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Principal Investigator: STEFFANIE A. STRATHDEE
Organization: UNIVERSITY OF CALIFORNIA, SAN DIEGO
Fiscal Year: 2022
Award: $379,961
Funding agency: National Institute on Drug Abuse
In response to NOT-OD-22-159, this project will leverage an ongoing cohort of people who inject drugs (PWID)
in the U.S.-Mexico border region to study the epidemiology of monkeypox virus (HMPXV) to inform prevention
interventions to diagnose and treat HMPXV and curtail transmission. Although it is well known that PWID face
numerous health disparities including higher rates of HIV, HCV and sexually transmitted infections (STIs) than
the general population, experts are concerned that the ongoing outbreak of HMPXV, which is the largest
international outbreak recorded since this virus first emerged in the 1970’s, will soon disproportionately affect
people experiencing homelessness (PEH), which includes a high proportion of PWID. Our team includes
epidemiologists, prevention interventionists, molecular virologists and infectious disease physicians to address
these aims: Aim 1. To determine the prevalence and correlates of subclinical and symptomatic HMPXV
infection among PWID in the San Diego/Tijuana (SD/TJ) border region to inform the development of prevention
interventions. H1. PWID who are unstably housed (H1.1), Latinx (H1.2) or living with HIV and not receiving
ART (H1.3) will be significantly more likely to test positive for HMPXV infection. Aim 2. To estimate incidence
and risk factors of HMPXV infection among PWID over a one-year period. H2.1 PWID who report recently
having abscesses associated with injection drug use, STIs or open sores will be more likely to acquire HMPXV
during follow-up. H2.2. PWID who report engaging in sex work and those with higher numbers of sex partners
will be more likely to acquire HMPXV during follow-up. Aim 3. To determine network features associated with
cross-border transmission of HMPXV among PWID. H3.1 Cross-border drug tourism between SD and TJ (by
participants & their network contacts) will be associated with HMPXV infection. H3.2. Network-level risk factors
such as total number of contacts and number of contacts who are MSM, sex workers, unstably housed, or
have a history of incarceration will be independently associated with HMPXV infection after controlling for
individual-level risk factors. Aim 4: To conduct phylogenomic characterization of circulating HMPXV variants in
the SD/TJ region including mutation signatures (e.g., APOBEC3). H4.1 Circulating HMPXV will have a single
origin (lineage B.1) followed by local dispersal. We will leverage the binational infrastructure of our NIDA-
funded binational cohort of PWID, and support from a new pandemic preparedness institute at UCSD to
conduct HMPXV PCR testing and sequencing on swabs collected from any suspect lesions/vesicles as well as
oral and anal swabs. Serologic HMPXV testing will be done in-kind by the CDC. Findings will inform potential
interventions and policies, including whether PWID and/or PEH should be recommended for routine
vaccination and whether subsequent interventions to increase HMPXV testing, vaccination and treatment in
this vulnerable population should be network or venue-based, following NIMHD’s conceptual model for
structural interventions.
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Infections><Health system><Hepatitis A Virus><Hepatitis C virus><History><Homelessness><Human><Human Immunodeficiency Viruses><Human T-Lymphotropic Virus Type III Infections><Immunosuppression><Immunosuppression Effect><Immunosuppressive Effect><Imprisonment><Incidence><Individual><Infection><Infectious Disease Contact Tracing><Infectious Disease Pathway><Infectious Diseases><Infectious Disorder><Infrastructure><Injecting drug user><Injection Drug User><Injections><Institutes><International><Intervention><Intervention Strategies><Interviewer><Investigation><LAV-HTLV-III><Latin America><Latinx><Leisures><Lesion><Letters><Location><Lymphadenopathy-Associated Virus><M tuberculosis infection><M. tb infection><M. tuberculosis infection><M.tb infection><M.tuberculosis infection><MSM><MTB infection><Masks><Mediating><Medication><Mexico><Migrant><Modern Man><Molecular><Monkey Pox Virus><Monkeypox virus><Monkeypoxvirus><Mutation><Mycobacterium tuberculosis (MTB) infection><Mycobacterium tuberculosis infection><NCMHD><NIDA><NIMHD><National Center on Minority Health and Health Disparities><National Institute of Drug Abuse><National Institute on Drug Abuse><National Institute on Minority Health and Health Disparities><Oral><Outbreaks><PWID><Participant><Persons><Pharmaceutic Preparations><Pharmaceutical Preparations><Physicians><Policies><Population><Prevalence><Preventative intervention><Prevention><Primary Prevention><Recording of previous events><Reporting><Risk Factors><Rocky Mountain Spotted Fever><Rodent><Rodentia><Rodents Mammals><SARS corona virus 2><SARS-CO-V2><SARS-COVID-2><SARS-CoV-2><SARS-CoV2><SARS-associated corona virus 2><SARS-associated coronavirus 2><SARS-coronavirus-2><SARS-related corona virus 2><SARS-related coronavirus 2><SARSCoV2><Sao Paulo Typhus><Scientist><Secondary Prevention><Serology><Serology test><Severe Acute Respiratory Coronavirus 2><Severe Acute Respiratory Distress Syndrome CoV 2><Severe Acute Respiratory Distress Syndrome Corona Virus 2><Severe Acute Respiratory Distress Syndrome Coronavirus 2><Severe Acute Respiratory Syndrome CoV 2><Severe Acute Respiratory Syndrome-associated coronavirus 2><Severe Acute Respiratory Syndrome-related coronavirus 2><Severe acute respiratory syndrome associated corona virus 2><Severe acute respiratory syndrome corona virus 2><Severe acute respiratory syndrome coronavirus 2><Severe acute respiratory syndrome related corona virus 2><Sexual Partners><Sexually Transmitted Diseases><Sexually Transmitted Disorder><Sexually Transmitted Infection><Shigella><South America><Structural Models><Substance Use Disorder><Survey Instrument><Surveys><Swab><Syphilis><TB infection><Testing><Transmission><Tuberculosis><Ulcer><Ulceration><United States Centers for Disease Control><United States Centers for Disease Control and Prevention><Vaccination><Variant><Variation><Venereal Diseases><Venereal Disorders><Venereal Infections><Vesicle><Virus><Virus-HIV><Vulnerable Populations><Work><Wuhan 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intervention><preventional intervention strategy><preventive intervention><public health emergency><response><serology assay><sex><sex partner><substance use><substance using><transmission process><tuberculosis infection><tuberculous spondyloarthropathy><unhoused><unstable housing><unstably housed><vulnerable group><vulnerable people>