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

在乌干达普遍检测和治疗时代，建立减少有害酒精使用对艾滋病毒传播和死亡率的影响模型

• 批准号: 10475245
• 负责人: Adriane Michelle Wynn
• 金额: $ 17.75万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-25 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10475245
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; Africa South of the Sahara; Alcohol consumption; Alcohols; Attention; Award; CD4 Lymphocyte Count; Clinical; Collaborations; Cost Analysis; Country; Data; Decision Making; Diagnosis; Disease; Disease Progression; Effectiveness of Interventions; Epidemic; Epidemiology; Ethics; Evidence based intervention; Face; Failure; Funding; Goals; Grant; HIV; HIV risk; Health; Incidence; Individual; Intervention; Maps; Measures; Methods; Modeling; National Institute on Alcohol Abuse and Alcoholism; Pathway interactions; Pattern; Persons; Policies; Population; Population Study; Preparation; Prevalence; Prevention; Public Health; Publications; Reporting; Research; Research Priority; Resource Allocation; Resource-limited setting; Resources; Risk; Role; Rural; Sex Behavior; Strategic Planning; Testing; Time; Uganda; United States National Institutes of Health; Update; Viral; Viral Load result; Virus Replication; Work; World Health Organization; Writing; alcohol measurement; alcohol risk; alcohol use disorder; antiretroviral therapy; binge drinking; career; career development; cost effectiveness; disease transmission; economic evaluation; health economics; high risk sexual behavior; implementation facilitation; improved; infectious disease model; insight; mortality; prevent; reduced alcohol use; response; scale up; skill acquisition; skills; sociodemographics; transmission process; uptake

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.

摘要 世界卫生组织（世卫组织）建议所有艾滋病毒感染者（PWH）开始接受抗逆转录病毒治疗， 撒哈拉以南非洲（SSA）国家已开始推出普遍检测和治疗（UTT）战略。最近 试验表明，扩大治疗并不总是导致人群中艾滋病毒发病率的降低 水平问题仍然是潜在因素的作用，可能会减少UTT的好处，并推动艾滋病毒 疫情根据联合国艾滋病规划署最近的一份报告，饮酒是艾滋病毒流行病中一个被忽视的因素， 需要更多的关注。饮酒通过性行为增加艾滋病毒风险，减少摄入量， 因此，饮酒可能导致人口水平无法实现艾滋病毒消除。 目标的我提议的研究将评估有害酒精使用对艾滋病毒的长期人口影响 在乌干达UTT时代的传播和死亡率。乌干达是世界上人均饮酒量最高的国家之一。 撒哈拉以南非洲的人均艾滋病毒感染率为5.7%，艾滋病毒普遍流行。UTT战略于 2017年，乌干达。然而，在2019年，乌干达22%的PWH没有接受ART，36%没有病毒感染 抑制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 将评估投资于酒精使用干预措施以减少艾滋病毒传播的资金价值 在乌干达的UTT。这一项目将增进对有害饮酒与 （1）估计有害饮酒的流行率， 乌干达UTT时期接受抗逆转录病毒治疗和病毒载量抑制的关系2） 在UTT时代，乌干达有害酒精使用对艾滋病毒传播和死亡率的贡献， 传染病建模3)确定减少饮酒干预措施的成本效益， 艾滋病毒在乌干达的传播。候选人Adriane Wynn博士完全有资格进行这项研究 由于她在定量方法和出版物的跟踪记录方面的强大背景， 授予写作。在5年的奖励期内，Wynn博士将实现以下职业发展目标： 1)发展流行病学和酗酒与艾滋病毒和减少酒精的交叉方面的专门知识 在撒哈拉以南非洲的UTT时代的干预措施。2)获得建模人口影响的技能 酒精使用对艾滋病毒传播和疾病进展的影响。3)获得卫生经济学评价方面的专业知识 减少酒精干预措施，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： 关于饮酒人群和艾滋病毒感染者或高危人群的研究的道德行为。第五章） 通过进一步发展，扩大专业发展技能，为成功的学术生涯做准备 在出版、出版和科学合作方面的技能。这些目标与艾滋病办公室一致 研究高度优先主题："降低艾滋病毒/艾滋病发病率"和NIAAA战略计划。