Drug tourism to Mexico: Impact of Mexicos new drug law on HIV-HCV-TB in US IDUs

墨西哥毒品旅游：墨西哥新毒品法对美国注射吸毒者 HIV-HCV-TB 的影响

• 批准号: 8141202
• 负责人: Richard S Garfein
• 金额: $ 60.45万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8141202
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adult; Affect; Area; Attitude; Behavior; Behavior assessment; Biological Assay; Border Crossings; California; Cannabis; Charge; Cities; Cocaine; Cohort Studies; Collaborations; Communities; Comorbidity; Complement; Country; Crime; Data; Data Collection; Diffusion of Innovation; Disease; Disease Progression; Drug Legislation; Drug usage; Drug user; Epidemic; Epidemiologic Studies; Evaluation; Frequencies; Fright; Funding; Future; Goals; Gold; HIV; HIV Antibodies; HIV Infections; Health Status; Health behavior; Health behavior outcomes; Hepatitis C; Hepatitis C Antibodies; Hepatitis C Prevalence; Hepatitis C virus; Heroin; High Prevalence; Home environment; Illicit Drugs; Incidence; Infection; Injecting drug user; Intervention; Interview; Knowledge; Laws; Lead; Legal; Location; Marijuana; Measures; Methamphetamine; Methods; Mexican; Mexico; Modeling; Mycobacterium tuberculosis; Narcotics; National Institute of Drug Abuse; Natural experiment; New Mexico; Participant; Perception; Persons; Pharmaceutical Preparations; Policies; Prevalence; Process; Production; Qualitative Methods; Recruitment Activity; Reporting; Research; Respondent; Risk; Risk Behaviors; Risk Factors; Role; Sampling; Serologic tests; Serum; Sister; Specific qualifier value; Statutes and Laws; Testing; Time; Travel; Tuberculosis; United States National Institutes of Health; Universities; Visit; Vulnerable Populations; base; behavioral health; cohort; design; disorder risk; effective intervention; experience; follow-up; insight; instrument; male; meetings; novel; peer; response; risk perception; theories; transmission process

DESCRIPTION (provided by applicant): The goal of the proposed 5-year epidemiologic study is to assess the impact of Mexico's new drug laws on behaviors and disease incidence among injection drug users (IDUs) in the U.S. In August, 2009, Mexico enacted a controversial law decriminalizing possession of personal-sized quantities of drugs including heroin, cocaine, methamphetamine and cannabis. The sister-cities of San Diego, CA, USA and Tijuana, BC, Mexico share the world's busiest land border crossing and are home to nearly 4 million residents. Through research collaborations with the University of California, San Diego and partners in Tijuana, we found: i) increasing drug use and HIV prevalence in Tijuana; ii) dramatically higher prevalence of hepatitis C virus (HCV) and M. tuberculosis (Mtb) infections among IDUs in Tijuana versus San Diego; and, iii) injecting in Mexico reported by 21% of IDUs in San Diego. "Drug tourism" to Mexico among San Diegan IDUs may be an unintended consequence of Mexico's relaxed drug laws and could increase their risk for HCV, Mtb and HIV infections. This epidemiologic study aims to: 1) identify sociodemographic, behavioral, and health status differences between IDUs in San Diego who do and do not inject in Mexico; 2) describe changes in San Diegan IDUs' knowledge, attitudes, and experiences related to Mexican drug policies and assess their influences on decisions about injecting in Mexico; and 3) determine whether San Diegan IDUs who inject in Mexico are at increased risk for incident HCV and Mtb infection and identify risk factors for infection. To achieve these aims, we will use a mixed-methods design involving quantitative and qualitative data collection. Quantitative methods include recruiting a cohort of 750 IDUs in San Diego via respondent driven sampling for semi-annual behavioral assessments and serologic testing for HIV, HCV, and Mtb infections over 24 months of follow-up. HIV and HCV antibody testing will be performed on serum using standard practices; Mtb infection will be detected by QuantiFERON TB-Gold assay. Qualitative methods involve selecting 20 participants after each assessment visit (total=100) for in-depth interviews that will be used to: i) explore novel findings that emerge in preliminary analysis of the quantitative data; ii) identify new areas of inquiry for addition to the quantitative assessments; and iii) assess the validity of quantitative findings by presenting them for interpretation to study participants in qualitative interviews. The iterative process of using qualitative and quantitative data to inform methods and interpret findings of each approach facilitates a comprehensive understanding of the conceptual model describing how Mexico's new law will impact the behaviors and health outcomes of IDUs in San Diego. This study meets NIDA priorities supporting epidemiologic research on HIV/AIDS co-morbidities including HCV and tuberculosis, and the prevention of HIV among vulnerable populations. This study exploits a rare natural experiment to evaluate the impact of opposing drug policies on interconnected, bordering communities, and will provide important insights for future policies. PUBLIC HEALTH RELEVANCE: Injection drug users (IDUs) are disproportionately affected by HIV, hepatitis C, and tuberculosis, and, the recently recognized convergence of these diseases in Tijuana, Mexico-sister city to San Diego, CA- suggests that progression of disease and rates of transmission will increase without effective interventions. In August, 2010 Mexico enacted new legislation decriminalizing possession of personal-size quantities of narcotic drugs (e.g., methamphetamine, heroin, cocaine, and cannabis), which it is feared will encourage more U.S. IDUs to visit Mexico to buy and use drugs. In parallel with a NIDA-funded study that will assess the law's impact on IDUs in Tijuana, we will conduct a longitudinal cohort study to examine the law's impact on the behaviors and disease risks among IDUs in San Diego who can readily cross the border to and from Mexico.

描述（由申请人提供）：拟议的为期 5 年的流行病学研究的目标是评估墨西哥新毒品法对美国注射吸毒者 (IDU) 行为和疾病发病率的影响。2009 年 8 月，墨西哥颁布了一项有争议的法律将持有个人数量的毒品（包括海洛因、可卡因、甲基苯丙胺和大麻）合法化。美国加利福尼亚州圣地亚哥和墨西哥不列颠哥伦比亚省蒂华纳这对姐妹城市拥有世界上最繁忙的陆路过境点，拥有近 400 万居民。通过与加州大学圣地亚哥分校和蒂华纳合作伙伴的研究合作，我们发现： i) 蒂华纳的吸毒和艾滋病毒流行率不断增加； ii) 与圣地亚哥相比，蒂华纳注射吸毒者中丙型肝炎病毒 (HCV) 和结核分枝杆菌 (Mtb) 感染率显着升高； iii) 据圣地亚哥 21% 的注射吸毒者报告，墨西哥注射毒品。圣地亚哥注射吸毒者到墨西哥的“毒品旅游”可能是墨西哥放松禁毒法的意外后果，并可能增加他们感染丙型肝炎病毒、结核分枝杆菌和艾滋病毒的风险。这项流行病学研究的目的是： 1) 确定在墨西哥注射和不注射的圣地亚哥注射吸毒者之间的社会人口统计学、行为和健康状况差异； 2) 描述圣地亚哥注射吸毒者与墨西哥毒品政策相关的知识、态度和经验的变化，并评估其对墨西哥注射决定的影响； 3) 确定在墨西哥注射的圣地亚哥注射吸毒者感染 HCV 和 Mtb 的风险是否增加，并确定感染的危险因素。为了实现这些目标，我们将使用涉及定量和定性数据收集的混合方法设计。定量方法包括通过受访者驱动抽样在圣地亚哥招募 750 名注射吸毒者，在 24 个月的随访期间进行每半年的行为评估和 HIV、HCV 和 Mtb 感染的血清学检测。将使用标准做法对血清进行 HIV 和 HCV 抗体检测； Mtb 感染将通过 QuantiFERON TB-Gold 检测进行检测。定性方法包括在每次评估访问后选择 20 名参与者（总计 = 100）进行深度访谈，这些访谈将用于： i) 探索定量数据初步分析中出现的新发现； ii) 确定新的调查领域以补充定量评估； iii) 通过在定性访谈中向研究参与者提供解释来评估定量结果的有效性。使用定性和定量数据为方法提供信息并解释每种方法的结果的迭代过程有助于全面理解描述墨西哥新法律将如何影响圣地亚哥注射吸毒者行为和健康结果的概念模型。这项研究符合 NIDA 的优先事项，支持对艾滋病毒/艾滋病合并症（包括丙型肝炎和结核病）进行流行病学研究，以及在弱势群体中预防艾滋病毒。这项研究利用一项罕见的自然实验来评估反对毒品政策对相互关联、毗邻社区的影响，并将为未来的政策提供重要的见解。 公共卫生相关性：注射吸毒者 (IDU) 受艾滋病毒、丙型肝炎和结核病的影响尤为严重，而且最近认识到这些疾病在墨西哥蒂华纳（加利福尼亚州圣地亚哥的姐妹城市）的集中，这表明疾病的进展和如果没有有效的干预措施，传播率将会增加。 2010 年 8 月，墨西哥颁布了新立法，将持有个人数量的麻醉药品（例如甲基苯丙胺、海洛因、可卡因和大麻）合法化，人们担心这将鼓励更多的美国注射吸毒者前往墨西哥购买和使用毒品。国家开发署资助的一项研究将评估该法律对提华纳注射吸毒者的影响，与此同时，我们将开展一项纵向队列研究，以考察该法律对圣地亚哥注射吸毒者的行为和疾病风险的影响，这些注射吸毒者可以轻松跨越边境进入来自墨西哥。