March 30, 2011

Late last year, five new research teams began work to address HIV/AIDS and drug use in areas where it is already at epidemic proportions or where it is quickly emerging to become one if efforts are not made to halt or reverse the current momentum. The research projects are the result of NIDA grants designed to stimulate collaborative research among foreign investigators from the same geographic regions to address regional issues on the intersection of HIV/AIDS and drug use in international settings. It is hoped that the research that results from the grants will enhance availability of evidence-based biomedical and behavioral strategies that will improve public health approaches to the prevention and treatment of HIV/AIDS associated with drug use.

The research teams began in earnest late last year to conduct surveillance, prevention, and treatment research utilizing special collaborative opportunities, expertise, resources, populations, and settings to address regionally focused international issues. Three of the five research teams include former NIDA International Program fellows. Highlights of the five projects are provided below:

  • Dr. Sergii Dvoriak, Ukraine, former Hubert H. Humphrey Fellow and recently awarded INVEST-Clinical Trials Network (CTN) Fellow, is working with U.S. investigator Dr. Frederick Lewis Altice, Yale University, to create an innovative and new collaborative research program in Ukraine called PRIDE (Prison-Related Research, Intervention Development, and Evaluation) to address research and implementation issues associated with HIV, substance abuse, and the criminal justice system in the former Soviet Union region. PRIDE creates an infrastructure for research that involves both researchers and the criminal justice system partners and includes collaborators from Ukraine, Kazakhstan, and Georgia. The synergy between researchers and criminal justice system partners allows an open dialogue and opportunity to incorporate implementation research using the Plan-Do-Study-Act (PDSA) method, with the intent that it will yield the most effective outcomes. The three-phase study will include surveillance activities, selection of evidence-based interventions suggested by the surveillance and needs assessment, and pilot testing of the selected interventions. It is hoped that this research will promote and facilitate research to impede the HIV epidemic among injection drug users (IDUs) in Ukraine.
  • Sonia Miranda, Guatemala, and Dr. Carmen Fernandez-Casanueva, Mexico, are conducting research to gain a better understanding of the patterns and context of drug use along the Mexico/Guatemala border and how substance use is related to the spread of HIV, hepatitis C virus (HCV), and sexually transmitted infections (STIs). They aim to describe the contextual factors affecting drug use and patterns of use in high-risk populations along the border; determine the prevalence and correlates of HIV, HCV, and STIs among substance users; and explore the phylo-geography and molecular epidemiology of HIV-1 infection in at-risk groups. This collaborative project will strengthen regional cooperation between researchers in Guatemala, Mexico, and the United States, and help inform the development of HIV interventions and prevention programs that may avert risky substance use behaviors before they become further established. The U.S. principal investigator for this team is Dr. Kimberly C. Brouwer, University of California, San Diego.
  • Olga Levina, NGO Stellit, St. Petersburg, Russia, and Anneli Uuskula University of Tartu, Estonia, are investigating the HIV epidemic in Russia and Estonia, which is largely driven by viral transmission among IDUs. The researchers intend to determine the impacts of ethnicity and stigma on HIV prevalence and on access to care in cities in both countries. They will begin with a rapid policy assessment that offers a better understanding for how systems of prevention and care are organized and how IDUs feel about accessing these services. Further explorations will be done to understand the nature of the three facets of stigma as perceived by IDUs from the dominant and nondominant ethnic groups in each city. The researchers also will conduct a quantitative study to test hypotheses about the impacts of ethnicity and stigma on HIV prevalence and access to prevention and care services. The international researchers are working with Yale University’s Dr. Robert Heimer.
  • U.S. investigator Dr. Hendree Jones is collaborating with Dr. Irma Kirtadze, a 2010 World Health Organization/NIDA/College on Problems of Drug Dependence International Traveling Fellow, and Dr. David Otiashvili, M.D., former NIDA Hubert H. Humphrey Fellow, the Republic of Georgia, to identify the patterns of drug use and cultural contexts of risks in order to adapt and test a comprehensive treatment model for women IDUs with the intent to avert an HIV epidemic and further increases in HCV within the country. Dr. Evgeny Krupitsky, Bekhterev Research Psychoneurological Institute, St. Petersburg, Russia, and 2010 recipient of the NIDA International Award of Excellence, is a co-investigator in Russia and is providing his expert guidance and input on the unique and similar aspects that are occurring in Georgia and Russia which drive the rates of HIV and related co-diseases. He also will provide the scientific team with insight into the factors operating to maintain and reduce drug use in women.
  • South African researchers Drs. Jessie Mbwambo and Anne-Gloria Moleko, along with U.S. investigator Dr. William W. Latimer, Johns Hopkins University, are working to address the large-scale HIV pandemic in Sub-Saharan African countries. A 2008 Joint United Nations Programme on HIV/AIDS report indicates that adults and children living with HIV/AIDS in South Africa and Tanzania account for more than 6.5 million cases in the worldwide epidemic. The researchers plan to test a brief intervention model that can feasibly reach large numbers of drug users at increased risk for HIV. They also aim to test a more intensive couples intervention that may be needed to foster behavior change among high-risk groups disproportionately affected by HIV, including young women who use drugs and trade sex.