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 #
5R01DA036307-04
Application #
9021629
Study Section
Special Emphasis Panel (ZDA1)
Program Officer
Jenkins, Richard A
Project Start
2013-06-01
Project End
2018-02-28
Budget Start
2016-03-01
Budget End
2017-02-28
Support Year
4
Fiscal Year
2016
Total Cost
Indirect Cost
Name
University of British Columbia
Department
Type
DUNS #
251949962
City
Vancouver
State
BC
Country
Canada
Zip Code
V6 1Z3
Amram, Ofer; Wang, Lu; Sereda, Paul et al. (2018) ASSESSING THE RELATIONSHIP BETWEEN PHYSICIAN AVAILABILITY AND VIRAL LOAD SUPPRESSION IN BRITISH COLUMBIA. Can Geogr 62:120-129
Card, Kiffer G; Lachowsky, Nathan J; Armstrong, Heather L et al. (2018) The additive effects of depressive symptoms and polysubstance use on HIV risk among gay, bisexual, and other men who have sex with men. Addict Behav 82:158-165
Eyawo, Oghenowede; Hull, Mark W; Salters, Kate et al. (2018) Cohort profile: the Comparative Outcomes And Service Utilization Trends (COAST) Study among people living with and without HIV in British Columbia, Canada. BMJ Open 8:e019115
Armstrong, Heather L; Roth, Eric Abella; Rich, Ashleigh et al. (2018) Associations between sexual partner number and HIV risk behaviors: implications for HIV prevention efforts in a Treatment as Prevention (TasP) environment. AIDS Care 30:1290-1297
Mosley, Terrance; Khaketla, Moliehi; Armstrong, Heather L et al. (2018) Trends in Awareness and Use of HIV PrEP Among Gay, Bisexual, and Other Men who have Sex with Men in Vancouver, Canada 2012-2016. AIDS Behav 22:3550-3565
Nosyk, Bohdan; Min, Jeong E; Krebs, Emanuel et al. (2018) The Cost-Effectiveness of Human Immunodeficiency Virus Testing and Treatment Engagement Initiatives in British Columbia, Canada: 2011-2013. Clin Infect Dis 66:765-777
Roth, Eric Abella; Cui, Zishan; Wang, Lu et al. (2018) Substance Use Patterns of Gay and Bisexual Men in the Momentum Health Study. Am J Mens Health 12:1759-1773
Roth, Eric Abella; Cui, Zishan; Rich, Ashleigh et al. (2018) Seroadaptive Strategies of Vancouver Gay and Bisexual Men in a Treatment as Prevention Environment. J Homosex 65:524-539
Beaulieu, Tara; Hayashi, Kanna; Milloy, Michael J et al. (2018) HIV Serostatus and Having Access to a Physician for Regular Hepatitis C Virus Care Among People Who Inject Drugs. J Acquir Immune Defic Syndr 78:93-98
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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