Coping With HIV/AIDS in Tanzania

描述（由申请人提供）：超过3800万艾滋病毒/艾滋病患者中有三分之二居住在撒哈拉以南非洲。在不太富裕的国家，获得抗逆转录病毒疗法（ART）的机会正在迅速扩大，迫切需要了解影响依从性的因素，这是ART持续疗效的关键决定因素，以便限制抗药性病毒的产生和传播。拟议的研究小组已经确定，在坦桑尼亚莫希，29%的接受ART治疗超过6个月的诊所就诊者依从性不佳，同时记录了32%的患者缺乏病毒学抑制，10%的患者缺乏抗逆转录病毒药物耐药性。我们建议在该地区对750名新诊断的艾滋病毒阳性者、500名以前诊断的艾滋病毒阳性者和750名艾滋病毒阴性者进行3年以上的随访。新诊断的HIV+和HIV-队列将通过自愿咨询和检测（VCT）中心的连续采样获得，正在进行的HIV+队列将同样从5英里外的三级医疗中心的传染病诊所（IDC）抽取。该研究小组在自愿咨询和检测中心和国际数据中心的站点都有成功的过去和正在进行的研究的记录。我们将使用基线数据来检查心理社会（包括创伤，心理健康治疗，应对策略和生活事件），社会人口学和经济因素与健康状况，坚持ART，健康促进和高风险活动之间的关联。纵向分析将检查自变量和因变量变化之间的因果关系。结果将导致为该地区和其他类似地区建立更有效的预防和护理模式。在资源匮乏的环境中研究ART初治患者人群提供了一个独特的机会窗口，可以收集旨在增加我们对与依从性不良和风险行为相关的潜在变量的理解的数据。心理社会决定因素是这一建议的独特优势。这项研究将产生至少7篇同行评审的文章，并在年度国家（美国和坦桑尼亚）和国际艾滋病、公共卫生和精神卫生会议上传播研究结果，包括年度坦桑尼亚国家艾滋病会议。将向国家和国际领导人分发一份政策报告。

DESCRIPTION (provided by applicant): Two-thirds of the >38 million people with HIV/AIDS reside in Sub-Saharan Africa. Access to antiretroviral therapy (ART) in less wealthy nations is expanding quickly, creating an urgent need to understand those factors influencing adherence, a key determinant of ongoing efficacy of ART, so that the creation and spread of medication-resistant virus is limited. The proposed research team has identified suboptimal adherence among 29% of clinic attendees taking ART for > 6 months in Moshi Tanzania, while documenting lack of virologic suppression in 32% and antiretroviral drug resistance in 10%. We propose to follow 750 newly diagnosed HIV+ persons, 500 previously diagnosed HIV+ persons and 750 HIV-negative persons in over 3 years in this region. The newly diagnosed HIV+ and HIV- cohorts will be obtained through consecutive sampling in a Voluntary Counseling and Testing (VCT) site and the on-going HIV+ cohort will be similarly drawn from the Infectious Disease Clinic (IDC) in the tertiary care medical center 5 miles away. This research team has a track record of successful past and ongoing research at both the VCT and the IDC sites. Baseline data we will used to examine associations between psychosocial (including trauma, mental health symptomatology, coping strategies and life events), sociodemographic, and economic factors and health status, adherence to ART, and health promotion and high risk activities. Longitudinal analyses will examine causal relationships between changes in the independent and dependent variables. Results will lead to the creation of more effective prevention and care models for the area and other similar areas. Studying the population of ART naive patients in a resource poor setting provides a unique window of opportunity to gather data designed to increase our understanding of underlying variables associated with maladherence and risk behaviors. Psychosocial determinants are a unique strength of this proposal. The study will result in a minimum of 7 peer reviewed articles and dissemination of findings at annual national (US and Tanzanian) and international AIDS, Public Health and Mental Health conferences, including the annual Tanzania national AIDS conference. A policy related report will be disseminated to national and international leaders.