ARV effects on HIV epidemiology and behaviors in Rakai, Uganda

抗逆转录病毒药物对乌干达拉凯艾滋病毒流行病学和行为的影响

• 批准号: 7233967
• 负责人: Maria J Wawer
• 金额: $ 164.73万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-15 至 2010-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7233967
• 关键词: AIDS prevention; Address; Adherence; Adult; Affect; Africa; Alcohol consumption; Anti-Retroviral Agents; Antiretroviral resistance; Attitude; Behavior; Behavioral; Belief; Birth; CCL4 gene; Caring; Censuses; Cessation of life; Characteristics; Child; Clinical; Cohort Studies; Communities; Community Surveys; Complex; Consent; Contraceptive Usage; Counseling; Couples; Data; Data Analyses; Depth; Developed Countries; Disinhibition; Divorce; Drug resistance; Effectiveness; Eligibility Determination; Epidemic; Epidemiology; Equilibrium; Failure; Family; Focus Groups; Fostering; Funding; General Population; Grant; Growth; HIV; HIV Infections; HIV diagnosis; HIV drug resistance; Health; Health Sciences; Hemoglobin; Home environment; Household; Human Milk; Incidence; Individual; Infant; Infection; Interview; Knowledge; Laboratories; Liver; Marital Fertility; Marital Status; Medical Surveillance; Milk Substitutes; Monitor; Mothers; Mutation; Nevirapine; Observational Study; Orphan; Out-Migrations; Patients; Perception; Persons; Pharmaceutical Preparations; Population; Pregnancy Rate; Pregnancy loss; Prevalence; Prevention; Prevention education; Principal Investigator; Qualitative Research; Rate; Recombinants; Renal function; Reporting; Research; Research Personnel; Resistance; Risk Behaviors; Rural; Sample Size; Screening procedure; Services; Social support; Stigmata; Structure; Subgroup; Surveys; Testing; Time; Uganda; Unmarried person; Vertical Disease Transmission; Viral Load result; Woman; aged; antiretroviral therapy; base; behavioral health; cost; experience; follow-up; high risk behavior; marital violence; mortality; novel; prevention service; programs; response; service utilization; social; social stigma; transmission process; trend

DESCRIPTION (provided by applicant): The provision of HIV antiretroviral (ARV) therapy in Africa will have beneficial health and social effects, but will present many challenges. Since the drugs are now being initiated in Uganda, we have a narrow window of opportunity to assess the population-level impact of ARVs on HIV transmission and epidemiology, on behaviors in both HIV+ and HIV uninfected persons, and on sociodemographic indicators. Information is also needed on the emergence and transmission of drug resistance mutations, the effects of prior maternal nevirapine use on subsequent ARV effectiveness, and on barriers to ARV acceptance and adherence. The Rakai Health Sciences Program has received PEPFAR funds to initiate an ARV program in rural Rakai District, Uganda. Since 1994, we have conducted the Rakai Community Cohort Study (RCCS) and have longitudinal population-based information on HIV epidemiology, and on community risk behaviors, health and sociodemographic characteristics. These data provide a baseline for the assessment of ARV effects. Rakai has a mature, generalized epidemic, with a prevalence of 15% and an incidence of approximately 1.4/100 py. Under the proposed R01 (complementary to PEPFAR), we plan to conduct integrated quantitative and qualitative research in RCCS communities (n= 12,000 adults and approximately 600 children) and in non-RCCS comparison communities (n = 1,000 adults). We propose to examine epidemiological effects of ARVs (HIV incidence and prevalence; emergence and transmission of drug-resistant HIV, treatment acceptance and effectiveness, mother-to-child HIV transmission by subtype [A, D, AD recombinant]; as well as behavioral, social and demographic effects (behavioral disinhibition, use of HIV counseling and testing, use of other prevention services, contraceptive use, mortality, fertility, marital stability and orphanhood). We will also examine knowledge and attitudes towards ARVs, and the effects of stigma on ARV use. The study will provide unique data to guide HIV care in Africa and for projecting the course of the epidemic in the ARV era.

描述（由申请人提供）：在非洲提供HIV抗逆转录病毒（ARV）疗法将具有有益的健康和社会影响，但会带来许多挑战。由于目前正在乌干达开始使用这些药物，因此我们有一个狭窄的机会窗口来评估ARV对HIV传播和流行病学的人群级别的影响，对未感染的HIV+和HIV未感染的人的行为以及对社会人口统计学指标的行为。还需要有关耐药性突变的出现和传播，先前母体奈韦拉平对随后的ARV有效性的影响以及ARV接受和依从性的障碍。 Rakai Health Sciences计划已获得PEPFAR资金，以在乌干达Rakai区启动ARV计划。自1994年以来，我们进行了Rakai社区队列研究（RCC），并拥有基于纵向人群的艾滋病毒流行病学信息以及社区风险行为，健康和社会人口统计学特征。这些数据为评估ARV效应提供了基准。 Rakai具有成熟的，普遍的流行病，患病率为15％，发生率约为1.4/100 Py。 根据拟议的R01（对PEPFAR的补充），我们计划在RCCS社区（n = 12,000名成年人和大约600名儿童）和非RCC比较社区（n = 1,000名成年人）中进行综合定量和定性研究。 We propose to examine epidemiological effects of ARVs (HIV incidence and prevalence; emergence and transmission of drug-resistant HIV, treatment acceptance and effectiveness, mother-to-child HIV transmission by subtype [A, D, AD recombinant]; as well as behavioral, social and demographic effects (behavioral disinhibition, use of HIV counseling and testing, use of other prevention services, contraceptive use, mortality, fertility,婚姻稳定性和孤儿院也将检查对ARV的知识和态度，污名对ARV的影响将提供独特的数据，以指导非洲的艾滋病毒护理和预测ARV时代的流行病学。