Quality of Life and Aging with HIV in Rural Uganda

! 摘要 美国政府已出资500多亿美元，用于扩大抗逆转录病毒疗法的普及。 于撒哈拉以南非洲的随着本区域艾滋病毒感染者（PLWH）认识到这些药物的医疗益处， 通过这些举措，他们与艾滋病有关的死亡率正在下降，预期寿命正在增加。然而，这些方案 通常只关注与艾滋病相关的健康，忽视了生活质量的驱动因素。 艾滋病毒感染者的数量增加，并有可能失去通过对艾滋病毒护理项目的投资所取得的巨大成果。 因此，有必要确定撒哈拉以南非洲老年艾滋病毒携带者生活质量的决定因素， 并评估干预措施以维持健康。到目前为止，该地区大多数关于艾滋病毒感染者老龄化的研究都是 这些研究是跨部门的，侧重于单一发病领域（如高血压）。有显著的 关于老年艾滋病毒/艾滋病感染者生活质量的区域偏好和决定因素的数据很少。我们的初步 乌干达老年艾滋病毒携带者数据显示，在生物医学、社会和艾滋病毒特异性风险方面存在显著差异 与西方环境相比，艾滋病毒污名化对社会功能和福祉的影响巨大。 同样，我们和其他人已经表明，由于艾滋病毒造成的死亡而造成的家庭结构的改变可能 影响该地区的生活质量。因此，我们的科学前提是，社会，生物医学和艾滋病毒- 撒哈拉以南非洲农村地区老年艾滋病毒携带者生活质量的疾病特异性决定因素将不同于 在美国。我们的首要目标是阐明老年人生活质量的决定因素 乌干达农村地区的艾滋病毒携带者和艾滋病毒感染者，以及艾滋病毒如何对他们产生影响，最终制定有效的干预措施， 改善这一人群生活质量。在本提案中，我们将通过以下方式解决该领域的重要差距： 1)使用定性方法制定艾滋病毒如何影响生活质量的概念框架， 乌干达的老年艾滋病毒携带者，并为这项建议提供信息，2）证明艾滋病毒感染如何 影响乌干达农村的功能和生活质量轨迹; 3）确定干预目标， 评估解决生活质量差问题的干预措施的可接受性和可行性。我们的建议是 与艾滋病研究办公室的高优先级主题有关，并响应多个国家老龄化研究所 通过其重点关注的主题领域：1）艾滋病毒，社会决定因素，功能状态和 健康; 2）艾滋病毒感染和认知功能之间的关系; 3）老年人的方法， 评估老年艾滋病毒感染者。在解决这些高度优先的调查领域的同时，我们的研究将 通过为姆巴拉拉科学大学的初级研究人员提供一个平台来建立研究能力， 技术，作为哈佛医学院（NIH D43 TW 010128）培训计划的一部分。我们的研究是 通过为干预措施的选择和评价提供信息， 提高撒哈拉以南非洲农村地区大量且不断增长的老年艾滋病毒携带者和艾滋病患者的生活质量。 !

! ABSTRACT The United States government has contributed over $50 billion to expand antiretroviral therapy (ART) access in sub-Saharan Africa. As people living with HIV (PLWH) in the region realize the medical benefits of these initiatives, their AIDS-related mortality is declining and their life expectancy is increasing. Yet, these programs typically apply a narrow focus on AIDS-related health, which overlooks the drivers of quality of life for this population, and risks losing the tremendous gains achieved through investments in HIV care programs. Consequently, there is a need to identify determinants of quality of life for older PLWH in sub-Saharan Africa, and evaluate interventions to sustain wellbeing. To date, most studies of aging with HIV in the region have been cross-sectional and have focused on single morbidity domains (e.g. hypertension). There is remarkably little data about regional preferences for and determinants of quality of life for older PLWH. Our preliminary data among older PLWH in Uganda demonstrate meaningfully different biomedical, social and HIV-specific risk profiles, and outsized effects of HIV stigma on social functioning and wellbeing, compared to western settings. Similarly, we and others have shown that alterations to family structures caused by deaths due to HIV might undermine quality of life in the region. Thus, our scientific premise is that the social, biomedical, and HIV- disease specific determinants of quality of life for older PLWH in rural sub-Saharan Africa will be different from those in the United States. Our overarching goal is to elucidate the determinants of quality of life for older PLWH in rural Uganda, and how HIV contributes to them, to ultimately develop effective interventions to improve quality of life for this population. In the current proposal, we will address important gaps in the field by: 1) using qualitative methods to develop a conceptual framework for how HIV impacts quality of life among older PLWH in Uganda, and inform measure selection for this proposal, 2) demonstrating how HIV infection affects trajectories of functioning and quality of life in rural Uganda; and 3) identifying intervention targets and assessing the acceptability and feasibility of interventions to address poor quality of life. Our proposal is relevant to Office of AIDS Research high-priority topics and responds to multiple National Institute of Aging topic areas through its focus on: 1) interactions between HIV, social determinants, functional status and wellbeing; 2) relationships between HIV infection and cognitive functioning; and 3) geriatric approaches to assessment of older adults with HIV. While addressing these high-priority areas of investigation, our study will build research capacity by providing a platform for junior investigators at the Mbarara University of Science and Technology, as part of a training initiative with Harvard Medical School (NIH D43 TW010128). Our study is anticipated to have significant public health impact by informing selection and evaluation of interventions to improve quality of life among the large and growing population of older PLWH in rural sub-Saharan Africa. !