Given the observed increased risk of HIV due to policing behaviors, a police education program (PEP) is being conducted in Tijuana, Mexico to protect police officers from occupational needlestick injuries while simultaneously harmonizing law enforcement and public health priorities. The long-term sustainability of this intervention is dependent upon whether it is cost-effective in terms of reducing HIV incidence. Indeed, structural interventions such as police education interventions may hold promise as novel strategies to reduce HIV transmission among people who inject drugs in many locations around the world where policing behavior contribute to HIV transmission. To evaluate the potential of PEPs on reducing HIV incidence, this mentored research scientist development award will focus on building dynamic cost-effectiveness and mathematical models to examine the impact of the PEP on the PWID population in Tijuana.
The first aim i s to model the cost-effectiveness of the police education program, including both individual and population prevention benefits on the HIV epidemic among PWID in Tijuana;
the second aim i s to model the potential impact of increased police referrals to harm reduction services (SEP and OST) on HIV incidence among PWID; and the third aim is to explore how increased police referral of PWID to SEP and OST services could improve the overall cost- effectiveness of the police education program. The candidate, Dr. Javier Cepeda, is well-qualified to conduct this research because of his strong background in quantitative methods and track record of producing high impact work. Over the 5 year award period, Dr. Cepeda will achieve the following career development objectives: 1) Acquire expertise in the principles of health economic evaluation and cost-effectiveness analysis with an emphasis on HIV preventative interventions 2) Develop skills in mathematical modeling of infectious disease transmission with a focus on HIV epidemics among people who inject drugs 3) Acquire training in the design and implementation of theory-driven structural interventions focusing on HIV prevention in resource- limited settings 4) Obtain expertise in the ethical conduct of research pertaining to structural HIV prevention interventions among vulnerable populations in resource limited settings 5) Expand professional development skills in preparation for a successful academic career by developing grantsmanship, publishing manuscripts, and future scientific collaborations To accomplish these training aims, he has assembled an outstanding team of mentors with expertise in HIV, substance abuse, epidemiology, mathematical modeling, cost-effectiveness and design of HIV prevention interventions. Under their supervision, he will complete coursework and attend workshops, scientific meetings, and conduct research to apply the skills to become an independent researcher in HIV, substance abuse, mathematical modeling leading to independence. These training and research aims are inline with the Office of AIDS Research high priority topics: ?Reducing Incidence of HIV/AIDS? and ?Research Training of the workforce required to conduct High Priority HIV/AIDS or HIV/AIDS-related research?.

Public Health Relevance

This proposal will determine whether a police education program in will have an impact on reducing HIV transmission among people who inject drugs in Tijuana. If cost-effectiveness is demonstrated then police education programs could be implemented in many regions where policing behaviors increase HIV. Identifying novel, cost-effective HIV preventative interventions will be especially important as treatment and prevention and services are scaled-up in resource-limited settings.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Scientist Development Award - Research & Training (K01)
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Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
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Jenkins, Richard A
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Johns Hopkins University
Public Health & Prev Medicine
Schools of Public Health
United States
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Cepeda, Javier A; Eritsyan, Ksenia; Vickerman, Peter et al. (2018) Potential impact of implementing and scaling up harm reduction and antiretroviral therapy on HIV prevalence and mortality and overdose deaths among people who inject drugs in two Russian cities: a modelling study. Lancet HIV 5:e578-e587
Bekker, Linda-Gail; Alleyne, George; Baral, Stefan et al. (2018) Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society-Lancet Commission. Lancet 392:312-358
Borquez, Annick; Beletsky, Leo; Nosyk, Bohdan et al. (2018) The effect of public health-oriented drug law reform on HIV incidence in people who inject drugs in Tijuana, Mexico: an epidemic modelling study. Lancet Public Health 3:e429-e437
Garfein, Richard S; Liu, Lin; Cuevas-Mota, Jazmine et al. (2018) Tuberculosis Treatment Monitoring by Video Directly Observed Therapy in 5 Health Districts, California, USA. Emerg Infect Dis 24:1806-1815
Burgos, Jose Luis; Cepeda, Javier A; Kahn, James G et al. (2018) Cost of provision of opioid substitution therapy provision in Tijuana, Mexico. Harm Reduct J 15:28
Morales, Mario; Rafful, Claudia; Gaines, Tommi L et al. (2018) Factors associated with extrajudicial arrest for syringe possession: results of a department-wide survey of municipal police in Tijuana, Mexico. BMC Int Health Hum Rights 18:36
Cepeda, Javier A; Strathdee, Steffanie A; Arredondo, Jaime et al. (2017) Assessing police officers' attitudes and legal knowledge on behaviors that impact HIV transmission among people who inject drugs. Int J Drug Policy 50:56-63