Modeling reductions in harmful alcohol use on HIV transmission and mortality in the era of universal test and treat in Uganda

摘要 世界卫生组织(WHO)建议所有艾滋病毒携带者(PWH)发起抗逆转录病毒治疗并 撒哈拉以南非洲(SSA)国家已经开始推出普遍检测和治疗(UTT)战略。近期 试验表明，扩大治疗并不总是能降低人群中艾滋病毒的发病率。 水平。关于潜在因素的作用仍然存在疑问，这些因素可能会减少UTT的好处并推动艾滋病毒 流行病。根据联合国艾滋病规划署最近的一份报告，酒精使用是艾滋病毒流行中一个被忽视的因素 需要更多的关注。饮酒通过性行为和减少吸毒量增加艾滋病毒风险 对艺术的坚持。因此，饮酒可能导致人群水平无法实现艾滋病毒消除。 目标。我提议的研究将评估有害饮酒对艾滋病毒的长期人群影响。 乌干达UTT时代的传播和死亡率。乌干达是世界上酒精使用率最高的国家之一。 SSA的人均感染率为5.7%，并普遍流行艾滋病毒。UTT战略于#年生效 2017年在乌干达。然而，2019年，乌干达22%的PWH没有服用抗逆转录病毒药物，36%的人没有通过病毒感染 被压制了。乌干达有机会通过减少有害的酒精使用来解决这两个负担。我的研究 将评估在这个时代投资酒精使用干预措施以减少艾滋病毒传播的价值 在乌干达的UTT。该项目将提高人们对有害饮酒和 艾滋病毒流行通过以下目的：1)估计有害饮酒的流行率和 乌干达UTT时代接受抗逆转录病毒治疗和病毒载量抑制的关系2)量化 在UTT时代，有害饮酒对乌干达艾滋病毒传播和死亡率的贡献，使用 传染病模型。3)确定减少饮酒干预措施的成本效益，以防止 艾滋病毒传播，在乌干达。候选人Adriane Wynn博士非常有资格进行这项研究 由于她在定量方法方面有很强的背景，并在出版和成功的记录中取得了成功 格兰特写作。在5年的获奖期内，韦恩博士将实现以下职业发展目标： 1)发展流行病学方面的专门知识，以及酒精使用与艾滋病毒和减少酒精之间的交叉 撒哈拉以南非洲UTT时代的干预措施。2)掌握建模人口影响的技能 酒精对艾滋病毒传播和疾病进展的影响。3)获得卫生经济评估方面的专业知识 减少酒精的干预措施包括预防艾滋病毒传播的好处。4)获得以下方面的专业知识 关于酒精使用人群和艾滋病毒高危人群或艾滋病毒携带者的研究的道德行为。5) 通过进一步发展，提高专业发展技能，为成功的学术生涯做准备 在技术、出版和科学合作方面的技能。这些目标与艾滋病办公室是一致的 研究优先主题：“减少艾滋病毒/艾滋病发病率”和NIAAA的战略计划。

Abstract The World Health Organization (WHO) recommends that all people with HIV (PWH) initiate ART and countries in Sub-Saharan Africa (SSA) have started to roll-out a universal test and treat (UTT) strategy. Recent trials have shown that expanded treatment does not always result in reduced HIV incidence at the population level. Questions remain on the role of underlying factors that may reduce the benefits of UTT and drive the HIV epidemic. According to a recent UNAIDS report, alcohol use is an overlooked factor in the HIV epidemic that requires greater attention. Alcohol use increases HIV risk through sexual behaviors and reducing uptake and adherence to ART. Thus, alcohol use may contribute to population level failure to achieve HIV elimination targets. My proposed research will estimate the long-term, population impact of harmful alcohol use on HIV transmission and mortality in the UTT era in Uganda. Uganda has one of the highest levels of alcohol use per capita in SSA and has a generalized HIV epidemic, with a prevalence of 5.7%. The UTT strategy took effect in Uganda in 2017. However, in 2019, 22% of PWH in Uganda were not on ART and 36% were not virally suppressed. Uganda has an opportunity address both burdens by reducing harmful alcohol use. My research will assess the value for money of investing in alcohol use interventions to reduce HIV transmission in the era of UTT in Uganda. This project will improve understanding of the relationship between harmful alcohol use and the HIV epidemic through the following aims: 1) Estimate the prevalence of harmful alcohol use and relationships with receipt of ART and viral load suppression in the era of UTT in Uganda 2) Quantify the contribution of harmful alcohol use to HIV transmissions and mortality in Uganda during the UTT era, using infectious disease modeling. 3) Determine the cost-effectiveness of alcohol reduction interventions to prevent HIV transmission, in Uganda. The candidate, Dr. Adriane Wynn, is well qualified to conduct this research because of her strong background in quantitative methods and track record of publications and successful grant writing. Over the 5-year award period, Dr. Wynn will achieve the following career development objectives: 1) Develop expertise in the epidemiology and intersection of alcohol use and HIV and alcohol reduction interventions in the era of UTT in Sub-Saharan Africa. 2) Gain skills in modeling the population impact of alcohol use on HIV transmission and disease progression. 3) Acquire expertise in health economic evaluation of alcohol reduction interventions incorporating HIV transmission prevention benefits. 4) Obtain expertise in the ethical conduct of research pertaining to alcohol-using populations and those at risk for or living with HIV. 5) Expand professional development skills in preparation for a successful academic career by further developing skills in grantsmanship, publication, and scientific collaborations. These aims are in line with the Office of AIDS Research high priority topics: “Reducing Incidence of HIV/AIDS” and the NIAAA’s Strategic Plan.