The AIDS Research Program (ARP) at the National Institute on Drug Abuse (NIDA) convened a group of experts on November 9 and 14, 2018 (See Agenda and Attendee List for both Workshops (PDF, 680KB)), to provide individual input on research gaps and opportunities for advancement of science at the intersection of HIV/AIDS and substance use, abuse, and addiction. The meeting held on November 9, 2018, addressed basic science, while the meeting on November 14, 2018, focused on clinical research. To foster rigorous discussion and elicit valuable feedback, the meetings were structured in a discussion format centered around session topics relevant to NIDA’s mission and the overarching NIH research priorities for HIV and HIV-related research.
Major themes from the meeting included:
- Implementation of PrEP, and HIV and substance use treatments: identifying barriers to implementation e.g. addressing social and provider stigma related to SUDs; ensuring integration of care at all levels of care settings; approaches to identify and recruit difficult to reach populations into HIV care continuum; patient-centered approaches to improving treatment adherence and PrEP intake; coupling novel behavioral interventions with cART and MAT; evaluating the effectiveness of SUD treatment strategies on PrEP intake, ART adherence and other HIV-related health outcomes;
- Biology of HIV acquisition, transmission and persistence in CNS in people using drugs: better knowledge of biological underpinnings of HIV transmission at the mucosal sites; defining neurochemical and signaling processes involved in inflammation and neurological disease; enhanced understanding of host and viral genetic interplay in HIV transcription, latency and persistence in CNS reservoirs in people using drugs; assessing influence of cannabis on HIV and HIV-related comorbidities; identify and validate novel biomarkers for neurocognitive impairment and disease progression; explore role of drugs, HIV and ART on immune mechanisms and on relevant target cell types in CNS; and role of microbiome in HIV infection in the context of drugs.
- Comorbidities and complications related to HIV: targeted therapies to address neurocognitive impairment; integration of testing and care for HCV; addressing frailty and aging in drug using population infected with HIV; administering differentiated models of care; communication of benefits, risks, and adverse effects of drugs to people engaged in policy making (e.g. Marijuana legalization); addressing effects of various types of marijuana on outcomes relevant to HIV and comorbidities; enhanced focus on Cocaine, Heroin, and Methamphetamine, and continued consideration of influence of Nicotine and alcohol addiction in HIV research, care, and health outcomes.
- Tools, technologies and resources: novel neuroimaging technologies to assess disease progress and treatment responses; using multi-Omics approaches to identify novel biomarkers and therapeutic targets; developing better animal models for biomarker and pathogenesis studies and to test novel therapies; setting up centralized testing resources for testing for various types of drugs from a spectrum of biological specimens; creating access to quality biospecimens, biologic and phenotypic data for basic science research; Improving access to drug using populations in clinical research; improve inclusion of drug users in cure and treatment trials; and developing novel therapeutic delivery technologies that cross Blood Brain Barrier.
- Big data, modeling, and bioinformatics: Access to bigdata; better data collection by updating the question frame work around substance use and implementation to enable real-time data collection, data sharing and data harmonization related to substance use; linking to agency-level data for modeling to inform systems-level interventions; incorporate both model and data-driven approaches to care and prevention of HIV and SUD; leveraging multiple data sources; data collection on various types of substances, their use, misuse and addiction, and transitions to substance use in the context of HIV at all level of community settings including rural, suburban and urban to identify predictors of future incidences of HIV and HIV related comorbidities e.g. HCV; and Social network analysis to identify hotspots and key drivers of HIV and HCV transmission
- Vulnerable populations and research across life span: enhanced focus on health disparities research; addressing gaps in diagnosing, treatment and prevention in key populations at increased risk for HIV and substance use e.g. African American, Hispanic or Latino, MSM, Black MSM, and young African American women; research on HIV and drug use in adolescent youth; tailored treatments for youth vs. aging populations with HIV and SUDs e.g. technology-driven approaches mHealth etc. for the young adults at high risk for HIV and SUD.
- Training of next-generation scientists: training program to train next generation scientists in multiple disciplines relevant to HIV and SUD research; training instruments to help new investigators transition to independence (K to R grants); future training efforts to promote training via team science approaches for solving complex problems; and creating opportunities for exposing trainees and postdoctoral fellows to NIDA grant opportunities, program scope, and grant application processes.
- Innovation through team science: Exploring ways to address complex research questions by bridging across scientific disciplines, community, national agencies and global -level resources; novel platforms to enrich collaborations and cross-fertilization through bringing together scientists and other key stakeholders, ideas, and resources; creating novel forums for public-academic-private-government partnerships.
NIDA intends to publish an RFI in the week of January 7, 2019. Feedback from the RFI, strategic planning meetings, and input from key NIH and NIDA leadership will assist in the development of the NIDA HIV/Drug Use, Abuse, and Addiction Research Strategic Plan. An overview of the strategic plan will be presented to The National Advisory Council on Drug Abuse (NACDA) in May 2019 and will be available to the public soon after the approvals.