Responding to HIV and other blood-borne pathogens among people who use illicit drugs

The intertwined pandemics of addiction and HIV/AIDS remain a public health crisis. Among people who use drugs, a substantial number live with HIV/AIDS and many experience suboptimal treatment outcomes.

Efforts to control the spread of HIV/AIDS through scale-up of HIV testing and treatment has been shown to be effective in the general population. However, the strategy has yet to be fully evaluated among groups of people who use drugs. To control the spread of HIV/AIDS in these groups most effectively, more information is needed about the effects on them of social/ structural exposures such as criminalization, marginalization and impoverishment.

This five-year program aims to produce scientific evidence to improve the health of people who are addicted to illicit drugs by targeting the associated blood-borne infections, in particular HIV and hepatitis C, along the following framework:

1. Identifying modifiable social/structural and environmental barriers to optimal outcomes for HIV and hepatitis C treatment, informed by the risk environment framework. 
2. Modelling model social/ structural and environmental factors that affect HIV viral load and new HIV infections at the community level, in the context of BC's province-wide HIV treatment-as-prevention effort.
3. Evaluating the effects on outcomes of HIV treatment of various aspects of the local healthcare systems, such as harm-reduction-based outpatient ART adherence support interventions, using causal inference approaches.
4. Evaluating the uptake and effectiveness of DAA and identifying barriers to successful treatment among drug users infected with both HIV and hepatitis C.

The ultimate goal is to control the spread of HIV/AIDS and improve the health of British Columbians by combining clinical and social epidemiologic approaches to identify the social-structural drivers of ill health and effective evidence-based healthcare interventions.