Understanding alcohol misuse and its impact on viral suppression in youth living with HIV in East Africa

了解东非艾滋病毒感染者滥用酒精及其对病毒抑制的影响

基本信息

批准号：
10159591
负责人：
Sarah Brown Puryear
金额：
$ 20.17万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-15 至 2025-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10159591
关键词：
Accounting Acquired Immunodeficiency Syndrome Address Adolescence Adult Affect Africa Africa South of the Sahara Age Alcohol consumption Alcohols Behavior Behavior Therapy Behavioral Biologic Development Biological Markers Biometry Blood Caring Cause of Death Chronic Chronic Disease Clinical Investigator Clinical Trials Consumption Data Data Analyses Development Elderly Epidemiology Family Focus Groups Foundations Frequencies Gender Goals HIV HIV Seronegativity Individual Intervention Interview Investigation Kenya Knowledge Life Life Cycle Stages Link Longevity Longitudinal cohort Measures Mental Depression Mentors Methods Modality National Institute on Alcohol Abuse and Alcoholism Outcome Outcome Study Parents Patient Self-Report Pattern Pharmaceutical Preparations Prevalence Process Provider Public Health Qualitative Research Randomized Controlled Trials Research Research Priority Resources Review Literature Risk Factors Risk-Taking Schools Stress Structure Surveys Techniques Testing Theory of Change Time Training Training Support Uganda Viral Work Youth alcohol expectancy alcohol intervention alcohol misuse alcohol misuse prevention alcohol research alcohol risk alcohol testing alcohol use disorder behavior change career career development cohort comorbidity design drinking drinking onset early onset epidemiologic data high risk improved intervention cost men mortality peer phosphatidylethanol recruit reduced alcohol use sex skills social factors social stigma substance misuse systematic review therapy design therapy development transmission process trend underage drinking ward

项目摘要

PROJECT SUMMARY/ABSTRACT Youth (ages 15-24) in sub-Saharan Africa (SSA) are disproportionately affected by HIV and are the most likely group to have poor outcomes along the HIV care cascade. The developmental changes of youth influence risk-taking behavior and increase their likelihood of alcohol use, which may be a key contributor to poor HIV outcomes. However, there are substantial knowledge gaps on the scope, context, and impact of alco- hol use on HIV outcomes among youth living with HIV (YLWH) in SSA and a need for youth-specific interven- tions to address risk factors that contribute to poor viral suppression outcomes and high rates of mortality. The proposed training and research plan for this K23 application will allow Sarah Puryear, MD, MPH, to acquire the necessary skills to achieve her career goal of becoming an independent clinical investigator with expertise in quantitative HIV/alcohol research and behavioral intervention design and implementation, to re- duce the negative impact of alcohol use on HIV outcomes, transmission, and co-morbidities among youth in low-resource settings. Under the guidance of a dedicated mentoring team, Dr. Puryear will test the central hy- pothesis that alcohol use among YLWH negatively impacts viral suppression in a life-stage and sex-dependent fashion. She will utilize her findings to develop a preliminary alcohol intervention for youth at high-risk of alco- hol-associated viral non-suppression. The rationale for this project is that high quality epidemiologic data can be used to establish a causal link between alcohol use and viral non-suppression among youth and leveraged to develop much-needed youth-specific solutions that can reduce alcohol use, improve viral suppression, and contribute to decreasing transmission. The central hypothesis will be tested by pursuing two specific aims: 1) Characterize the prevalence, patterns and trajectories of alcohol use among YLWH and examine predictors by life-stage and sex and 2) Determine how alcohol use contributes to viral non-suppression among YLWH. This will be applied in a third aim to (3) Develop a preliminary alcohol intervention that is youth-specific and cultur- ally appropriate. These scientific aims will support training in 1) youth behavior change theory, 2) advanced biostatistics, including causal inference and longitudinal data analysis, and 3) qualitative research for the pur- pose of intervention development. The proposed research will lay the epidemiologic foundation for further work on alcohol use among YLWH in East Africa, closing a critical knowledge gap. It will guide the identification of who (YLWH at highest risk for alcohol-associated viral non-suppression) and when (point in the life course, shifts in drinking pattern) to target interventions and it will incorporate these findings to develop a preliminary youth-specific, culturally appropriate alcohol intervention that will be refined and piloted in a subsequent R34, and subsequent R01 randomized-controlled-trial.

项目概要/摘要撒哈拉以南非洲 (SSA) 的青少年（15-24 岁）受艾滋病毒影响尤为严重，并且是最有可能在艾滋病毒护理级联过程中取得不良结果的群体。青少年的发展变化影响冒险行为并增加饮酒的可能性，这可能是导致艾滋病毒结果不佳。然而，人们对酒精的范围、背景和影响还存在巨大的知识差距。 hol 使用 SSA 感染艾滋病毒的青少年 (YLWH) 的艾滋病毒结果以及针对青少年的干预措施的需要解决导致病毒抑制结果不佳和死亡率高的风险因素。针对该 K23 应用程序拟议的培训和研究计划将使 Sarah Puryear（医学博士、公共卫生硕士）能够获得必要的技能来实现成为一名独立临床研究者的职业目标定量艾滋病毒/酒精研究和行为干预设计和实施方面的专业知识，以重新减少饮酒对青少年艾滋病毒结果、传播和合并症的负面影响低资源设置。在专门的指导团队的指导下，Puryear 博士将测试中央 Hy- 假设 YLWH 中的饮酒会对生命阶段和性别依赖性的病毒抑制产生负面影响时尚。她将利用她的发现为酒精高危青少年制定初步的酒精干预措施。 hol相关病毒不受抑制。该项目的基本原理是高质量的流行病学数据可以用于建立青少年饮酒和病毒不抑制之间的因果关系开发急需的针对青少年的解决方案，以减少饮酒、改善病毒抑制，以及有助于减少传播。将通过追求两个具体目标来检验中心假设：1）描述 YLWH 中饮酒的流行率、模式和轨迹，并通过以下方式检查预测因素：生命阶段和性别；2) 确定饮酒如何有助于 YLWH 中的病毒不被抑制。这将应用于第三个目标（3）制定针对青年和文化的初步酒精干预措施盟友合适。这些科学目标将支持 1) 青少年行为改变理论、2) 高级培训生物统计学，包括因果推理和纵向数据分析，以及 3) 目的的定性研究干预发展的姿态。拟议的研究将为进一步的工作奠定流行病学基础东非 YLWH 的饮酒情况，缩小了关键的知识差距。它将指导识别谁（YLWH 与酒精相关的病毒不抑制的风险最高）以及何时（生命历程中的点，饮酒模式的转变）来制定有针对性的干预措施，并将结合这些发现制定初步的针对青少年的、文化上适当的酒精干预措施将在随后的 R34 中进行完善和试点，以及随后的 R01 随机对照试验。