Alcohol Research Consortium in HIV: Epidemiology Research Arm

不健康的酒精使用在艾滋病毒感染者（PWH）中普遍存在，并与不良结果相关 包括减少参与艾滋病毒护理连续体（HIV-CC）和增加与年龄相关的合并症。 酒精研究联盟在艾滋病毒流行病学研究组（ARCH-ERA）成立， 酒精对CFAR综合临床网络中PWH预后的短期和长期影响 系统（CNICS）。CNICS是一个8个站点的网络，是一个庞大的、地理和种族多样化的、性别 护理中的> 37，000名PWH的代表性队列。仔细的结局裁定，大量多样化的人群，以及 对患者报告的酒精使用、药物使用、精神健康症状 坚持，以及基于背景的因素，如住房状况，耻辱和社会支持，使严格的 方法对艾滋病毒和酒精的关键问题是高度响应NIH艾滋病毒的优先事项和RFA-AA-20- 009.我们对COVID-19大流行的快速反应表明了CNICS在适应新冠肺炎疫情方面的卓越灵活性。 医疗保健和研究优先事项的变化。我们之前已经描述了高 PWH中不健康酒精使用的流行率及其对结果（包括HIV-CC）的有害影响 步我们在这项工作的基础上再接再厉，在当前流行病不断扩大的时代， 远程医疗;扩大重点，包括酒精护理连续体（Alc-CC）以及其他模式， 酒精使用;增加年龄相关的结果，如心力衰竭，这在老年人中变得越来越重要。 威尔斯亲王医院人口老化;以及纳入新出现的结果，例如与COVID-19有关的疾病。 利用CNICS的资源和基础设施，我们提出了以下目标：1。获取，扩展， 改进和验证高质量的酒精和健康数据的社会决定因素，包括扩大国家信息和通信系统 支持更好地捕捉酒精使用模式，并添加美国人口普查数据，以更好地捕捉社会经济 背景; 2.研究酒精使用、药物使用和精神健康障碍的纵向关系， 艾滋病毒-CC和Alc-CC，包括流行病的影响和健康的主要社会决定因素， 有时是威尔斯亲王医院的隐藏或边缘化群体。3.确定患有不健康的PWH的临床结局 酒精使用，包括年龄相关合并症和COVID-19相关疾病，以及酒精使用的作用 健康模式和社会决定因素对这些和其他长期结果的影响。 ARCH-ERA将利用和扩展CNICS的全面临床数据，以解决新的研究 关于PWH中酒精使用影响的问题，包括产生关于以下交叉点的新知识： 艾滋病毒和酒精为未来的研究和临床护理提供信息。ARCH-ERA将增强整体性能 通过提供新的和扩展的数据类型，为酒精干预提供信息，并利用结果， 从这个丰富的队列中提供数据并解决关注酒精使用影响的重要问题 在现代流行病的情况下，威尔斯亲王医院目前的护理和健康结果的模式。

Unhealthy alcohol use is prevalent among people with HIV (PWH) and associated with poor outcomes including less engagement in the HIV Care Continuum (HIV-CC) and increased age-related comorbidities. Alcohol Research Consortium in HIV–Epidemiology Research Arm (ARCH-ERA) was formed to investigate short and long-term effects of alcohol on outcomes among PWH in the CFAR Network of Integrated Clinical Systems (CNICS). CNICS is an 8-site network that is a large, geographically and racially diverse, gender representative cohort of >37,000 PWH in care. Careful outcomes adjudication, a large diverse population, and systematic longitudinal assessments of patient reported alcohol use, drug use, mental health symptoms, adherence, and context-based factors such as housing status, stigma, and social support enables a rigorous approach to key questions on HIV and alcohol that are highly responsive to NIH HIV priorities and RFA-AA-20- 009. Our rapid response to the COVID-19 pandemic demonstrates the remarkable agility of CNICS to adapt to changes in health care and research priorities as they emerge. We have previously described the high prevalence of unhealthy alcohol use among PWH, and its detrimental effects on outcomes including HIV-CC steps. We build on that work focusing on the HIV-CC in the current era of a pandemic and expanding telehealth; expanding focus to including the Alcohol Care Continuum (Alc-CC) as well as additional patterns of alcohol use; adding age-related outcomes such as heart failure that are becoming increasingly important in the aging population of PWH; and incorporating emerging outcomes such as due to COVID-19-related illness. Capitalizing on the resources and infrastructure of CNICS, we propose the following aims: 1. Obtain, expand, improve, and validate high quality alcohol and social determinants of health data including expanding CNICS PROs to better capture alcohol use patterns and adding U.S. Census data to better capture socioeconomic context; 2. Examine longitudinal relationships of alcohol use, drug use, and mental health disorders on the HIV-CC and Alc-CC including impacts of the pandemic and key social determinants of health such as among sometimes hidden or marginalized groups of PWH. 3. Determine clinical outcomes among PWH with unhealthy alcohol use including age-related comorbidities and COVID-19 related illness, and the role of alcohol use patterns and social determinants of health on these and other long-term outcomes. ARCH-ERA will capitalize on and expand CNICS’s comprehensive clinical data to address novel research questions on the impact of alcohol use among PWH including generating new knowledge on the intersection of HIV and alcohol to inform future research and clinical care. ARCH-ERA will enhance the overall ARCH consortium by providing new and expanded data types, informing alcohol interventions, and leveraging results from this rich cohort to provide data and address important questions focusing on the impact of alcohol use patterns on current care and health outcomes of PWH within the modern pandemic context.