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 #
3R01DA011591-13S1
Application #
8899303
Study Section
Program Officer
Lambert, Elizabeth
Project Start
2014-08-01
Project End
2014-11-30
Budget Start
2014-08-01
Budget End
2014-11-30
Support Year
13
Fiscal Year
2014
Total Cost
$200,000
Indirect Cost
$14,815
Name
University of British Columbia
Department
Type
DUNS #
251949962
City
Vancouver
State
BC
Country
Canada
Zip Code
V6 1-Z3
Lee, William; Ti, Lianping; Marshall, Brandon D L et al. (2015) Childhood Sexual Abuse and Syringe Sharing Among People Who Inject Drugs. AIDS Behav 19:1415-22
Escudero, Daniel J; Kerr, Thomas; Wood, Evan et al. (2015) Acceptability of HIV Pre-exposure Prophylaxis (PREP) Among People Who Inject Drugs (PWID) in a Canadian Setting. AIDS Behav 19:752-7
Lappalainen, Leslie; Hayashi, Kanna; Dong, Huiru et al. (2015) Ongoing impact of HIV infection on mortality among people who inject drugs despite free antiretroviral therapy. Addiction 110:111-9
Lake, Stephanie; Wood, Evan; Dong, Huiru et al. (2015) The impact of childhood emotional abuse on violence among people who inject drugs. Drug Alcohol Rev 34:9-Apr
Long, Cathy; DeBeck, Kora; Feng, Cindy et al. (2014) Income level and drug related harm among people who use injection drugs in a Canadian setting. Int J Drug Policy 25:458-64
Hayashi, Kanna; Milloy, Michael-John; Wood, Evan et al. (2014) Predictors of liver-related death among people who inject drugs in Vancouver, Canada: a 15-year prospective cohort study. J Int AIDS Soc 17:19296
Nolan, Seonaid; Dias Lima, Viviane; Fairbairn, Nadia et al. (2014) The impact of methadone maintenance therapy on hepatitis C incidence among illicit drug users. Addiction 109:2053-9
Cotton, Laura A; Kuang, Xiaomei T; Le, Anh Q et al. (2014) Genotypic and functional impact of HIV-1 adaptation to its host population during the North American epidemic. PLoS Genet 10:e1004295
Markwick, Nicole; Ti, Lianping; Callon, Cody et al. (2014) Willingness to engage in peer-delivered HIV voluntary counselling and testing among people who inject drugs in a Canadian setting. J Epidemiol Community Health 68:675-8
Lima, Viviane Dias; Kerr, Thomas; Wood, Evan et al. (2014) The effect of history of injection drug use and alcoholism on HIV disease progression. AIDS Care 26:123-9

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