Unhealthy alcohol use, other drug use, and mental health disorders: comorbidity burden in people with HIV, gaps in treatment, and impact on the HIV care continuum

不健康的饮酒、其他药物使用和精神健康障碍：艾滋病毒感染者的合并症负担、治疗差距以及对艾滋病毒护理连续性的影响

• 批准号: 9925957
• 负责人: Catherine Lesko
• 金额: $ 18.24万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-25 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9925957
• 关键词: Accounting; Acquired Immunodeficiency Syndrome; Address; Alcohol abuse; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Antidepressive Agents; Anxiety; Bayesian Method; Bayesian Modeling; Caring; Clinic; Clinical; Clinical Data; Clinical Management; Clinical assessments; Cocaine; Comorbidity; Continuity of Patient Care; Data; Diagnosis; Disease; Drug Use Disorder; Drug usage; Ensure; Epidemic; Epidemiologist; Face; Feedback; Geography; Goals; Grant; HIV; Healthcare; Heroin; High Prevalence; Individual; Intervention; Lead; Long-Term Effects; Longterm Follow-up; Major Depressive Disorder; Measurement; Medical Records; Mental Depression; Mental Health; Mental disorders; Mentored Research Scientist Development Award; Mentors; Methods; Minority; Modernization; Outcome; Outcome Measurement Error; Patient Outcomes Assessments; Patient Self-Report; Patients; Pattern; Persons; Pharmacological Treatment; Pharmacology; Prevalence; Prevention; Psychiatric epidemiology; Regimen; Reporting; Research; Research Personnel; Resources; Sampling; Screening procedure; Site; Symptoms; System; Time; Training; Treatment Effectiveness; Validation; Viral; Viral Load result; Work; Writing; alcohol abuse therapy; alcohol and other drug; alcohol intervention; alcohol misuse; alcohol use disorder; antiretroviral therapy; care outcomes; career; clinical Diagnosis; clinical care; clinically relevant; cocaine use; depressive symptoms; experience; heroin use; improved; innovation; insight; multiple chronic conditions; opioid use; opioid use disorder; reduced alcohol use; scale up; symposium

PROJECT SUMMARY The overall goal of this K01 application is to examine the impact of unhealthy alcohol use, cocaine use, non- prescribed opioid use, depression, and anxiety on HIV care outcomes. Despite the durability of modern antiretroviral therapy (ART) regimens, there is still a substantial minority of patients who have trouble maintaining viral suppression. Unhealthy alcohol use, other drug use, and mental health disorders have all been identified as drivers of viral non-suppression among people with HIV (PWH), yet these conditions have typically been considered independently from one another. Furthermore, the impact of these conditions is difficult to describe because symptoms are likely underreported and they are largely undertreated. Pharmacologic treatments for alcohol use disorder (AUD), opioid use disorder, depression, and anxiety are available but their long-term effects, particularly in people with comorbid substance use and mental health disorders, and particularly on HIV care continuum outcomes has been insufficiently studied. The goal of this K01 is to train the recipient to study the intersection of unhealthy alcohol use, other drug use, and mental health disorders in people with HIV, accounting for challenges in identifying these conditions. Research aims of this project are to: (1) describe the prevalence, co-occurrence, and durability of unhealthy alcohol use, cocaine use, non-prescribed opioid use, depression, and anxiety among PWH in care, accounting for underreporting of these conditions; (2) describe the care continua for AUD, opioid use disorder, cocaine use, depression, and anxiety – that is, rates of clinical diagnoses, initiation on, and retention on pharmacologic treatment for these disorders; and (3) estimate long-term effects of pharmacologic interventions on alcohol consumption, other drug use, and mental health symptoms, and ultimately retention in HIV care and viral load. The training aims of this project are to: (1) gain understanding of current and best practices for the prevention and clinical management of unhealthy alcohol use, other drug use, and mental health disorders for PWH; (2) apply innovative methods for handling measurement error in these conditions; (3) explore Bayesian methods for one means of handling measurement error in the absence of validation data; and (4) obtain the research, writing, and administrative expertise, and preliminary data, to submit a successful R01 grant in the penultimate year of the K01 award period. Training aims will be accomplished through rigorous coursework, seminar participation, mentored and collaborative research, and conference participation. Research aims will be conducted using data from the Center for AIDS Research Network of Integrated Clinical Systems, which includes medical record data and patient reported outcomes from over 34,000 PWH engaged in clinical care from 1995-present at eight US HIV clinics. This project will address a critical gap in our understanding of how alcohol and other drug use and mental health comorbidities co-occur to impact HIV outcomes, and give clues to the potential impact that scaling up pharmacologic treatment of these comorbidities could have on ending the HIV epidemic.

项目摘要 该K01应用的总体目标是检查不健康的酒精使用，可卡因使用，非 - 对艾滋病毒护理结果的处方使用，抑郁和焦虑。尽管现代的耐用性 抗逆转录病毒疗法（ART）方案，遇到麻烦的患者仍然存在很大 保持病毒抑制。不健康的饮酒，其他毒品使用和心理健康障碍都有 被确定为艾滋病毒（PWH）患者中病毒式不抑制的驱动因素，但是这些情况有 通常被视为彼此独立。此外，这些条件的影响是 很难描述，因为症状可能被低估了，并且在很大程度上被低估了。 酒精使用障碍的药理治疗（AUD），阿片类药物使用障碍，抑郁和动画是 可用，但它们的长期影响，尤其是在合并药物使用和心理健康的人中 疾病，尤其是在艾滋病毒护理方面的持续性疾病不足以研究。目标的目标 K01是培训接收者，以研究不健康的酒精使用，其他吸毒和心理的交集 患有艾滋病毒的人的健康障碍，应对识别这些疾病的挑战。研究目的 该项目是：（1）描述不健康的酒精使用的患病率，同时出现和耐用性，可卡因 在护理中使用，非处方阿片类药物使用，抑郁和动画 这些条件； （2）描述AUD，阿片类药物使用障碍，可卡因使用，抑郁和抑郁症的护理连续性 焦虑 - 即，临床诊断的率，主动性和保留在药物治疗上 疾病； （3）估计药物干预对饮酒的长期影响，其他 药物使用以及心理健康症状，并最终保留在艾滋病毒护理和病毒负荷中。培训目的 该项目是：（1）了解预防和临床的当前和最佳实践 对PWH的不健康饮酒，其他毒品使用和心理健康障碍的管理； （2）申请 在这些条件下处理测量误差的创新方法； （3）探索一个贝叶斯方法 在没有验证数据的情况下处理测量误差的手段； （4）获取研究，写作， 和行政专业知识和初步数据，以在倒数第二年提交R01赠款 K01奖励期。培训目标将通过严格的课程，开创性的参与来实现 指导和协作研究以及会议参与。研究目的将使用 来自艾滋病综合临床系统研究网络的数据，其中包括医疗 记录数据和患者报告的结果来自1995年至今的34,000多个PWH从事临床护理的结果 在八个美国艾滋病毒诊所。该项目将解决我们对酒精和其他方式的理解的关键差距 药物使用和心理健康合并症共发生以影响艾滋病毒的结果，并提供了潜在的线索 对这些合并症的药物治疗扩展可能会影响艾滋病毒流行的影响。