Oral diseases and quality of life in older adults on anti-retroviral therapy in Uganda (ODQoL-UG)

乌干达接受抗逆转录病毒治疗的老年人的口腔疾病和生活质量 (ODQoL-UG)

• 批准号: 10696977
• 负责人: Steffany Chamut Villarreal
• 金额: $ 17.07万
• 依托单位: MBARARA UNIVERSITY/SCIENCE/ TECHNOLOGY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-18 至 2025-09-17
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10696977
• 关键词: Administrator; Adult; Affect; Africa; Africa South of the Sahara; African; Age; Area; Behavioral; Biochemistry; Biological; Caring; Clinical; Clinical Research; Clinical Trials; Communities; Dental Epidemiology; Dental caries; Development; Disease Progression; Early Diagnosis; Elderly; Epidemiology; Foundations; Funding; Future; Gender; Goals; Guidelines; HIV; HIV Infections; HIV/AIDS; Health; Health Disparities Research; Health Services; Health system; Healthcare; Impaired cognition; Incidence; Individual; Intervention; Intervention Studies; Interview; Investigation; Knowledge; Longevity; Longitudinal cohort; Measures; Mental Depression; Mental Health; Modeling; Mouth Diseases; National Institute of Dental and Craniofacial Research; Neurocognition; Neurocognitive Deficit; Oral; Oral Examination; Oral health; Outcome; Periodontal Diseases; Personal Satisfaction; Persons; Physicians; Policy Maker; Population; Population Heterogeneity; Positioning Attribute; Prevalence; Prevention; Preventive; Provider; Psyche structure; Public Health; Quality of life; Questionnaires; Research; Research Infrastructure; Research Methodology; Research Priority; Resource-limited setting; Risk; Risk Factors; Rural; Scientist; Services; Social Functioning; Syndrome; Uganda; United States National Institutes of Health; Xerostomia; age effect; aged; antiretroviral therapy; burden of illness; care recipients; care systems; clinical care; co-infection; cohort; comorbidity; design; frailty; health care service; health disparity; health related quality of life; high risk; high risk population; improved; informant; mild cognitive impairment; multidisciplinary; multiple chronic conditions; neglect; permanent tooth; programs; social culture; therapy design; treatment strategy; years lived with disability

ABSTRACT Oral diseases (periodontal disease, caries, and xerostomia) have major deleterious effects on long-term health and quality of life, and are thought to be more prevalent in older adults living with HIV. Despite this, oral and dental health remains a neglected area of research within the field of HIV and associated clinical care, and is absent from nearly all HIV clinical guidelines in Sub-Saharan Africa. A demonstrated reciprocal association between geriatric syndromes and poor oral health that affects quality of life among older people living with HIV has been well described in the developed world such as the US but not in resource limited settings such as Uganda. We hypothesize that the combined effects of HIV, frailty, depression, and cognitive decline are risk factors for poorer oral health and quality of life among older people living with HIV. Our goal is to determine the impacts of the geriatric syndromes (frailty, depression, and cognitive decline) on oral health and quality of life in people with HIV, and to explore the mechanisms of integration of oral health services into routine HIV care in the context of rural Sub-Saharan Africa. The specific aims for this study are: 1a) to determine the contributions of frailty, neurocognition, and depression as risks to the epidemiology of periodontal disease, dental caries, and xerostomia among older adults living with and without HIV in Uganda, 1b) to estimate the contributions of periodontal disease, dental caries and xerostomia to oral and overall health-related quality of life, and 2) to explore the barriers to and facilitators of integration of oral health services into routine HIV care in Uganda. To achieve this goal we will leverage the existing clinical research infrastructure/NIH-supported longitudinal cohort (UGANDAC, R01 AG059504, PI Mark Siedner) study of older adults aged 50 and older living with HIV in southwestern Uganda and their age and gender-matched HIV uninfected controls. Our proposed research is unique in that it will be: a) among the first to describe the epidemiology of oral health, the contributions of HIV, and geriatric syndromes on oral health in Uganda, b) focuses on quality of life and well-being among older people in a vulnerable, diverse population, and c) uses mixed methods research to both describe the determinants of poor health and develop interventions to respond to a public health need to improve oral health in a high-risk population. We have a multidisciplinary team of professional physicians and scientists from Africa and the US that brings broad expertise in oral, mental, and HIV care and research; epidemiology, biochemistry, and global population public health to achieve the set independent proposed aims of this application. The study's findings will show the most frequent oral and dental health problems among Ugandan older individuals living with HIV, their effects on quality of life, and, most importantly, their determinants. As a result, we will be in a better position to design an intervention in southwestern Uganda to assess the inclusion of an oral and dental health preventive and promotion program to routine HIV care. The findings will form the basis for our applications for an R01 funded clinical trial to design and study this intervention.

抽象的 口腔疾病（牙周疾病，龋齿和静态疾病）对长期健康有重大有害影响 和生活质量，被认为在艾滋病毒的老年人中更为普遍。尽管如此，口头和 牙齿健康仍然是艾滋病毒和相关临床护理领域中被忽视的研究领域，并且是 撒哈拉以南非洲的几乎所有HIV临床指南都没有。展示的相互关联 在老年艾滋病毒的老年人生活质量的老年综合症和口腔健康状况不佳之间 在美国等发达世界中的描述很好，但在资源有限的设置中没有得到很好的描述，例如 乌干达。我们假设艾滋病毒，脆弱，抑郁和认知能力的综合作用是风险 艾滋病毒感染者口腔健康和生活质量较差的因素。我们的目标是确定 老年综合征（脆弱，抑郁和认知能力下降）对口腔健康和生活质量的影响 患有艾滋病毒的人，并探索口服健康服务整合到常规艾滋病毒护理中的机制 撒哈拉以南非洲的背景。这项研究的具体目的是：1a）确定贡献 脆弱，神经认知和抑郁症是牙周疾病的流行病学，牙齿龋齿的风险 在乌干达和患有艾滋病毒的老年人中，1B）的静态症，以估计 牙周疾病，龋齿和口服和整体健康相关的生活质量，以及2） 探索将口腔健康服务整合到乌干达常规艾滋病毒护理中的障碍和促进者。到 实现这一目标，我们将利用现有的临床研究基础设施/NIH支持的纵向队列 （乌干达，R01 AG059504，PI Mark Siedner）研究50岁及以上艾滋病毒的老年人 西南乌干达及其年龄和性别匹配的艾滋病毒未感染的控制。我们提出的研究是 它的独特之处在于：a）最早描述口腔健康流行病学的人，艾滋病毒的贡献， 和乌干达口腔健康的老年综合症，b）专注于年龄较大的生活质量和福祉 脆弱，多样化的人群中的人，c）使用混合方法研究来描述 健康状况不佳的决定因素并制定干预措施以应对公共卫生需要改善口腔健康 在高危人群中。我们有一个由非洲的专业医生和科学家组成的多学科团队 以及在口头，心理和艾滋病毒护理和研究方面具有广泛专业知识的美国；流行病学，生物化学， 以及全球人口公共卫生，以实现该应用程序的独立拟议目标。这 研究的发现将显示乌干达老年人中最常见的口腔和牙齿健康问题 患有艾滋病毒，对生活质量的影响，最重要的是他们的决定因素。结果，我们将 可以更好地设计在乌干达西南部的干预措施，以评估口服和 牙科健康预防和促进计划常规艾滋病毒护理。这些发现将构成我们的基础 R01资助的临床试验的申请，以设计和研究此干预措施。