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.

这项研究将表征与二进制药物有关的HIV，HCV和OD发病率的趋势墨西哥圣地亚哥（SD）和蒂华纳（TJ）之间的市场和毒品旅游业（DT）。 TJ坐在专业毒品贩运路线，海洛因，芬太尼，甲基苯丙胺和可卡因被贩运到美国。墨西哥之后 2009年部分合法化的少量药物，六分之一的人在SD中注入药物（PWID）据报道，在TJ中注射药物，那里的药物“更便宜，更容易购买”。自最近墨西哥以来放宽了其优化处方法，药物可用性差异以及SD和TJ之间的价格差异可能会扩大，加剧了增加的DT，这将影响上述健康结果。我们假设这一点芬太尼在当地药物市场中的渗透将与更风险的行为有关增加HIV和HCV发病率。我们的研究是及时的吸毒者可能会获得更风险的行为。这些边境城市的健康结果可能作为美国其他城市的“腰底”。我们拟议的研究的具体目的称为LaLínea （“线”）是：目标1。为了代表SD和TJ之间的跨境DT及其与零售药物市场特征相关。目标2。以零售药物市场趋势的特征通过进行流行病学和人种学监测，三角测量和定量，TJ与SD 定性发现和DEA行政数据。目标3。研究实时HCV和HIV跨境与分子流行病学之间的PWID传播。目标4。表征OD事件及其与毒品零售市场和DT的关联。目的5。进行未来HIV的动态建模HCV 在不断变化的毒品零售市场的情况下，SD中PWID的OD事件以告知预防干预措施。 LaLínea将进行预期的定量和定性监视 SD和TJ的零售药物市场，再加上600 PWID的流行病学数据收集（200 来自SD的吸毒者；来自SD的200名非毒品游客，来自TJ的200名非毒品游客）和一个民族志亚怪异（n = 75;每组25）。我们将分析PWID的HIV和HCV测序数据前瞻性评估跨境传播。我们将合并二进制的纵向数据零售药物市场以及HIV和HCV测序数据将数据纳入动态数学模型，以预测未来的HIV，HCV和OD事件趋势。由于跨境HIV传播的方向是第一次从墨西哥到美国发生，TJ的PWID中的艾滋病毒事件很高，监测边境地区艾滋病毒和HCV发病率的趋势对于避免未来的美国至关重要爆发。这项研究涵盖了NIDA的Heal倡议和桨的Trans-NIH计划，通过进行时间敏感的研究来告知及时干预措施的实施 HIV，HCV和OD的发病率。