Quality of Life and Aging with HIV in Rural Uganda

好了！ 摘要 美国政府已出资500多亿美元扩大抗逆转录病毒疗法(ART)的使用范围 在撒哈拉以南非洲。随着该地区艾滋病毒携带者(PLWH)意识到这些药物的医疗益处 通过采取主动行动，他们与艾滋病相关的死亡率正在下降，预期寿命正在增加。然而，这些项目 通常将狭隘的重点放在与艾滋病相关的健康上，而忽视了这方面的生活质量驱动因素 这对人口构成了威胁，并有可能失去通过对艾滋病毒护理方案进行投资而取得的巨大成果。 因此，有必要确定撒哈拉以南非洲老年人生活质量的决定因素， 并评估维持健康的干预措施。到目前为止，大多数关于该地区艾滋病毒携带者老龄化的研究都 是横断面的，侧重于单一的发病领域(例如高血压)。值得注意的是， 关于老年人生活质量的地区偏好和决定因素的数据很少。我们的预赛 乌干达老年PLWH的数据显示，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，艾滋病毒污名对社会功能和福祉的影响更大。 同样，我们和其他人已经表明，艾滋病毒死亡导致的家庭结构变化可能 破坏了该地区的生活质量。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老年人PLWH生活质量的疾病特异性决定因素将不同于 那些在美国的人。我们的首要目标是阐明老年人生活质量的决定因素 乌干达农村的公共卫生部门，以及艾滋病毒如何对其作出贡献，以最终制定有效的干预措施，以 提高这些人口的生活质量。在目前的提案中，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以下人群生活质量的概念框架 乌干达较年长的PLWH，并为该提案的措施选择提供信息，2)展示艾滋病毒感染是如何 影响乌干达农村地区的功能和生活质量；以及3)确定干预目标和 评估解决不良生活质量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相关的高优先级主题和对多个国家老龄研究所的回应 通过其重点关注的专题领域：1)艾滋病毒、社会决定因素、职能地位和 幸福；2)艾滋病毒感染和认知功能之间的关系；3)老年治疗方法 对携带艾滋病毒的老年人的评估。在处理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平台来建设研究能力 技术，作为与哈佛医学院(NIH D43 TW010128)培训计划的一部分。我们的研究是 预计将通过告知选择和评估干预措施对公共卫生产生重大影响 改善撒哈拉以南非洲农村地区数量庞大且不断增长的老年人口的生活质量。 好了！

! 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. !