NIH Funding Opportunity for Drug Abuse Prevention Research Holds Potential for Addressing Viral Hepatitis

The National Institute on Drug Abuse (NIDA), part of NIH, has released a Funding Opportunity Announcement (FOA) for research that will increase understanding of the science of drug use prevention within diverse populations and settings. Given the high prevalence of hepatitis C virus (HCV) infection among persons who inject drugs (PWID), this research also holds the potential to inform our efforts to prevent the transmission of HCV associated with drug use

To reduce the incidence of viral hepatitis associated with drug use behaviors, the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis (Action Plan) calls for ensuring that individuals who inject drugs have access to viral hepatitis prevention, care, and treatment services as well as for advancing research to improve the prevention of viral hepatitis among persons who use drugs.

Under this new FOA, NIDA – one of the federal partners in the Action Plan – seeks grant applications that identify and test population-level approaches for the prevention of: drug use and abuse; drug-related problems (such as mental health, interpersonal violence, criminal involvement, and productivity loss); and conditions where drug use or drug administration (e.g., injection) significantly contributes to risk, recurrence, or severity of other illnesses (e.g., bloodborne infections like HCV and other conditions, such as psychiatric disorders).

The FOA seeks proposals that may include studies of cognitive, behavioral, and social processes related to:

• Development of novel prevention approaches
• Efficacy and effectiveness of prevention interventions or programs
• Processes that optimize the selection, integration, implementation and sustainability of science-based prevention, including systems-level and health economic factors
• Methodologies appropriate for studying complex aspects of prevention science.

The injection of illegal drugs, like heroin, is a contributing factor to the current HCV epidemic in the United States. 2002-2009 surveillance data from the Massachusetts Department of Health revealed increasing rates of HCV infection among young people who inject drugs (PWID). Subsequent studies from other parts of the country have indicated similar trends, with HCV rates increasing in suburban and rural settings among young people who have transitioned to heroin injection following misuse of oral prescription opioids. The Centers for Disease Control and Prevention’s 2012 Viral Hepatitis Surveillance Report indicates that the prevalence of HCV continued to grow among young injectors from 2010-2012, highlighting the importance of drug use prevention efforts as important opportunities to prevent the further spread of HCV.

In February 2013 the U.S. Department of Health and Human Services (HHS) Office of HIV/AIDS and Infectious Disease Policy (OHAIDP) convened a 2-day technical consultation of key experts and stakeholders to explore the emerging epidemic of HCV among young PWID. In the consultation reportExit Disclaimer, several barriers to addressing HCV in young PWID were identified, including:

• Asymptomatic disease and low utilization of healthcare by young injectors
• Challenges in accessing young nonurban injectors
• Lack of culturally appropriate drug treatment programming in nonurban areas
• Limited HCV treatment availability in nonurban areas
• Limited interest in drug or HCV treatment among young PWID

In the 2013 Progress Report on the Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis, Dr. Elinore McCance-Katz, Chief Medical Officer at the Substance Abuse and Mental Health Services Administration (SAMHSA), commented that “Viral hepatitis is a major comorbidity among persons who inject drugs. It has been estimated that 11 percent of PWID are infected with hepatitis B and 64 percent are infected with hepatitis C. It is also important to note the evolving epidemiology of hepatitis C in the United States, which includes increased HCV in young people who inject heroin and who initiated opioid use with prescription opioid analgesics… In the context of intoxication, risky behaviors, such as injection by those who do not regularly inject or engaging in high-risk sexual behaviors that can also result in viral hepatitis transmission, underscore the need to enhance our outreach, prevention, screening, and treatment efforts with all drug users.”

Through research into targeted prevention efforts, this FOA will provide opportunities to further our understanding of how best to prevent drug use and HCV infection among vulnerable populations. The open date for this FOA is May 5, 2015, with non-AIDS applications due June 5, 2015 and AIDS and AIDS-related applications due September 7, 2015.