Hepatitis C is a major public health challenge particularly among HIV infected people who inject drugs (PWID). Despite recent availability of new oral, efficacious HCV therapies of short duration with minimal side effects, rates of HCV treatment in PWID remain low. Accelerated rates of liver disease progression in HIV/HCV co- infected individuals make HCV treatment among HIV infected PWID a priority. PWID social networks have the potential to serve as vehicles to increase rates of HCV treatment and prevent HCV reinfection. There is however little know about PWID social networks as it relates to HCV infection, care access and transmission patterns in inner city US populations. The goal of this project is to fill these knowledge gaps as a bridge to developing effective combined biomedical and behavioral (bio-behavioral) interventions to improve HCV treatment and prevent HCV reinfection among HIV infected PWID. I am an infectious disease trained physician with training in epidemiology, prior laboratory experience in molecular methods and practical clinical experience providing HIV and HCV care to inner-city HIV infected PWID. My long term goal is to conduct sophisticated clinical trials of combined biomedical and behavioral interventions to improve HCV/HIV medical care, treatment and prevention as well as understand transmission dynamics to prevent HCV reinfection. The proposed studies are nested in two NIDA funded PWID cohorts, the prevention and testing (Lighthouse) study and the AIDS Linked to the IntraVenous Experience (ALIVE) cohort, both representing HIV infected and uninfected inner-city Baltimore PWID.
Aim 1 utilizes data from social networks of index HIV-infected PWID to determine if HCV clusters within PWID social networks.
Aim 2 will assess individual- and network-level barriers and facilitators of HCV care among HIV infected PWID in the oral DAA era.
Aim 3 will assess if social networks document HCV transmission through use of complementary social network and phylogenetic analyses. The proposed career development plan will expand my technical skills through additional expertise in: (1) social network analyses; (2) recruitment of PWID social networks and assessment of social determinants of PWID HCV/HIV related health outcomes; 3) phylogenetic analyses and 4) implementation of bio-behavioral interventions. I will be well supported within the Department of Medicine at Johns Hopkins University and will benefit from the excellent research infrastructure of the Lighthouse and ALIVE studies at Johns Hopkins. With the recent national epidemic of transition from oral opioid to injection drug use and attendant increase in HIV and HCV infection rates, development of sustainable interventions to increase rates of HCV treatment among PWID and reduce rates of HIV/HCV infection have become a priority. This award will facilitate my pathway to an independent career as a patient-oriented clinical investigator committed to developing interventions to increase rates of HCV treatment and prevent HCV reinfection among HIV infected PWID.

Public Health Relevance

Despite the availability of simple effective therapies that can cure hepatitis C infection in 3 months or less, hepatitis C related mortality remains a major challenge among HIV infected persons who inject drugs (PWID). We seek to understand the role of PWID social networks in HCV distribution, care access, and HCV transmission patterns. Knowledge gained from these studies will inform development of effective strategies to improve rates of HCV treatment and prevent HCV reinfection, thus improving survival and quality of life among HIV infected PWID

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23DA041294-05
Application #
9939494
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Mandler, Raul N
Project Start
2016-07-15
Project End
2021-06-30
Budget Start
2020-07-01
Budget End
2021-06-30
Support Year
5
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21205
Falade-Nwulia, O; Sulkowski, M S; Merkow, A et al. (2018) Understanding and addressing hepatitis C reinfection in the oral direct-acting antiviral era. J Viral Hepat 25:220-227
Falade-Nwulia, Oluwaseun; Suarez-Cuervo, Catalina; Nelson, David R et al. (2017) Oral Direct-Acting Agent Therapy for Hepatitis C Virus Infection: A Systematic Review. Ann Intern Med 166:637-648
Wansom, Tanyaporn; Falade-Nwulia, Oluwaseun; Sutcliffe, Catherine G et al. (2017) Barriers to Hepatitis C Virus (HCV) Treatment Initiation in Patients With Human Immunodeficiency Virus/HCV Coinfection: Lessons From the Interferon Era. Open Forum Infect Dis 4:ofx024
Falade-Nwulia, Oluwaseun; Sutcliffe, Catherine; Moon, Juhi et al. (2017) High hepatitis C cure rates among black and nonblack human immunodeficiency virus-infected adults in an urban center. Hepatology 66:1402-1412
Falade-Nwulia, Oluwaseun; Sulkowski, Mark (2017) The HCV care continuum does not end with cure: A call to arms for the prevention of reinfection. J Hepatol 66:267-269
Falade-Nwulia, O; McAdams-Mahmoud, A; Irvin, R et al. (2016) Primary Care Providers Knowledge, Attitude and Practices Related to Hepatitis C Screening and Treatment in the Oral Direct Acting Antiviral Agents Era. J Community Med Health Educ 6: