Proyecto Vida: Developing an HIV, HCV and opioid use MOST intervention for persons who inject drugs along the Texas-Mexico Border

University Of California, San Francisco, San Francisco CA

Investigators

Abstract

Project Summary The proposed K01 supports the training of a Chicana epidemiologist in intervention science and phylogenetic analysis to address the co-occurring and mutually reinforcing epidemics of HIV, hepatitis C (HCV) and opioid use among Latino persons who inject drugs (PWID) living along the Texas-Mexico Border. The study location, Ciudad Juárez, Mexico, is largely underserved and associated with a high prevalence of HCV (>80%) and HIV (>10%) among the 10,000 Latino PWID who largely inject opioids (>90%).The proposal draws from the multiphase optimization strategy (MOST), an intervention framework for developing and testing multi-component interventions within real-world constraints. Career development activities are centered around the MOST Preparation Phase that includes optimizing four intervention protocols, developing a testable conceptual model, and conducting a 2-to-3 factorial experiment to assess the feasibility and acceptability of a future larger trial. Intervention components and outcomes include (a) peer navigation for to increase HCV treatment engagement and cure (HCV-PN), (b) HIV testing and PrEP education (HIVT/PrEP) to increase quarterly HIV testing and PrEP knowledge, (c) opioid agonist treatment (OAT) to decrease opioid use , and (d) syringe services to reduce sharing injection equipment. A novel strategy toward HCV and HIV elimination among PWID is to merge intervention science with phylogenetic testing to reveal subgroups experiencing suboptimal HCV care outcomes and track transmission networks. Career development activities will include didactic training in intervention science and phylogenetics, with applied learning activities conducting a small-scale MOST trial paired with HCV phylogenetics. Phylogenetic testing is a powerful mechanism for distinguishing between HCV treatment failure and reinfection, which can lead to resistance associated substitutions. Phylogenetic results can then feed into the HCV-PN intervention to address the needs of PWID sub-groups experiencing HCV sub-optimal care who need additional support. The proposed K01 specific aims, mentorship, training plan, community partnerships, and prior training will launch this early-stage investigator’s independent research career using modern intervention science methods integrated with biomarkers. Finally, the proposed research activities will pave the way for a larger R01-funded study and aligns with NIDA’s Strategic Plan 2022-26 of addressing of co-occurring epidemics, applying novel interventions strategies, and accelerating the implementation of evidence-based strategies in real-world settings that benefit underserved communities.