UNAIDS has announced a goal of Getting to Zero New HIV infections and Secretary Clinton has announced a goal of an AIDS free generation. Completely eliminating new HIV infections may not be possible in any large population of persons at high risk for HIV, but combined prevention, including treatment as prevention (TasP) may permit getting very close to zero new HIV infections. Psychoactive drug use generates many impediments getting close to zero. Drug use can lead to HIV infection through both sharing injection equipment and through drug use related unsafe sexual behavior. Drug use may also interfere with accessing and adhering to antiretroviral therapy (ART). Psychoactive drug use is also strongly associated with higher rates of HIV infection among racial/ethnic minorities. In this research, we will examine whether combined prevention can get close to zero new HIV infections among injecting and non-injecting drug users in New York City, including whether getting close to zero can minimize racial/ethnic disparities. If combined prevention does lead to getting close to zero new infections drug users in NYC. This will require a) an analytic description of combined prevention, b) a clear conceptualization of getting close to zero, and c) new metrics and methods for assessing being close to zero. We will study getting close to zero new HIV infections for drug users in NYC through four specific aims: 1. Determine the extent to which combined prevention is getting close to zero for injecting related transmission of HIV in NYC. Develop new metrics for measuring a CtZ situation for injecting-related transmission and how racial/ethnic disparities might be minimized. 2. Conduct mathematical modeling, using biomarkers for high injecting risk (HCV infection) and high sexual risk (HSV-2 infection) and behavioral data to analyze HIV infection among PWID in terms of: 1) the PWID population as a whole, 2) disparities among major racial/ethnic groups, 3) sustainability for maintaining a CTZ situation with combined prevention, and 4) injecting related vs. sexual transmission of HIV among PWID. 3. Determine the extent to which combined prevention is reducing drug related sexual (DRS) transmission of HIV among non-injecting drug users (NIDUs) and PWID in NYC. Develop new metrics for measuring the potential for continuing sexual transmission and assess coverage of Treatment as Prevention (TasP) among NIDUs. Monitor trends in HSV-2 infection as a continuing driver of drug use sexual transmission. 4. Utilize geospatial analysis to characterize hotspots for continuing transmission of HIV among drug users in NYC, including potential geographic overlap between injecting related and sexual transmission of HIV, and racial/ethnic and HIV service characteristics of hotspots. We will accomplish these aims through interviews and HIV, HCV, and HSV-2 testing of 600 subjects per year and continuation of our long-standing collaborations with the NY City and State Health Departments.

Public Health Relevance

UNAIDS has announced a goal of 'getting to zero' new HIV infections and the US government has announced a parallel goal of achieving 'an AIDS free generation. We will study whether combined prevention leads to 'getting close to zero' new HIV infections for injecting and non-injecting drug users in New York City. This will include developing bio-behavioral metrics for use in getting close to zero, mathematical modeling, and identifying geographic 'hotspots' of persistent probability of HIV transmission.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA003574-33
Application #
8996712
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Hartsock, Peter
Project Start
1994-09-10
Project End
2020-01-31
Budget Start
2017-02-01
Budget End
2018-01-31
Support Year
33
Fiscal Year
2017
Total Cost
$627,852
Indirect Cost
$257,438
Name
Icahn School of Medicine at Mount Sinai
Department
Physiology
Type
Schools of Medicine
DUNS #
078861598
City
New York
State
NY
Country
United States
Zip Code
10029
Des Jarlais, Don C; McKnight, Courtney; Feelemyer, Jonathan et al. (2018) Heterosexual male and female disparities in HIV infection at the end of an epidemic: HIV infection among persons who inject drugs in New York City, 2001-2005 and 2011-2015. Drug Alcohol Depend 185:391-397
Campbell, Aimee N C; Wolff, Margaret; Weaver, Laurel et al. (2018) ""It's Never Just About the HIV:"" HIV Primary Care Providers' Perception of Substance Use in the Era of ""Universal"" Antiretroviral Medication Treatment. AIDS Behav 22:1006-1017
Des Jarlais, D C; Cooper, H L F; Arasteh, K et al. (2018) Potential geographic ""hotspots"" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York City, 2011-2015, with implications for the current opioid epidemic in the US. PLoS One 13:e0194799
Jõgeda, Ene-Ly; Avi, Radko; Pauskar, Merit et al. (2018) Association of IFN?4 rs12979860 polymorphism with the acquisition of HCV and HIV infections among people who inject drugs. J Med Virol 90:1779-1783
Des Jarlais, Don C; Arasteh, K; Feelemyer, J et al. (2018) Hepatitis C virus prevalence and estimated incidence among new injectors during the opioid epidemic in New York City, 2000-2017: Protective effects of non-injecting drug use. Drug Alcohol Depend 192:74-79
Elliott, Jennifer C; Hasin, Deborah S; Des Jarlais, Don C (2017) Perceived health and alcohol use in individuals with HIV and Hepatitis C who use drugs. Addict Behav 72:21-26
Jõgeda, Ene-Ly; Huik, Kristi; Pauskar, Merit et al. (2017) Prevalence and genotypes of GBV-C and its associations with HIV infection among persons who inject drugs in Eastern Europe. J Med Virol 89:632-638
Des Jarlais, Don C (2017) Harm reduction in the USA: the research perspective and an archive to David Purchase. Harm Reduct J 14:51
Des Jarlais, Don C; Arasteh, Kamyar; Feelemyer, Jonathan et al. (2017) Decline in Herpes Simplex Virus Type 2 Among Non-Injecting Heroin and Cocaine Users in New York City, 2005 to 2014: Prospects for Avoiding a Resurgence of Human Immunodeficiency Virus. Sex Transm Dis 44:85-90
Des Jarlais, Don C; Arasteh, Kamyar; McKnight, Courtney et al. (2017) What happened to the HIV epidemic among non-injecting drug users in New York City? Addiction 112:290-298

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