Prevalence and Correlates of Khat Use Among HIV-Positive Patients in Ethiopia

埃塞俄比亚艾滋病毒阳性患者使用卡塔叶的流行率和相关性

• 批准号: 8329267
• 负责人: ALAN R LIFSON
• 金额: $ 17.61万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8329267
• 关键词: Accounting; Acute; Address; Adult; Africa; African; Aftercare; Alcohol consumption; Alcohols; Amphetamines; Area; Attitude; Behavior; Behavioral; Body mass index; CD4 Lymphocyte Count; Caring; Cessation of life; Characteristics; Chronic; Clinic; Clinic Visits; Clinical; Community Surveys; Counseling; Country; Cox Proportional Hazards Models; Data; Demographic Analyses; Demographic Factors; Dependence; Development; Drug usage; Economics; Enrollment; Ethiopia; Event; Failure; Focus Groups; Grant; HIV; HIV Infections; HIV Seropositivity; Health Benefit; Health Surveys; Home environment; Intervention; Interview; Knowledge; Life; Mastication; Medical; Mental Health; Modeling; Multivariate Analysis; Participant; Patient Education; Patients; Persons; Pharmaceutical Preparations; Plants; Population Study; Prevalence; Proportional Hazards Models; Public Health; Quality of life; Recruitment Activity; Reporting; Research; Research Proposals; Risk; Risk Factors; Severities; Sex Behavior; Social support; Solid; Staging; Stigmata; Substance of Abuse; Surveys; Target Populations; Textiles; Time; abstracting; advanced disease; alcohol and other drug; antiretroviral therapy; base; community intervention; demographics; drug of abuse; evidence base; follow-up; high risk; informant; khat; meetings; physical conditioning; prevent; programs; response; social; social stigma

DESCRIPTION (provided by applicant): Up to five million people per day may use khat, a plant native to East Africa abused for its amphetamine- like effects. In Ethiopia, community surveys found >30% were khat users; studies have reported rates almost double that for persons living with HIV. Focus groups and key informant interviews conducted by Dr. Lifson and colleagues suggest use of khat is a risk factor for default from HIV care, but there no quantitative studies evaluating this association. Ethiopian studies report that only 75% of those started on antiretroviral therapy (ART) are retained in care after one year, with losses greatest i the first six months. Inability to retain HIV patients in care undermines medical and public health benefits of global initiatives to identify HIV patients and enroll them in treatment. This exploratory R21 grant will allow us to evaluate this understudied area among both ART and pre-ART patients who are newly enrolled in care, the groups at highest risk for short-term HIV treatment default. Among HIV-positive persons newly enrolled in HIV medical care, we will: evaluate the prevalence and characterize use of khat and other substances of abuse; analyze demographic, behavioral and clinical factors associated with khat use; evaluate the association between use of khat and retention in HIV care; and identify other factors (including use of other drugs) associated with retention in HIV care 500 HIV-positive adults newly enrolled for medical care will be recruited from two major HIV Clinics in Bahir Dar, and will receive a baseline and 6-month follow-up health survey including: demographic characteristics; khat, alcohol and other drug use; HIV knowledge; quality of life; attitudes about HIV status and internalized stigma; social support; and perceived barriers to medical care. Every 6 months, additional data collected from the HIV Clinic will include body mass index, WHO clinical stage, CD4+ count, and dates of all HIV Clinic visits. Analysis of predictors of current khat use will include demographics, clinial status, and survey responses, with multivariate analyses to identify factors independently associated with khat use. We will also evaluate the correlation between khat and use of other drugs (including alcohol). Retention in HIV care will be defined based upon the fraction of all patients initiating care who continue to be alive and access HIV care according to defined follow-up criteria for ART and pre-ART patients. Our primary hypothesis is that current use of khat is associated with poorer retention in care. Proportional hazards models will be used to estimate associations between covariates and retention, and multivariate models use to identify independent predictors of retention, and to see if there is an association between retention and khat after adjustment for potential confounders. Our plan as a follow-up to this R21 study is to implement and evaluate an intervention to prevent HIV treatment default, including programs to specifically address khat using HIV patients. Data from this study will be used to develop community interventions that contain education, patient support, and motivational counseling. This research will provide us with a solid evidence base on which to build such an intervention. PUBLIC HEALTH RELEVANCE: This study, to be conducted in northern Ethiopia, will evaluate among HIV-positive persons the prevalence and predictors of use of khat, a plant which is commonly abused for its stimulant effects. We will also evaluate the impact of khat use on default from HIV care and treatment, adjusting for other potential confounders including alcohol use.

描述（由申请人提供）：每天多达500万人可能使用阿拉伯茶，这是一种原产于东非的植物，因其类似安非他明的作用而被滥用。在埃塞俄比亚，社区调查发现，超过30%的人是阿茶使用者;研究报告称，这一比例几乎是艾滋病毒感染者的两倍。Lifson博士及其同事进行的焦点小组和关键线人访谈表明，使用阿拉伯茶是艾滋病毒护理违约的风险因素，但没有定量研究评估这种关联。埃塞俄比亚的研究报告指出，开始接受抗逆转录病毒疗法（ART）的患者中，只有75%在一年后仍在接受治疗，其中前六个月的损失最大。无法留住艾滋病毒患者的护理损害了医疗和公共卫生 确认艾滋病毒患者并让他们接受治疗的全球倡议的好处。这项探索性的R21赠款将使我们能够在新登记的ART和ART前患者中评估这一研究不足的领域，这些患者是短期艾滋病毒治疗违约风险最高的群体。在新登记接受艾滋病毒医疗护理的艾滋病毒抗体阳性者中，我们将：评估阿拉伯茶和其他滥用物质的流行率和使用特点;分析与阿拉伯茶使用有关的人口、行为和临床因素;评估阿拉伯茶使用与继续接受艾滋病毒护理之间的关系;并确定其他因素（包括其他药物的使用）将从巴希尔达尔的两个主要艾滋病毒诊所招募新登记接受医疗护理的阳性成年人，并将接受基线和6个月的后续健康调查，包括：人口特征;阿拉伯茶、酒精和其他毒品使用情况;艾滋病毒知识;生活质量;对艾滋病毒状况的态度和内在的耻辱;社会支持;和感知的医疗保健障碍。每6个月，从HIV诊所收集的额外数据将包括体重指数、WHO临床分期、CD 4+计数和所有HIV诊所访视的日期。 对当前阿茶使用的预测因素的分析将包括人口统计学、临床状况和调查答复，并进行多变量分析，以确定与阿茶使用独立相关的因素。我们还将评估阿拉伯茶与使用其他药物（包括酒精）之间的相关性。根据ART和ART前患者的既定随访标准，将根据所有开始治疗的患者中继续存活并获得HIV治疗的比例来定义HIV治疗的保留率。我们的主要假设是，目前使用阿拉伯茶与护理保留较差有关。比例风险模型将用于估计协变量和保留之间的关联，多变量模型用于识别保留的独立预测因子，并在调整潜在混杂因素后观察保留和阿拉伯茶之间是否存在关联。 我们的计划作为这项R21研究的后续行动，是实施和评估一项预防艾滋病毒治疗违约的干预措施，包括专门针对艾滋病毒患者使用阿拉伯茶的方案。本研究的数据将用于制定社区干预措施，包括教育、患者支持和动机咨询。这项研究将为我们提供一个坚实的证据基础，以建立这样的干预。 公共卫生相关性：这项研究将在埃塞俄比亚北方进行，将评价艾滋病毒抗体阳性者中阿拉伯茶的流行情况和使用阿拉伯茶的预测因素，阿拉伯茶是一种因其兴奋剂作用而经常被滥用的植物。我们还将评估卡塔叶使用对艾滋病毒护理和治疗的影响，并对其他潜在的混杂因素进行调整，包括饮酒。