From November 2014 to May 2017, our team conducted multi-wave data collection with 346 current PWID in the rural interior of Puerto Rico via project supported by NIH grant R01DA037117. This research was organized around four specific aims: 1) Use network-based sampling, ethnographic fieldwork, and HIV and HCV testing to determine behavioral and structural factors affecting HIV and HCV incidence and prevalence rates among people who inject drugs (PWID) in rural areas of Puerto Rico; 2) Estimate the range of HIV and HCV prevalence and incidence rates in rural Puerto Rico for 5, 10, and 20 year time spans using network-structured, agent based simulation; 3) Simulate common interventions aimed at preventing HIV and HCV infection in a dynamic risk network environment to determine which interventions (or combinations of interventions) are most appropriate for preventing the spread of HIV and HCV among PWID in rural Puerto Rico; 4) In collaboration with our Dissemination Advisory Board, apply an integrated knowledge-exchange approach with our target audiences (policymakers, public health officials, and harm reduction providers in Puerto Rico and in New York, where many rural injectors go when they become HIV+). In September 2017, hurricane Maria devastated Puerto Rico's infrastructure. The impact of the disaster on drug-related morbidity and mortality are likely to be large. Currently, little is known about post-disaster patterns of drug-related risk of infection or overdose, outside of recent research under economic restructuring. What evidence exists points to an escalation of risk across the full range of HIV and hepatitis C infection scenarios. While the damage from Maria is relatively unprecedented, large scale natural and social disasters are increasingly common. From a planning and intervention perspective, greater understanding of the impacts of such events on (short term) overdose rates and (long-term) HIV/HCV infection prevalence are critical. This competing revision allows for an originally unanticipated wave of post-disaster data collection with rural PWID in Puerto Rico that will repeat strategies used to establish PWID risk network topologies and epidemiological dynamics during two waves of data collection in 2016 and 2017. Post-hurricane data collection will provide greater understanding of the impact of large scale social and ecological destruction on the range of factors associated with Aims 1-3. It will also allow our team to re-establish the integrated knowledge exchange with our Dissemination Advisory Board, whose understanding of the situation on the ground in Puerto Rico is likely to have shifted dramatically. While our specific aims remain the same, the impact of the overall project will be significantly expanded by the inclusion of a first-ever pre-/post-disaster network data collection among PWID.

Public Health Relevance

This research will document behavior and network-based risk for HIV among rural drug injectors in Puerto Rico following Hurricane Maria. This population plays a disproportionate role in the spread of HIV when compared to other rural populations, and is likely to have changed HIV and drug-use risk behaviors as a result of destruction to the local medical and social infrastructure caused by the storm. The regional and long term dynamics of HIV post-disaster will be established via simulation based data collected in the project, and the success and cost- effectiveness of potential interventions will be tested.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
3R01DA037117-05S1
Application #
9617992
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Hartsock, Peter
Project Start
2014-08-01
Project End
2019-07-31
Budget Start
2018-08-01
Budget End
2019-07-31
Support Year
5
Fiscal Year
2018
Total Cost
Indirect Cost
Name
University of Nebraska Lincoln
Department
Social Sciences
Type
Schools of Arts and Sciences
DUNS #
555456995
City
Lincoln
State
NE
Country
United States
Zip Code
68503
Hautala, Dane; Abadie, Roberto; Thrash, Courtney et al. (2018) Latent Risk Subtypes Based on Injection and Sexual Behavior Among People Who Inject Drugs in Rural Puerto Rico. J Rural Health 34:236-245
Thrash, Courtney; Welch-Lazoritz, Melissa; Gauthier, Gertrude et al. (2018) Rural and urban injection drug use in Puerto Rico: Network implications for human immunodeficiency virus and hepatitis C virus infection. J Ethn Subst Abuse 17:199-222
Abadie, Roberto; Goldenberg, Shira; Welch-Lazoritz, Melissa et al. (2018) Establishing trust in HIV/HCV research among people who inject drugs (PWID): Insights from empirical research. PLoS One 13:e0208410
Abadie, R; Gelpi-Acosta, C; Davila, C et al. (2018) ""It Ruined My Life"": The effects of the War on Drugs on people who inject drugs (PWID) in rural Puerto Rico. Int J Drug Policy 51:121-127
Khan, Bilal; Duncan, Ian; Saad, Mohamad et al. (2018) Combination interventions for Hepatitis C and Cirrhosis reduction among people who inject drugs: An agent-based, networked population simulation experiment. PLoS One 13:e0206356
Habecker, Patrick; Abadie, Roberto; Welch-Lazoritz, Melissa et al. (2018) Injection Partners, HCV, and HIV Status among Rural Persons Who Inject Drugs in Puerto Rico. Subst Use Misuse 53:1128-1138
Duncan, Ian; Curtis, Ric; Reyes, Juan Carlos et al. (2017) Hepatitis C serosorting among people who inject drugs in rural Puerto Rico. Prev Med Rep 6:38-43
Dombrowski, Kirk; Khan, Bilal; Habecker, Patrick et al. (2017) The Interaction of Risk Network Structures and Virus Natural History in the Non-spreading of HIV Among People Who Inject Drugs in the Early Stages of the Epidemic. AIDS Behav 21:1004-1015
Abadie, Roberto; Welch-Lazoritz, Melissa; Bilal, Khan et al. (2017) Social Determinants of HIV/HCV Co-Infection: A case Study from People Who Inject Drugs in Rural Puerto Rico. Addict Behav Rep 5:29-32
Welch-Lazoritz, Melissa; Hautala, Dane; Habecker, Patrick et al. (2017) Association between alcohol consumption and injection and sexual risk behaviors among people who inject drugs in rural Puerto Rico. J Subst Abuse Treat 82:34-40

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