Alcohol Research Consortium in HIV: Epidemiology Research Arm

不健康的饮酒在HIV(PWH)患者中很普遍，并与不良结局有关 包括减少对艾滋病毒护理连续体(HIV-CC)的参与，增加与年龄有关的合并症。 艾滋病毒-流行病学研究机构中的酒精研究联盟(ARCH-ERA)成立，以调查 综合临床CFAR网络中酒精对PWH预后的短期和长期影响 系统(CNIC)。CNICs是一个由8个站点组成的网络，它是一个巨大的、地理和种族多样化的性别 护理中的37,000名威斯康星医院的代表队列。慎重的结果裁决，大量不同的人口，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 关于艾滋病毒和酒精的关键问题的方法，这些问题对NIH艾滋病毒优先事项和RFA-AA-20高度响应- 009.我们对新冠肺炎大流行的快速反应表明了CNIC适应的非凡灵活性 随着医疗保健和研究优先事项的出现而发生变化。我们之前曾描述过 威斯康星医院中不健康饮酒的流行率及其对包括HIV-CC在内的预后的不利影响 台阶。我们在这项工作的基础上再接再厉，将重点放在当前大流行时代的艾滋病毒-CC上，并不断扩大 远程医疗；将重点扩展到包括酒精护理连续性(Alc-CC)以及其他模式 饮酒；增加与年龄相关的结果，如心力衰竭，这些结果在 威尔斯亲王医院的人口老龄化；以及纳入新出现的结果，如由新冠肺炎相关疾病引起的结果。 利用中投公司的资源和基础设施，我们提出了以下目标：1.获得、扩大、 改进和验证高质量的酒精和社会健康数据决定因素，包括扩大CNIC 赞成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.检查酒精使用、药物使用和精神健康障碍的纵向关系 HIV-CC和Alc-CC，包括大流行的影响和健康的关键社会决定因素，例如 有时威尔斯亲王医院的隐藏或边缘化群体。3.确定不健康的PWH患者的临床结局 饮酒，包括与年龄相关的合并症和新冠肺炎相关疾病，以及饮酒的作用 健康的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的全面临床数据来解决新的研究 关于威尔斯亲王医院饮酒影响的问题，包括产生关于交叉口的新知识 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ARCH 通过提供新的和扩展的数据类型、通知酒精干预和利用结果 从这个丰富的队列中提供数据并解决重点放在饮酒影响的重要问题 现代大流行背景下威斯康星医院目前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.