Community and Interpersonal Stress, Alcohol, and Chronic Comorbidities among PLWH

感染者中的社区和人际压力、酒精和慢性合并症

• 批准号: 9917264
• 负责人: Tekeda F. Ferguson
• 金额: $ 10.42万
• 依托单位: LSU HEALTH SCIENCES CENTER
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9917264
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adult; Age; Aging; Alcohol consumption; Alcohols; Basic Science; Behavioral; Behavioral Mechanisms; Biological; Cardiovascular Diseases; Caring; Chronic; Chronic Disease; Clinical; Clinical Data; Cognitive; Communities; Continuity of Patient Care; Data; Diabetes Mellitus; Discrimination; Disease Management; Disease Progression; Distal; Elderly; Ensure; Environmental Risk Factor; Epidemiology; Exposure to; General Population; Geography; Goals; HIV; HIV antiretroviral; Health; Health behavior; Healthcare; Household; Individual; Infrastructure; Intervention; Kidney Diseases; Knowledge; Life Expectancy; Link; Malignant Neoplasms; Measurable; Mediating; Mediation; Mental Health; Metabolic; Mission; Modeling; National Institute on Alcohol Abuse and Alcoholism; Neighborhoods; Neurocognitive Deficit; Osteoporosis; Outcome; Participant; Pathway interactions; Persons; Physiological; Play; Population; Public Health; Quality of life; Research; Risk; Role; Science; Secondary Prevention; Shapes; Social support; Space Models; Stress; Structure; Syndrome; Techniques; Testing; Time; Translations; United States; Viral Load result; Virus Diseases; Vulnerable Populations; alcohol comorbidity; alcohol effect; alcohol risk; alcohol use disorder; antiretroviral therapy; base; behavioral/social science; cardiometabolism; care outcomes; cohort; comorbidity; comparison group; coping mechanism; evidence base; experience; frailty; health disparity; high risk; housing instability; immunological status; improved; minority communities; minority health; mortality; novel; psychosocial; social; social determinants; social space; socially disenfranchised; stressor; success

Abstract LSUHSC CARC Research Component 1: Community and Interpersonal Stress, Alcohol, and Chronic Comorbidities among PLWH Aging persons living with HIV (PLWH) are a vulnerable population at higher risk for chronic illnesses and geriatric syndromes (i.e., metabolic alterations, diabetes, cardiovascular disease, cancer, renal disease, and osteoporosis). Higher levels of both psychosocial and physiological stress among PLWH have also been associated with poorer immune status, increased viral load over time, faster disease progression, and higher rates of mortality. Comorbid conditions in PLWH can be further exacerbated by at-risk alcohol use; and PLWH are two to three times more at risk of alcohol use disorder (AUD). There is a critical need for a deeper understanding of the roles that social determinants at the community and interpersonal levels play in chronic comorbidities in PLWH. Neighborhoods and social spaces are important contexts through which social determinants act to shape health and health behavior. However, there is a fundamental gap in current scientific evidence-based knowledge about what people actually experience in these contexts, their impact on care for PLWH, and how they may interact with other drivers of sub-optimal care such as at-risk alcohol use and clinical comorbidities. Our preliminary data suggest a significant role of stress exposure at multiple levels on alcohol use outcomes and comorbidities. The objective of Research Component 1 (RC1) is to determine the impact of community and interpersonal stress on behavioral and chronic comorbidities among PLWH, and the unique role that alcohol use plays in the pathways. Our central hypothesis is that exposure to stressors at the community and interpersonal levels will impact clinical comorbidities, such as cardiometabolic and cognitive outcomes in PLWH, through impacts on alcohol use and additional behavioral and coping mechanisms. Our approach will involve the incorporation of individual level demographic and clinical data along with neighborhood data and interpersonal exposures from PLWH and HIV- adults. We will incorporate advance modeling techniques to determine the relation of individual, interpersonal, and community level measurable variables and latent constructs, testing longitudinally the mediation of the effects by alcohol consumption. We will also explore in depth individual space and time geographical momentary assessment (GMA) data collected from this cohort. RC1’s proposed research links basic science with behavioral and social sciences, to epidemiology to determine the role in alcohol in HIV-associated comorbidities. Our project will provide key data that will directly inform multilevel interventions to improve the health of minority communities and neighborhoods that continually sustain the biggest burden of HIV and associated comorbidities.

摘要LSUHSC CARC研究组件1： PLWH中的社区和人际压力，酒精和慢性合并症 患有艾滋病毒（PLWH）的老龄化患者是慢性疾病和老年病风险较高的脆弱人群 综合征（即代谢改变，糖尿病，心血管疾病，癌症，肾脏疾病和 骨质疏松症）。 PLWH中的社会心理和身体压力的较高水平也是 与较差的免疫状况相关，随着时间的流逝，病毒载荷增加，疾病进展更快以及更高 死亡率。 PLWH中的合并症可能会因高危酒精的使用而进一步加剧；和plwh 面临饮酒障碍风险的两到三倍（AUD）。迫切需要更深入 了解社会决定者在社区中的角色和人际关系级别在慢性中的作用 PLWH的合并症。社区和社会空间是社会的重要背景 决定因素可以塑造健康和健康行为。但是，目前的科学存在根本差距 关于人们在这些情况下实际经历的基于证据的知识，他们对护理的影响 PLWH，以及它们如何与其他亚最佳护理的驱动因素（例如酒精使用和临床）相互作用 合并症。我们的初步数据表明，在多个级别上，压力暴露在饮酒中的重要作用 结果和合并症。研究组件1（RC1）的目的是确定 社区和人际压力对PLWH的行为和慢性合并症以及独特的角色 酒精使用在路径中发挥作用。我们的中心假设是，社区承受压力源 人际关系水平将影响临床合并症，例如心脏代谢和认知结果 PLWH，通过对饮酒以及其他行为和应对机制的影响。我们的做法意愿 涉及将个人级别的人口统计和临床数据以及邻里数据和 PLWH和HIV-成年人的人际关系暴露。我们将将预先建模技术纳入 确定个人，人际和社区级别可测量变量和潜在的关系 构造，纵向测试饮酒的介导。我们还将探索 深度从该队列收集的深度个人空间和时间地理位置瞬时评估（GMA）数据。 RC1提出的研究将基础科学与行为和社会科学联系起来，与流行病学联系起来 在酒精中的艾滋病毒相关合并症中的作用。我们的项目将提供关键数据，以直接告知 多层次干预措施，以改善不断维持的少数民族和社区的健康 艾滋病毒和相关合并症最大的伯恩。