus cohort drug market epidemiologic data male mathematical model non-drug prescription opioid prevent preventive intervention prospective structural determinants trafficking transmission process trend

项目摘要

This study will characterize trends in incidence of HIV, HCV and OD associated with binational drug markets and drug tourism (DT) between San Diego (SD) and Tijuana (TJ), Mexico. TJ sits on a major drug trafficking route whereby heroin, fentanyl, meth & cocaine are trafficked to the US. After Mexico partially decriminalized small amounts of drugs in 2009, 1 in 6 people who inject drugs (PWID) in SD reported injecting drugs in TJ, where drugs were “cheaper and easier to buy”. Since Mexico recently relaxed its opiate prescription laws, disparities in drug availability and price between SD and TJ will likely widen, fueling increased DT that will impact the above health outcomes. We hypothesize that greater penetration of fentanyl into local drug markets will be associated with riskier behaviors that increase HIV and HCV incidence. Our study is timely since retail drug markets are changing in Tijuana with drug tourists likely to be acquiring riskier behaviors. Health outcomes in these border cities likely serve as a ‘bellwether’ for other U.S. cities. The specific aims for our proposed study, called La Línea (“The Line”) are: AIM 1. To prospectively characterize cross-border DT between SD and TJ and its association with retail drug market characteristics. AIM 2. To characterize retail drug market trends in TJ versus SD by conducting epidemiologic and ethnographic surveillance, triangulating quantitative and qualitative findings and DEA administrative data. AIM 3. To study real-time HCV and HIV cross-border transmission among PWID with molecular epidemiology. AIM 4. To characterize OD incidence and its associations with drug retail markets and DT. AIM 5. To conduct dynamic modeling of future HIV, HCV and OD incidence among PWID in SD in the context of changing drug retail markets to inform prevention interventions. La Línea will conduct prospective quantitative and qualitative surveillance of retail drug markets in both SD and TJ, coupled with epidemiologic data collection of 600 PWID (200 drug tourists from SD; 200 non-drug tourists from SD and 200 non-drug tourists from TJ) and an ethnographic sub-cohort (N=75; 25 per group). We will analyze PWIDs’ HIV and HCV sequencing data to prospectively assess cross-border transmission. We will incorporate longitudinal data on binational retail drug markets and HIV and HCV sequencing data into dynamic mathematical models to forecast future HIV, HCV and OD incidence trends. Since the direction of cross-border HIV transmission is now occurring from Mexico to the US for the first time and HIV incidence among PWID in TJ is high, monitoring trends in HIV and HCV incidence in the border region is critical to avoid future US outbreaks. This study addresses both the NIDA’s HEAL initiative and the Trans-NIH plan of the OAR, by conducting time-sensitive research to inform implementation of timely interventions to reduce incidence of HIV, HCV and OD.

本研究将描述与跨国药物相关的 HIV、HCV 和 OD 发病率趋势圣地亚哥 (SD) 和墨西哥蒂华纳 (TJ) 之间的市场和毒品旅游 (DT) 占据重要地位。海洛因、芬太尼、冰毒和可卡因继墨西哥之后被贩运到美国的贩毒路线。 2009 年，部分少量毒品合法化，SD 地区每 6 名注射吸毒者 (PWID) 中就有 1 人据报道，在新泽西州注射毒品，自墨西哥以来，那里的毒品“更便宜且更容易购买”。放宽阿片类处方法后，SD 和 TJ 之间的药品供应和价格差异将可能会扩大，从而加剧 DT 的增加，从而影响上述健康结果。芬太尼更多地渗透到当地毒品市场将导致更高风险的行为，由于蒂华纳的零售药品市场正在发生变化，我们的研究是及时的。吸毒游客可能会在这些边境城市出现更高风险的行为。作为美国其他城市的“领头羊”，我们提出的研究的具体目标是拉利内亚（La Línea）。（“线路”）是：目标 1. 前瞻性地描述 SD 和 TJ 之间的跨境 DT 及其与零售药品市场特征的关联目标 2. 描述零售药品市场趋势。 TJ 与 SD 通过进行流行病学和人种学监测，三角测量定量和定性研究结果和 DEA 行政数据目标 3. 研究实时 HCV 和 HIV 跨境。吸毒者之间的传播与分子流行病学目的 4. 描述 OD 发病率及其特征。与药品零售市场和 DT 的关联 5. 对未来的 HIV、HCV 进行动态建模。在药品零售市场不断变化的背景下，SD 中吸毒者的 OD 发生率 La Línea 将进行前瞻性定量和定性监测。 SD 和 TJ 的零售药品市场，加上 600 名吸毒者的流行病学数据收集（200 来自 SD 的毒品游客；来自 SD 的 200 名非毒品游客和来自 TJ 的 200 名非毒品游客）和我们将分析注射吸毒者的 HIV 和 HCV 测序数据。为了前瞻性地评估跨境传播，我们将纵向整合两国数据。零售药品市场和 HIV 和 HCV 测序数据转化为动态数学模型进行预测未来HIV、HCV和OD发病趋势是目前HIV跨境传播的方向。首次从墨西哥到美国发生，并且 TJ 吸毒者的艾滋病毒感染率很高，监测边境地区艾滋病毒和丙型肝炎发病率的趋势对于避免未来美国的感染至关重要这项研究涉及 NIDA 的 HEAL 计划和 OAR 的 Trans-NIH 计划，通过开展时间敏感的研究，为实施及时干预措施提供信息，以减少 HIV、HCV 和 OD 的发病率。