Project: Research project

Project Details


Injection drug users play a central role in the current epidemics of HIV
infection and tuberculosis (TB) in the United States. However, important
questions remain unanswered concerning the incidence and prevalence of
Mycobacterium tuberculosis (MTB) infection and disease among drug users,
its specific relationship to drug use, and the effectiveness and impact of
standard TB control strategies (e.g., tuberculin screening, prophylaxis,
and treatment) in drug-using populations.

We propose a research project to address these questions, with three major
categories of study:

1. Studies of MTB Infection and Disease Among Drug Users: To determine the
incidence and prevalence of MTB infection and disease in several
populations of drug users in Connecticut, in relation to demographic,
social, clinical, and behavioral variables. We will describe the community
epidemiology of MTB in New Haven, CT, by creating detailed maps of the
spatial and temporal patterns of drug use, HIV, and MTB in the city
(including molecular genetic analysis of MTB strains), and predict trends
of MTB infection and disease in New Haven drug users over a 3-year period.

2. Studies of the Efficiency of MTB Screening and Prophylaxis as a
Community Intervention Among Drug Users: To estimate the completeness of
existing MTB skin-test screening and chemoprophylaxis programs for drug
injectors in New Haven, by monitoring the number of MTB infections in drug
injectors that are detected and prophylaxed, and using mathematical models
to compare the results with the total estimated number of MTB-infected
drug injectors in the city. We will also predict and determine the impact
of MTB skin-test screening and prophyiaxis among drug injectors on the TB
case rate in New Haven over a 3-year period.

3. Studies Identifying Barriers to Effective MTB Prophylaxis in Distinct
Populations of Drug Users: To compare the effectiveness of different
models for providing MTB chemoprophylaxis to drug users, studying barriers
to adherence with medication regimens in different treatment settings, and
identifying effective strategies for community-based TB control which
could be implemented in other urban settings.

This project brings together a strong, multidisciplinary group of
investigators with long experience in conducting clinical and
epidemiologic studies of TB and HIV infection among drug users. The
setting of a small city with high rates of drug use, MTB, and HIV
infection, a small network of closely linked clinical care providers and
public health agencies, and the broad resources of a major academic
institution, provide unique opportunities in New Haven for a multifaceted
and community-wide research project examining critical and timely issues
concerning TB in drug users and strategies for its control.
Effective start/end date9/1/941/31/99


  • Infectious Diseases
  • Psychiatry and Mental health


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