Understand and mitigating the influence of extreme weather events on HIV outcomes: A global investigation

了解并减轻极端天气事件对艾滋病毒感染结果的影响：一项全球调查

• 批准号: 10762607
• 负责人: Denis Nash
• 金额: $ 79.2万
• 依托单位: GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-21 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762607
• 关键词: Address; Adolescent; Affect; Africa South of the Sahara; African; Age; Agriculture; Back; Caring; Cessation of life; Cholera; Chronic; Climate; Clinic; Clinical; Clinical Data; Collaborations; Communicable Diseases; Communities; Country; Cross-Sectional Studies; Data; Data Analyses; Data Set; Databases; Development; Disease; Disparity; Documentation; Droughts; Enrollment; Epidemiology; Event; Exposure to; Floods; Food; Funding; Future; Geographic Locations; Geography; HIV; HIV/AIDS; Health; Health Services Accessibility; Heat Waves; Household; Hurricane; Incidence; Income; International; Intervention; Investigation; Kenya; Knowledge; Link; Literature; Malaria; Malnutrition; Mathematics; Mental Health; Methods; Monitor; Outcome; Pathway interactions; Patients; Persons; Philippines; Policies; Policy Maker; Population; Prevalence; Process; Public Health; Quasi-experiment; Rain; Research; Research Personnel; Resolution; Resources; Risk; Rural; Rwanda; Severities; Shapes; Subgroup; Temperature; Testing; Time; Treatment outcome; Viral; Viral Load result; Vulnerable Populations; Work; advanced disease; antiretroviral therapy; care outcomes; climate change; climate data; climate impact; climate-related health; cohort; extreme weather; follow-up; food insecurity; global health; health data; implementation barriers; insight; interest; migration; multidisciplinary; novel; pandemic disease; pregnant; programs; public repository; resilience; resilience factor; rural health clinic; sex; spatiotemporal; stem; therapy adherence; therapy development; tool

Project Summary/Abstract The health challenges arising from extreme weather events (EWEs), such as droughts, floods, and major storms (e.g., hurricanes, typhoons) are increasingly common and severe, threatening to undermine public health progress made over the past century. There is limited evidence on how EWEs affect care outcomes among the 37 million people living with HIV/AIDS (PLWH), particularly in geographic regions most vulnerable to EWEs. Cross-sectional studies have shown both drought and excess rainfall to be associated with higher HIV prevalence. However, very little is known about how EWEs impact short- and long-term HIV care outcomes. Our preliminary analysis of data from 11 sub-Saharan African countries found that extreme rainfall may delay the timely initiation of antiretroviral therapy (ART) and increase loss to follow-up among those newly enrolling in HIV care. Our preliminary qualitative work in Kenya suggests that exposure to drought and flooding adversely affects HIV outcomes through decreased food availability and ART adherence and increased infectious disease incidence. The absence of rigorous longitudinal assessments of the relationships and causal pathways between EWE exposures and HIV care outcomes remains a crucial gap in knowledge and obstacle to intervention development. The global IeDEA cohort collaboration, with >2 million PLWH enrolled in HIV care in 44 countries over a long time horizon (2004-present) provides an unparalleled opportunity to characterize the influence of EWEs on HIV care outcomes across several geographic contexts and sub-populations of PLWH (e.g., those with advanced disease, adolescents, those who are pregnant, etc). The proposed 5-year, mixed methods study will combine high resolution daily data on temperature and rainfall from five publicly available climate datasets with the global IeDEA cohort data from 2004-present to longitudinally assess the impacts of EWEs on HIV care outcomes (timely ART initiation HIV viral load monitoring, and HIV viral suppression) (Aim 1). In Aim 2, we will use a mixed methods approach to explore subgroups of vulnerability and resilience to EWEs among PLWH, mechanisms of impact, and adaptation and mitigation strategies employed in specific communities to inform interventions. In Aim 3, we will create and disseminate a country-level public use climate dataset with geocoded temperature and rainfall data going back to 1984 for ready use by other investigators, program implementers, and policymakers. We expect this novel study to inform climate mitigation and adaptation strategies, and lay the groundwork for the development of other targeted (population and region-specific) interventions to address deleterious health effects of EWEs. Moreover, we expect our study to have significant implications for global health programs, policies, mathematical modelers and funders, creating new health-related applications for climate datasets.

项目摘要/摘要 极端天气事件（EWES）引起的健康挑战，例如干旱，洪水和主要 风暴（例如飓风，台风）越来越普遍且严重，威胁要破坏公众 在过去的一个世纪中，健康进步取得了成就。关于母羊如何影响护理结果的证据有限 在艾滋病毒/艾滋病（PLWH）的3700万人中，尤其是在地理区域中 到母羊。横断面研究表明，干旱和多余​​的降雨量与较高 艾滋病毒患病率。但是，关于母羊如何影响短期和长期艾滋病毒护理的了解很少 结果。我们对来自11个撒哈拉以南非洲国家数据的数据的初步分析发现，极端降雨 可能会延迟及时的抗逆转录病毒疗法（ART）的开始，并增加对新近的人的随访损失 参加艾滋病毒护理。我们在肯尼亚的初步定性工作表明，暴露于干旱和洪水 通过降低食物的可用性和艺术依从性并增加了艾滋病毒的不利影响 传染病发病率。缺乏对关系和因果关系的严格纵向评估 母羊暴露与艾滋病毒护理结果之间的途径仍然是知识和障碍的关键差距 干预开发。全球IEDEA队列合作，> 200万PLWH参加了艾滋病毒护理 在44个国家 /地区的44个国家（2004年至今）提供了一个无与伦比的机会来表征 母羊对几种地理环境中的艾滋病毒护理结果的影响以及 PLWH（例如，患有晚期疾病的人，青少年，怀孕等）。 拟议的5年混合方法研究将结合高分辨率的每日温度和 来自五个公开可用气候数据集的降雨量以及全球IEDEA队列数据从2004年至今 纵向评估母羊对艾滋病毒护理结果的影响（及时的ART ART启动HIV病毒负荷 监测和HIV病毒抑制）（目标1）。在AIM 2中，我们将使用混合方法探索 PLWH之间的脆弱性和对母羊的韧性亚组，影响机制，适应和适应性和 在特定社区中采用的缓解策略为干预提供了信息。在AIM 3中，我们将创建和 传播具有地理编码温度和降雨数据的国家级别的公共使用气候数据集 到1984年，可以准备好被其他调查人员，计划实施者和政策制定者准备使用。我们期待这本小说 研究以告知气候缓解和适应策略，并为发展的基础奠定了基础 其他有针对性的（人口和特定地区）干预措施，以解决母羊的有害健康影响。 此外，我们希望我们的研究对全球健康计划，政策， 数学建模者和资助者，为气候数据集创建了新的与健康相关的应用程序。