ARV effects on HIV epidemiology & behaviors Rakai Uganda

抗逆转录病毒药物对艾滋病毒流行病学的影响

• 批准号: 6947956
• 负责人: Maria J Wawer
• 金额: $ 140万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-15 至 2010-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6947956
• 关键词: AIDS education /prevention; AIDS therapy; Africa; HIV infections; antiAIDS agent; behavioral /social science research tag; clinical research; combination chemotherapy; communicable disease transmission; drug resistance; epidemiology; gene mutation; health behavior; health care service evaluation; health care service utilization; human subject; human therapy evaluation; rural health; vertical transmission

DESCRIPTION (provided by applicant): The provision of HIV antiretroviral (ARV) therapy in Africa will have beneficial health and social effects, but will present many challenges. Since the drugs are now being initiated in Uganda, we have a narrow window of opportunity to assess the population-level impact of ARVs on HIV transmission and epidemiology, on behaviors in both HIV+ and HIV uninfected persons, and on sociodemographic indicators. Information is also needed on the emergence and transmission of drug resistance mutations, the effects of prior maternal nevirapine use on subsequent ARV effectiveness, and on barriers to ARV acceptance and adherence. The Rakai Health Sciences Program has received PEPFAR funds to initiate an ARV program in rural Rakai District, Uganda. Since 1994, we have conducted the Rakai Community Cohort Study (RCCS) and have longitudinal population-based information on HIV epidemiology, and on community risk behaviors, health and sociodemographic characteristics. These data provide a baseline for the assessment of ARV effects. Rakai has a mature, generalized epidemic, with a prevalence of 15% and an incidence of approximately 1.4/100 py. Under the proposed R01 (complementary to PEPFAR), we plan to conduct integrated quantitative and qualitative research in RCCS communities (n= 12,000 adults and approximately 600 children) and in non-RCCS comparison communities (n = 1,000 adults). We propose to examine epidemiological effects of ARVs (HIV incidence and prevalence; emergence and transmission of drug-resistant HIV, treatment acceptance and effectiveness, mother-to-child HIV transmission by subtype [A, D, AD recombinant]; as well as behavioral, social and demographic effects (behavioral disinhibition, use of HIV counseling and testing, use of other prevention services, contraceptive use, mortality, fertility, marital stability and orphanhood). We will also examine knowledge and attitudes towards ARVs, and the effects of stigma on ARV use. The study will provide unique data to guide HIV care in Africa and for projecting the course of the epidemic in the ARV era.

描述（由申请人提供）：在非洲提供艾滋病毒抗逆转录病毒（ARV）治疗将对健康和社会产生有益的影响，但也会带来许多挑战。由于这些药物目前正在乌干达启动，我们有一个狭窄的机会来评估抗逆转录病毒药物对艾滋病毒传播和流行病学、艾滋病毒+和艾滋病毒未感染者的行为以及社会人口指标的人群影响。还需要关于耐药突变的出现和传播、母亲先前使用奈韦拉平对随后抗逆转录病毒药物有效性的影响以及抗逆转录病毒药物接受和依从性障碍的信息。拉凯健康科学项目已收到总统紧急救援计划 (PEPFAR) 资金，用于在乌干达拉凯地区农村地区启动抗逆转录病毒项目。自 1994 年以来，我们开展了拉凯社区队列研究 (RCCS)，并拥有基于人群的艾滋病毒流行病学、社区危险行为、健康和社会人口特征的纵向信息。这些数据为评估 ARV 效果提供了基线。 Rakai 是一种成熟的、普遍的流行病，患病率为 15%，发病率约为 1.4/100 py。 根据拟议的 R01（对 PEPFAR 的补充），我们计划在 RCCS 社区（n = 12,000 名成人和约 600 名儿童）和非 RCCS 比较社区（n = 1,000 名成人）进行综合定量和定性研究。我们建议研究抗逆转录病毒药物的流行病学影响（艾滋病毒发病率和流行率；耐药艾滋病毒的出现和传播、治疗接受度和有效性、按亚型[A、D、AD重组]划分的母婴艾滋病毒传播；以及行为、社会和人口影响（行为去抑制、艾滋病毒咨询和检测的使用、其他预防服务的使用、避孕药具的使用、死亡率、生育力、 婚姻稳定和孤儿身份）。我们还将研究人们对抗逆转录病毒药物的知识和态度，以及耻辱感对抗逆转录病毒药物使用的影响。该研究将为指导非洲的艾滋病毒护理和预测抗逆转录病毒药物时代的流行病进程提供独特的数据。