Ethno-epidemiology of HCV, HIV and Overdose associated with Drug Markets and Drug Tourism

This Diversity Supplement will be conducted based on data obtained from the study Ethno- epidemiology of HCV, HIV and Overdose associated with Drug Markets and Drug Tourism project (R01DA049644, PI: Strathdee), called La Frontera. The overall goal of the parent grant is to characterize trends in incidence of HIV, HCV, and overdose associated with binational drug markets and drug tourism between San Diego and Tijuana, Mexico. La Frontera conducts prospective quantitative and qualitative surveillance of retail drug markets in both San Diego and Tijuana, coupled with epidemiologic data collection of 600 PWID (200 drug tourists from San Diego; 200 non-drug tourists from San Diego and 200 non-drug tourists from Tijuana). This Diversity Supplement is focused on access to water sanitation and hygiene (WASH) among the population of people who inject drugs (PWID) studied in La Frontera, and is planned to be feasibly conducted in the proposed two-year funding period. Data analyses proposed in this supplement will include data from La Frontera conducted among PWID in the Tijuana and San Diego metropolitan area, which was already collected. This dataset included a six-, 12-, and 18-month follow up during the COVID-19 pandemic, representing a valuable opportunity to assess shifts in health behavior and health risks among PWID in both cities. AIM 1 will describe WASH access at baseline interview, and at 6-month follow-up, among men and women who inject drugs in the Tijuana and San Diego metropolitan area, and by housing status during the COVID-19 pandemic period, from October 2020 to December 2021. AIM 2 will determine if limited access to WASH is associated with higher incidence and prevalence of abscesses in injection locations at over an 18-month follow-up period among PWID in the TJ and SD metropolitan area. AIM 3 will examine if limited access to WASH is associated with higher seroprevalence of SARS-CoV-2 infection among PWID in the Tijuana and San Diego metropolitan area. WASH is a human right and is often violated among vulnerable communities such as PWID, and people experiencing housing insecurity. Although access to WASH services has been poorly studied among PWID, there is ample room for concern, as non-hygienic environments or practices could increase risk of developing abscesses, HIV or Hepatitis C complications, and myocarditis. This supplement offers Dr. Calderon Villarreal a unique opportunity to collaborate and mutually strength the understanding of PWID's unmet needs and how they are driving poor health outcomes and will support her goal to becoming an independent investigator focusing on the intersection between substance use, WASH and health disparities.