This competing renewal U01 application proposes an investigation of the impact of rapidly evolving substance use patterns on HIV prevention and HIV-associated co-morbidities. We propose to undertake this work in Vancouver, Canada, where, as in many areas in the US, exponential growth in synthetic opioid use has become a health crisis. Accordingly, we seek to characterize emerging drug use patterns and the associated impacts on engagement in HIV prevention and medication assisted treatments for opioid use disorder (MAT). We also aim to assess willingness to use, uptake of, and adherence to new and emerging HIV-focused biomedical interventions (e.g., pre-exposure prophylaxis [PrEP], microbicides). In Vancouver, PrEP has recently been made available at no cost to those at high risk of HIV acquisition, including people who inject drugs (PWID). We further aim to examine key HIV-associated co-morbidities, in particular pain and neurocognitive impairment, among a combined sample of HIV-negative and HIV-positive PWID and the related impacts on substance use patterns, engagement in HIV prevention and MAT. This project involves the continuation of the Vancouver Drug Users Study (V-DUS; n = 1800), which is one of the longest-running prospective cohort studies of community-recruited people who use illicit drugs (PWUD) internationally. The V-DUS is comprised of two nested cohorts following HIV-negative street-involved drug-using youth aged 14-26 years and HIV-negative adult PWID since 1996. Our study setting is a key innovative feature of the proposed work. Vancouver is a port city that continues to experience high availability and prevalent use of a wide range of illicit drugs. It is home to one of the most dramatic outbreaks of HIV among PWID and is now an epicenter of the ongoing synthetic opioid epidemic. In response, a range of pioneering policies and programs specific to illicit drug use have been introduced, and several of these are now being scaled up and/or considered in the US. For example, a broad set of MAT are available for virtually free of charge through the universal healthcare plan and in a low threshold manner, which allows us to examine MAT-related outcomes without the confounding effects of insurance schemes and programmatic barriers associated with high-threshold provision of MAT. The V-DUS is also a member of the C3PNO consortium and thereby ideally positioned to advance team science approaches. V-DUS has been highly productive and is a globally unique, valuable resource for advancing HIV research and training future HIV researchers. During the past grant cycle, >130 of >160 peer-reviewed publications have been led by >70 trainees. The V-DUS is also harmonized with an ongoing NIDA-funded cohort of HIV-positive PWUD and therefore a key control/comparison in work focused on HIV/AIDS among PWUD is possible. Given our environment and track record to date, we are well positioned to generate important scientific evidence on HIV prevention and HIV- associated co-morbidities thereby contributing to high and medium research priorities identified by the NIH Office of AIDS Research and informing efforts to end the HIV/AIDS pandemic.

Public Health Relevance

The purpose of this proposed cohort study is to examine the impact of evolving substance use patterns on HIV prevention and HIV-associated co-morbidities. This study will involve 1800 participants in Vancouver, Canada, including HIV-negative adults who inject drugs and street-involved drug-using youth.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project--Cooperative Agreements (U01)
Project #
2U01DA038886-06
Application #
9997556
Study Section
Special Emphasis Panel (ZDA1)
Program Officer
Schulden, Jeffrey D
Project Start
2015-03-01
Project End
2025-04-30
Budget Start
2020-05-01
Budget End
2021-04-30
Support Year
6
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Simon Fraser University
Department
Type
DUNS #
208032946
City
Burnaby
State
BC
Country
Canada
Zip Code
V5 1S6
Melo, J S; Garfein, R S; Hayashi, K et al. (2018) Do law enforcement interactions reduce the initiation of injection drug use? An investigation in three North American settings. Drug Alcohol Depend 182:67-73
Prangnell, Amy; Shannon, Kate; Nosova, Ekaterina et al. (2018) Workplace violence among female sex workers who use drugs in Vancouver, Canada: does client-targeted policing increase safety? J Public Health Policy 39:86-99
Beaulieu, Tara; Ti, Lianping; Milloy, M-J et al. (2018) Major depressive disorder and access to health services among people who use illicit drugs in Vancouver, Canada. Subst Abuse Treat Prev Policy 13:3
Cheng, Tessa; Small, Will; Nosova, Ekaterina et al. (2018) Nonmedical prescription opioid use and illegal drug use: initiation trajectory and related risks among people who use illegal drugs in Vancouver, Canada. BMC Res Notes 11:35
Bozinoff, Nikki; DeBeck, Kora; Milloy, M-J et al. (2018) Utilization of opioid agonist therapy among incarcerated persons with opioid use disorder in Vancouver, Canada. Drug Alcohol Depend 193:42-47
Gaddis, Andrew; Lake, Stephanie; Tupper, Kenneth et al. (2018) Regular MDMA use is associated with decreased risk of drug injection among street-involved youth who use illicit drugs. Drug Alcohol Depend 192:112-117
Lake, Stephanie; Gaddis, Andrew; Tupper, Kenneth W et al. (2018) 3,4-Methylenedioxymethamphetamine (MDMA; ecstasy) use and transitions to injection drug use among street-involved youth. Subst Abus :1-6
Knight, Rod; Krüsi, Andrea; Carson, Anna et al. (2018) Criminalization of HIV non-disclosure: Narratives from young men living in Vancouver, Canada. PLoS One 13:e0201110
Cheng, Tessa; Small, Will; Dong, Huiru et al. (2018) An age-based analysis of nonmedical prescription opioid use among people who use illegal drugs in Vancouver, Canada. Subst Abuse Treat Prev Policy 13:41
Reddon, Hudson; DeBeck, Kora; Socias, Maria Eugenia et al. (2018) Cannabis use is associated with lower rates of initiation of injection drug use among street-involved youth: A longitudinal analysis. Drug Alcohol Rev 37:421-428

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