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

• 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
• 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

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.

项目摘要/摘要 撒哈拉以南非洲（SSA）的青年（15-24岁）受艾滋病毒的影响不成比例，是 在艾滋病毒护理级联级联的情况下，最有可能的群体的结果很差。青年的发展变化 影响冒险行为并增加其饮酒可能性，这可能是 艾滋病毒的不良结果。但是，关于alco-的范围，背景和影响的知识差距很大 在SSA中艾滋病毒（YLWH）青年中的艾滋病毒结局中使用HOL，并且需要特定于青年的介入 - 解决导致病毒抑制结果不良和高死亡率的危险因素的问题。 该K23应用的拟议培训和研究计划将使Sarah Puryear，MD，MPH， 获得必要的技能，以实现自己成为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 在青年中，饮酒对艾滋病毒结局，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 在YLWH中使用酒精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。她将利用自己的发现来为年轻人在Alco-of Alco-的高风险中开发初步的酒精干预措施 HOL相关病毒非抑制。该项目的理由是高质量的流行病学数据可以 用于在青年中建立酒精使用与病毒不抑制之间的因果关系 开发急需的青年特定解决方案，以减少酒精的使用，改善病毒抑制和 有助于减少传输。中央假设将通过追求两个具体目标来检验：1） 表征YLWH中酒精使用的患病率，模式和轨迹，并通过 生命阶段和性别以及2）确定酒精的使用如何有助于YLWH中的病毒不抑制。这 将在第三个目的中应用（3）开发初步的酒精干预措施，该干预措施是青年特定和文化 适合盟友。这些科学目标将支持培训1）青年行为改变理论，2） 生物统计学，包括因果推断和纵向数据分析，以及3）定性研究 干预开发的姿势。拟议的研究将为进一步工作奠定流行病学基础 关于东非的YLWH中的酒精使用，缩小了关键的知识差距。它将指导识别 谁（YLWH有与酒精相关的病毒非抑制风险最高的风险），以及（在生活中指向， 饮酒方式的转变）向目标干预措施，它将结合这些发现以开发初步 在随后的R34中将进行完善和试验，特定于青年的，适合文化的饮酒干预措施， 并随后进行R01随机控制 - 试验。