This application requests funding to undertake innovative research on a large-scale population-based Seek, Test, Treat and Retain (STTR) initiative. The Province of British Columbia (Canada) has embarked upon one of the world's largest and most advanced STTR initiatives, which was renewed in November 2012. The universal healthcare system within the province provides all medical care, including highly active antiretroviral therapy (HAART) and substance abuse treatment, free of charge. Extensive confidential record linkages allow the accurate attainment of all key measures, including health service utilization and HIV clinical outcomes. Taking advantage of this initiative and a large linked database, as well as the interdisciplinary research capacity of the British Columbia Centre for Excellence in HIV/AIDS (Vancouver), herein we propose a program of rigorous and innovative study that will marshal epidemiologic, clinical, geographic, and phylogenetic approaches to critically inform efforts to respond to HIV transmission and pathogenesis among HIV-infected individuals, with a particular emphasis on individuals who inject drugs (IDU). Specifically, we seek to augment our ongoing epidemiologic and clinical research activities with molecular genetics and geographic information systems (GIS) based methods to model the effect of this STTR initiative on the generation of antiretroviral drug resistance and HIV incidence. As well, we will use novel phylogenetic methods and next generation sequencing to assess the suitability of new HIV diagnoses as a surrogate for HIV incidence. In order to aid in the optimization of STTR approaches, we will also identify patterns and predictors of engagement in and leakage from the """"""""Cascade of Care'among IDU. Lastly, by integrating GIS with phylogenetic data, we will identify unrecognized foci of HIV transmission throughout the province. This proposal comes at a time of international consensus on the need to respond urgently to elevated levels of HIV-related morbidity and mortality, particularly among IDU. Evidence from mathematical modeling, observational cohorts and clinical trials has revealed the close link between HAART access and the risk of HIV transmission between individuals, resulting in markedly lower rates of infection in populations with higher levels of coverage of 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 HIV incidence. Given the research infrastructure established to date and our track record in undertaking novel and high impact research on STTR, we are uniquely well placed to prospectively assess key second-generation questions regarding the impact of STTR on engagement in treatment and care, HAART resistance, and HIV incidence. The work proposed herein is strongly aligned with the priorities in the FY 2013 Trans-NIH Plan for HIV-Related Research.

Public Health Relevance

HIV infection among people who inject drugs remains a global public health emergency. In response, we propose to develop of an innovative program of research focused on emerging issues specific to the enhancement and sustainability of the Seek, Test, Treat, and Retain (STTR) approach. We propose to take advantage of a large and evolving population-level, government-supported program of universal treatment for HIV disease, to identify opportunities to optimize and sustain STTR approaches globally.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
3R01DA036307-02S1
Application #
8841486
Study Section
Special Emphasis Panel (ZDA1)
Program Officer
Jenkins, Richard A
Project Start
2013-06-01
Project End
2018-02-28
Budget Start
2014-03-01
Budget End
2015-02-28
Support Year
2
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of British Columbia
Department
Type
DUNS #
City
Vancouver
State
BC
Country
Canada
Zip Code
V6 1Z3
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Card, Kiffer G; Armstrong, Heather L; Lachowsky, Nathan J et al. (2018) Belief in Treatment as Prevention and Its Relationship to HIV Status and Behavioral Risk. J Acquir Immune Defic Syndr 77:8-16
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Card, Kiffer G; Armstrong, Heather L; Carter, Allison et al. (2018) A latent class analysis of substance use and culture among gay, bisexual and other men who have sex with men. Cult Health Sex 20:1424-1439
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Card, Kiffer G; Armstrong, Heather L; Lachowsky, Nathan J et al. (2018) Patterns of Online and Offline Connectedness Among Gay, Bisexual, and Other Men Who Have Sex with Men. AIDS Behav 22:2147-2160
Colyer, Sean P; Lachowsky, Nathan J; Cui, Zishan et al. (2018) HIV treatment optimism and crystal methamphetamine use and initiation among HIV-negative men who have sex with men in Vancouver, Canada: A longitudinal analysis. Drug Alcohol Depend 185:67-74
Klimas, Jan; Dong, Huiru; Fairbairn, Nadia et al. (2018) Eligibility for heroin-assisted treatment (HAT) among people who inject opioids and are living with HIV in a Canadian setting. Addict Sci Clin Pract 13:3
Krebs, Emanuel; Min, Jeong E; Bayoumi, Ahmed M et al. (2018) Informing Targeted Interventions to Optimize the Cascade of HIV Care Using Cluster Analyses of Health Resource Use Among People Living with HIV/AIDS. AIDS Behav 22:234-244
Armstrong, Heather L; Wang, Lu; Zhu, Julia et al. (2018) HIV Testing Among a Representative Community Sample of Gay, Bisexual, and Other Men Who Have Sex with Men in Vancouver, Canada. AIDS Behav :

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