Leveraging Agriculture and Uniting Communities to Improve HIV Outcomes in Senegal

利用农业和团结社区改善塞内加尔的艾滋病毒防治成果

• 批准号: 10078557
• 负责人: Noelle Angelina Benzekri
• 金额: $ 26.73万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10078557
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; Africa; Agriculture; Appointment; Behavior; Caring; Central Africa; Cessation of life; Clinic; Collaborations; Communities; Continuity of Patient Care; Country; Data; Development; Drug resistance; Enrollment; Epidemic; Failure; Food; Funding; HIV; HIV Seropositivity; High Prevalence; Individual; Interruption; Intervention; Interview; Longitudinal Studies; Malnutrition; Measures; Nutritional status; Outcome; Patients; Perception; Prevalence; Program Acceptability; Risk; Role; Senegal; Services; Severities; Social Workers; Structure; Viral; Viral Load result; Weight; Work; antiretroviral therapy; base; comparison intervention; coping; experience; follow-up; food insecurity; food security; high risk behavior; improved; innovation; instrument; mortality; prevent; primary outcome; programs; secondary outcome; social stigma; standard of care; therapy adherence; transmission process; treatment arm; virology

PROJECT SUMMARY Innovative strategies are needed to improve progress towards the UNAIDS 90-90-90 targets in West Africa1. Among the 5 million people living with HIV (PLHIV) in West and Central Africa in 2018, 64% knew their HIV status, 51% were receiving antiretroviral therapy (ART), and 39% had suppressed viral loads2. Although 13% of PLHIV globally live in West and Central Africa, 21% of AIDS-related deaths in 2018 occurred in the region. Addressing weaknesses along the entire continuum of care, including barriers to sustained ART and viral suppression, is critical to interrupting transmission, preventing mortality, and ending the HIV epidemic. Our previous work has shown that the majority of PLHIV in Senegal are food insecure and that food insecurity is associated with poor HIV outcomes. Food insecurity can contribute to increased risk of HIV acquisition through high-risk behaviors and coping strategies. Food insecurity is a barrier to retention in care. In our K23 longitudinal study conducted among HIV-positive individuals initiating ART in Senegal, food insecurity was an independent predictor of loss to follow-up. Food insecurity is also associated with poor adherence to ART, which increases risk of virologic failure, HIV transmission, drug resistance, and death. The high prevalence of food insecurity among PLHIV in Senegal and its role as a driver of poor outcomes across the HIV care cascade, suggest that strategies to address food insecurity will be critical to achieving the 90-90-90 targets and ending the HIV epidemic. The Casamance, located in the south of Senegal, has been the most severely affected by the HIV epidemic and has the highest prevalence of food insecurity in the country. In collaboration with Development in Gardening, the Service des Maladies Infectieuses et Tropical, Centre Hospitalier Universitaire de Fann, and the Centre de Santé de Ziguinchor, we recently received funding to implement a clinic and community based agriculture program targeting PLHIV in Ziguinchor, located in the Casamance. In the proposed study, we will build upon findings from our K23 study of HIV, malnutrition, and food insecurity, and leverage our recently funded agriculture program, to evaluate the impact of a multisectoral agriculture intervention on HIV outcomes in the Casamance region of Senegal. The AIMS of this study are, AIM 1: Determine if participation in a multisectoral agriculture intervention is associated with improved HIV outcomes compared to the standard of care, AIM 2: Determine if participation in a multisectoral agriculture intervention is associated with improved food security and nutritional status among PLHIV compared to the standard of care, and AIM 3: Understand the impact of food insecurity on the behaviors and experiences of PLHIV and determine patient perceptions of a multisectoral agriculture intervention implemented in the Casamance region of Senegal.

项目概要 需要创新战略来促进西非 1 联合国艾滋病规划署 90-90-90 目标的进展。 2018 年，西非和中非的 500 万艾滋病毒感染者 (PLHIV) 中，64% 的人知道自己感染了艾滋病毒 状态，51% 正在接受抗逆转录病毒治疗 (ART)，39% 已抑制病毒载量2。 全球 10% 的艾滋病毒感染者生活在西非和中非，2018 年 21% 的艾滋病相关死亡发生在该地区。 解决整个护理过程中的弱点，包括持续抗逆转录病毒治疗和病毒治疗的障碍 抑制，对于阻断传播、预防死亡和结束艾滋病毒流行至关重要。 先前的工作表明，塞内加尔的大多数艾滋病毒感染者粮食不安全，而且粮食不安全是 粮食不安全可能导致感染艾滋病毒的风险增加。 高风险行为和应对策略 粮食不安全是我们 K23 保留护理的一个障碍。 对塞内加尔开始接受抗逆转录病毒治疗的艾滋病毒阳性者进行的纵向研究显示，粮食不安全是一个问题 粮食不安全也与 ART 依从性差有关。 这增加了病毒学失败、艾滋病毒传播、耐药性和死亡的风险。 塞内加尔艾滋病毒感染者的粮食不安全及其作为艾滋病毒护理结果不佳的驱动因素 级联，建议解决粮食不安全问题的战略对于实现 90-90-90 目标至关重要 位于塞内加尔南部的卡萨芒斯是艾滋病毒流行最严重的地区。 受艾滋病毒流行影响，粮食不安全的发生率是该国最高的。 园艺发展、传染病和热带疾病服务中心医院 Universitaire de Fann 和 Centre de Santé de Ziguinchor，我们最近收到了资金来实施 位于卡萨芒斯的济金绍尔针对艾滋病毒感染者的诊所和社区农业项目。 在拟议的研究中，我们将以 K23 关于艾滋病毒、营养不良和粮食不安全的研究结果为基础， 并利用我们最近资助的农业计划来评估多部门农业的影响 对塞内加尔卡萨芒斯地区艾滋病毒结果的干预 本研究的目的是，AIM 1： 确定参与多部门农业干预是否与改善艾滋病毒结果相关 与护理标准相比，目标 2：确定参与多部门农业干预是否是 与护理标准相比，艾滋病毒感染者的粮食安全和营养状况得到改善， 目标 3：了解粮食不安全对艾滋病病毒感染者和艾滋病毒感染者的行为和经历的影响 确定患者对卡萨芒斯地区实施的多部门农业干预措施的看法 塞内加尔。