The purpose of this competing renewal application is to evaluate the impact of evolving drug use patterns, as well as a range of social, structural, and environmental factors, on HIV incidence, morbidity, and mortality among a cohort of HIV-negative injection drug users (IDU) in Vancouver, Canada. We propose to undertake this work in a setting where a steady growth in methamphetamine injection has become an increasing concern. The proposed research involves the continuation of the Vancouver Injection Drug Users Study (VIDUS), which is among the longest-standing cohort studies in North America. Since 1997, this study has led to more than 120 peer-reviewed publications in the area of public health, HIV/AIDS, and injection drug use. Vancouver, Canada, is unique in North America and is ideally suited to the proposed research questions for several reasons. First, the city is home to one of the most explosive HIV epidemics ever documented among IDU in the developed world, with HIV incidence peaking at 18 per 100 person-years in 1997 and persistently elevated HIV rates continuing up to 2007. Second, like many West Coast cities, Vancouver is in the midst of a massive growth in the use of methamphetamine and is also seeing a dramatic increase in methamphetamine injection. Third, Vancouver is unique in having an exceptionally large and visible street-based drug market and a large network of single-room occupancy hotels (SROs). We seek to build upon our past work focused on individual risk factors and health service use by investigating the impact of various social, structural, and environmental factors on HIV risk behavior, HIV incidence, morbidity, mortality, and hospital utilization among IDU. Herein we propose to continue our cohort-based approach involving semi-annual follow-up of 1000 HIV-negative IDU. We also propose to continue taking advantage of the universal healthcare system and centralized health data in British Columbia by linking participant data to a range of healthcare databases. Our proposed continuation of cohort-based research offers an ideal opportunity to examine the impact of evolving drug use patterns, as well as the impact of various social, structural, and environmental factors on the natural history of injection drug use. Given that methamphetamine use emerged on the West Coast, our investigation of rising methamphetamine injection could provide important information and early warning to other North American settings. In sum, through the continuation of VIDUS, we aim to address several urgent global health challenges and inform the development of a range of policies and interventions.

Public Health Relevance

The purpose of this competing renewal application is to evaluate the impact of evolving drug use patterns, as well as a range of social, structural, and environmental factors on HIV incidence, morbidity and mortality among a cohort of HIV-negative injection drug users in a setting where a steady rise in methamphetamine injection has become an urgent concern. Through the continuation of the Vancouver Injection Drug Users Study, we aim to address several urgent global health challenges and inform the development of a range of policies and interventions.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA011591-11
Application #
8092797
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Lambert, Elizabeth
Project Start
1998-06-05
Project End
2014-07-31
Budget Start
2011-08-01
Budget End
2012-07-31
Support Year
11
Fiscal Year
2011
Total Cost
$454,046
Indirect Cost
Name
University of British Columbia
Department
Type
DUNS #
251949962
City
Vancouver
State
BC
Country
Canada
Zip Code
V6 1-Z3
Luongo, Nicole M; Dong, Huiru; Kerr, Thomas H et al. (2017) Income generation and attitudes towards addiction treatment among people who use illicit drugs in a Canadian setting. Addict Behav 64:159-164
Damon, Will; Small, Will; Anderson, Solanna et al. (2017) 'Crisis' and 'everyday' initiators: A qualitative study of coercion and agency in the context of methadone maintenance treatment initiation. Drug Alcohol Rev 36:253-260
Krüsi, Andrea; McNeil, Ryan; Moore, David et al. (2017) 'Because I've been extremely careful': HIV seroconversion, responsibility, citizenship and the neo-liberal drug-using subject. Health Risk Soc 19:58-73
Tucker, Devin; Hayashi, Kanna; Milloy, M-J et al. (2016) Risk factors associated with benzodiazepine use among people who inject drugs in an urban Canadian setting. Addict Behav 52:103-7
Kennedy, Mary Clare; Milloy, M-J; Markwick, Nicole et al. (2016) Encounters with private security guards among people who inject drugs in a Canadian setting. Int J Drug Policy 28:124-7
Luchenski, Serena; Ti, Lianping; Hayashi, Kanna et al. (2016) Protective factors associated with short-term cessation of injection drug use among a Canadian cohort of people who inject drugs. Drug Alcohol Rev 35:620-7
Lyons, Tara; Shannon, Kate; Richardson, Lindsey et al. (2016) Women Who Use Drugs and Have Sex with Women in a Canadian Setting: Barriers to Treatment Enrollment and Exposure to Violence and Homelessness. Arch Sex Behav 45:1403-10
Werb, Daniel; Garfein, Richard; Kerr, Thomas et al. (2016) A socio-structural approach to preventing injection drug use initiation: rationale for the PRIMER study. Harm Reduct J 13:25
Krebs, Emanuel; Kerr, Thomas; Wood, Evan et al. (2016) Characterizing Long-Term Health Related Quality of Life Trajectories of Individuals With Opioid Use Disorder. J Subst Abuse Treat 67:30-7
Poon, Art F Y; Gustafson, Réka; Daly, Patricia et al. (2016) Near real-time monitoring of HIV transmission hotspots from routine HIV genotyping: an implementation case study. Lancet HIV 3:e231-8

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