International Epidemiologic Databases to Evaluate AIDS-Southern Africa (IeDEA-SA)

评估南部非洲艾滋病的国际流行病学数据库 (IeDEA-SA)

• 批准号: 8299380
• 负责人: Mary-Ann Davies
• 金额: $ 386.83万
• 依托单位: UNIVERSITAT BERN
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8299380
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adolescent; Adult; Affect; Anthropometry; Anti-Retroviral Agents; Birth; Botswana; CD4 Positive T Lymphocytes; Cancer Patient; Caring; Cessation of life; Child; Clinical; Comorbidity; Country; Data; Databases; Epidemic; Epidemiology; Exposure to; Fertility; Government; Growth; HIV; Health Policy; Infant; International; Intervention; Lesotho; Link; Malawi; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Meta-Analysis; Methods; Monitor; Mozambique; Nature; Patients; Pregnancy Outcome; Pregnant Women; Program Effectiveness; Recurrence; Regimen; Risk; Rural; Screening procedure; South Africa; Southern Africa; Surveys; Time; Toxic effect; Tuberculosis; Viral Load result; Zambia; Zimbabwe; cohort; feeding; follow-up; mathematical model; mortality; neoplasm registry; postnatal; premature; public health research; resistance mutation; response; treatment program; treatment strategy; trend

DESCRIPTION (provided by applicant): Background: This proposal asks for continued support of leDEA-SA, a large collaborative network of HIV care and antiretroviral treatment (ART) programs in Southern Africa. Aims: (i) to provide the best available data on long-term program effectiveness in children, adolescents and adults; (ii) to describe long-term regimen durability and tolerability and examine different monitoring and treatment strategies, with a focus on viral load and second-line ART; (iii) to describe co-morbidities, focusing on tuberculosis and cancer and (iv) to follow up pregnant women on ART and cohorts of ART-exposed non HIV-infected infants and infected infants, and (v) to build capacity in the region. Methods: 20 urban and rural ART programs from 7 countries (Botswana, Lesotho, Malawi, Mozambique, Republic of South Africa, Zambia, Zimbabwe) with follow-up up to 10 years will pool data to create a database of 400,000 HIV-infected adults, 10,000 adolescents, 36,000 children and 6,700 infants, with about 70% of patients on ART. In South Africa, HIV data will be linked to the National Cancer Registry, National Death and Birth Registers, and the Tuberculosis Register. Mortality, loss to follow-up, tuberculosis and recurrent tuberculosis, and AIDS-defining and other cancers will be analyzed, as well as fertility, CD4 cell trajectories, treatment-limiting toxicities, response to second-line ART and resistance mutations in adults and children failing ART. Trends in exposure to antenatal and postnatal ARVs, pregnancy outcomes including prematurity and anthropometry, feeding practices and growth over 18 months will be examined in sub- cohorts of pregnant women and infants. We will survey the provision of care to cancer patients, and compare different screening strategies for invasive cervical cancer. Statistical analyses will consider the hierarchical nature of the data, missing data and loss to follow-up, competing risks and time-dependent confounding, and new methods will be developed. Accumulating results will be used to build and parameterize a mathematical model of ART in children, adolescents and adults, which will reflect the realities of HIV care and ART in Southern Africa, and inform health policy. RELEVANCE: Southern Africa is the region most heavily affected by the HIV epidemic. Since 2004, efforts by governments and others have resulted in a massive increase in HIV/AIDS interventions and particularly ART. Operational, clinical and public health research is urgently needed to guide the long-term delivery of HIV care and ART to the many patients in need, including pregnant women, infants, children and adolescents.

描述（由申请人提供）： 背景：该提案要求持续支持Ledea-SA，这是南部非洲的大型艾滋病毒护理和抗逆转录病毒治疗（ART）计划的大型合作网络。目的：（i）提供有关儿童，青少年和成人长期计划效率的最佳可用数据； （ii）描述长期疗法耐用性和耐受性并检查不同的监测和治疗策略，重点是病毒载荷和二线艺术； （iii）描述合并症，重点关注结核病和癌症，以及（iv），跟随孕妇在艺术和曝光的非HIV未感染的婴儿和受感染的婴儿中，以及（v）在该地区建立能力。方法：来自7个国家 /地区的20个城市和农村艺术计划（博茨瓦纳，莱索托，马拉维，莫桑比克，南非共和国，赞比亚，赞比亚，津巴布韦），最多10年的随访将汇总数据库，以创建400,000名受HIV感染的HIV感染的成人，10,000名少年，36,000名儿童，36,000名儿童和6,700名患者，包括大约70％的患者。在南非，艾滋病毒数据将与国家癌症登记处，国家死亡和出生记录以及结核病登记册有关。将分析死亡率，对随访的损失，结核病和复发性结核病以及定义的艾滋病和其他癌症，以及生育能力，CD4细胞轨迹，治疗限制性毒性，对成人和儿童失败的二线艺术和耐药性突变的反应。暴露于产前和产后ARV的趋势，包括早产和人体测量法，包括早产，喂养实践和18个月内的增长趋势，将在孕妇和婴儿的亚军中进行检查。我们将调查为癌症患者提供护理，并比较侵入性宫颈癌的不同筛查策略。统计分析将考虑数据的层次结构性质，缺少数据和随访，竞争风险和时间依赖的混杂性以及新方法。积累结果将用于建立和参数化儿童，青少年和成人艺术数学模型，这将反映南部非洲的艾滋病毒护理和艺术的现实，并为健康政策提供信息。 关联： 南部非洲是受艾滋病毒流行最严重影响的地区。自2004年以来，政府和其他人的努力导致艾滋病毒/艾滋病干预措施，尤其是艺术品的大量增加。迫切需要进行操作，临床和公共卫生研究，以指导为许多有需要的患者（包括孕妇，婴儿，儿童和青少年）长期提供艾滋病毒护理和艺术。