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 #
4R01DA011591-13
Application #
8515901
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
2013-08-01
Budget End
2014-07-31
Support Year
13
Fiscal Year
2013
Total Cost
$416,288
Indirect Cost
$30,836
Name
University of British Columbia
Department
Type
DUNS #
251949962
City
Vancouver
State
BC
Country
Canada
Zip Code
V6 1-Z3
Kerr, Thomas; Shannon, Kate; Ti, Lianping et al. (2016) Sex work and HIV incidence among people who inject drugs. AIDS 30:627-34
Jacka, Brendan; Applegate, Tanya; Poon, Art F et al. (2016) Transmission of hepatitis C virus infection among younger and older people who inject drugs in Vancouver, Canada. J Hepatol 64:1247-55
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
Fairbairn, Nadia; Hayashi, Kanna; Milloy, M-J et al. (2016) Hazardous Alcohol Use Associated with Increased Sexual Risk Behaviors Among People Who Inject Drugs. Alcohol Clin Exp Res 40:2394-2400
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
Escudero, Daniel J; Marshall, Brandon D L; Kerr, Thomas et al. (2016) No association between HIV status and risk of non-fatal overdose among people who inject drugs in Vancouver, Canada. Addict Behav 60:8-12
Montain, Jacqueline; Ti, Lianping; Hayashi, Kanna et al. (2016) Impact of length of injecting career on HIV incidence among people who inject drugs. Addict Behav 58:90-4
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
Caudarella, Alexander; Dong, Huiru; Milloy, M J et al. (2016) Non-fatal overdose as a risk factor for subsequent fatal overdose among people who inject drugs. Drug Alcohol Depend 162:51-5
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

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