The purpose of this application is to seek renewed funding for a long-running prospective cohort of HIV- infected individuals who use injection drugs (IDU) linked to comprehensive HIV clinical monitoring to examine the impacts of individual, social, policy, economic, and physical exposures on HIV treatment outcomes. We seek to analyse the effects of these contextual determinants, including incarceration, homelessness, and involvement in the sex trade, on HIV RNA plasma viral load at both the individual and community levels. We will augment our ongoing epidemiologic and clinical research activities with molecular genetics and geographic information systems (GIS) based methods to model the effect of these exposures on community-level plasma viral load, HIV incidence, and the generation of antiretroviral drug resistance. In recognition of the increasing international attention to the HIV "risk environment," a conceptual framework modeling the effect of exogenous and endogenous characteristics on the risk of HIV infection, we will employ this structure to integrate data from individual and community levels in analyses of HIV treatment outcomes. This proposal comes at a time of broad international consensus on the need to respond urgently to persistently elevated levels of HIV-related morbidity and mortality among IDU. Emerging evidence from mathematical modeling, observational cohorts and clinical trials has revealed the close link between the HIV RNA viral load within individuals and at the community level and the risk of HIV transmission between individuals, resulting in lower rates of infection in populations with higher levels of coverage of highly active antiretroviral therapy (HAART.) This observation has led to renewed HIV prevention efforts to seek out members of vulnerable populations, test them for HIV infection, and engage them in healthcare, including treatment for HIV infection, in order to reduce HIV-related morbidity and mortality and lower the incidence of HIV seroconversion. Our proposed study will be conducted during a province-wide "Seek, Test, and Treat" campaign. Given the study infrastructure established to date and our track record evaluating barriers to HAART access and adherence, we are uniquely well placed to prospectively assess second-generation questions regarding the treatment as prevention campaign's impacts on community-level plasma viral loads, HAART resistance, and HIV incidence. In this regard, evaluations of treatment as prevention are an urgent priority in the FY 2012 Trans-NIH Plan for HIV-Related Research. In addition to the "Seek, Test, and Treat" campaign, our study setting of Vancouver, Canada, is ideally suited to our study aims. The universal healthcare system provides all medical care, including HAART, free of charge. Confidential record linkages allow the accurate attainment of all key measures, including health service utilization and HIV clinical outcomes. This application proposes a program of rigorous and innovative study that will marshal epidemiologic, geographic, and phylogenetic approaches to critically inform efforts to respond to HIV transmission and pathogenesis among IDU.
High levels of HIV infection among people who use injection drugs is a global public health emergency. In response, we propose to renew our ongoing study of HIV-positive drug users to assess the effect of HIV treatment on patterns of antiretroviral drug resistance and patterns of HIV transmission in Vancouver, Canada.
|Lake, Stephanie; Milloy, M-J; Dong, Huiru et al. (2016) Initiation into prescription opioid injection and associated trends in heroin use among people who use illicit drugs. Drug Alcohol Depend 169:73-79|
|Joseph, Brenden; Wood, Evan; Hayashi, Kanna et al. (2016) Factors associated with initiation of antiretroviral therapy among HIV-positive people who use injection drugs in a Canadian setting. AIDS 30:925-32|
|Landsberg, Adina; Kerr, Thomas; Milloy, Michael-John et al. (2016) Declining trends in exposures to harmful policing among people who inject drugs in Vancouver, Canada. J Int AIDS Soc 19:20729|
|Prangnell, Amy; Daly-Grafstein, Ben; Dong, Huiru et al. (2016) Factors associated with inability to access addiction treatment among people who inject drugs in Vancouver, Canada. Subst Abuse Treat Prev Policy 11:9|
|Milloy, M-J; Wood, Evan; Kerr, Thomas et al. (2016) Increased Prevalence of Controlled Viremia and Decreased Rates of HIV Drug Resistance Among HIV-Positive People Who Use Illicit Drugs During a Community-wide Treatment-as-Prevention Initiative. Clin Infect Dis 62:640-7|
|Milloy, M-J; King, Alexandra; Kerr, Thomas et al. (2016) Improvements in HIV treatment outcomes among indigenous and non-indigenous people who use illicit drugs in a Canadian setting. J Int AIDS Soc 19:20617|
|Hayashi, Kanna; Dong, Huiru; Marshall, Brandon D L et al. (2016) Sex-Based Differences in Rates, Causes, and Predictors of Death Among Injection Drug Users in Vancouver, Canada. Am J Epidemiol 183:544-52|
|Bach, Paxton; Walton, Geoffrey; Hayashi, Kanna et al. (2016) Benzodiazepine Use and Hepatitis C Seroconversion in a Cohort of Persons Who Inject Drugs. Am J Public Health 106:1067-72|
|Damon, Will; Small, Will; Anderson, Solanna et al. (2016) 'Crisis' and 'everyday' initiators: A qualitative study of coercion and agency in the context of methadone maintenance treatment initiation. Drug Alcohol Rev :|
|Voon, Pauline; Ti, Lianping; Dong, Huiru et al. (2016) Risky and rushed public crack cocaine smoking: the potential for supervised inhalation facilities. BMC Public Health 16:476|
Showing the most recent 10 out of 147 publications