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

描述(申请人提供)：每天有多达500万人可以使用阿拉伯茶，这是一种原产于东非的植物，因其苯丙胺类作用而被滥用。在埃塞俄比亚，社区调查发现，30%的人使用阿拉伯茶；研究报告称，艾滋病毒携带者的这一比例几乎是前者的两倍。Lifson博士和他的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一个风险因素，但没有量化研究评估这种联系。埃塞俄比亚的研究报告称，在开始接受抗逆转录病毒疗法(ART)的患者中，只有75%的人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健康 识别艾滋病毒患者并让他们接受治疗的全球倡议的好处。这一探索性的R21拨款将使我们能够在新加入CARE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HIV治疗违约的最高风险群体。在新登记参加艾滋病毒医疗护理的艾滋病毒阳性者中，我们将：评估使用阿拉伯茶和其他滥用物质的流行率和特点；分析与使用阿拉伯茶有关的人口、行为和临床因素；评估使用阿拉伯茶与保留在艾滋病毒护理中的关系；并确定与保留在艾滋病毒护理中有关的其他因素(包括使用其他药物)500名新登记的艾滋病毒阳性成年人将从巴赫达尔的两个主要艾滋病毒诊所招募，并将接受基线和6个月的跟踪健康调查，包括：人口特征；阿拉伯茶、酒精和其他药物的使用；艾滋病毒知识；生活质量；对艾滋病毒状况和内在化污名的态度；社会支持；以及对医疗保健的感知障碍。每6个月，从艾滋病毒诊所收集的额外数据将包括体重指数、世卫组织临床分期、CD4+计数和所有艾滋病毒诊所的就诊日期。当前阿拉伯茶使用的预测因素分析将包括人口统计学、临床状态和调查反应，并进行多变量分析，以确定与阿拉伯茶使用独立相关的因素。我们还将评估阿拉伯茶与其他药物(包括酒精)的使用之间的相关性。根据为抗逆转录病毒治疗和抗逆转录病毒治疗前患者定义的后续标准，将根据所有开始接受治疗并继续活着并获得艾滋病毒护理的患者的比例来定义艾滋病毒护理中的保留。我们的主要假设是，目前使用阿拉伯茶与较差的护理保留有关。比例风险模型将用于评估协变量和保留之间的关联，多变量模型将用于确定保留的独立预测因素，并在调整潜在混杂因素后查看保留和阿拉伯茶之间是否存在关联。作为这项R21研究的后续行动，我们的计划是实施和评估一项预防艾滋病毒治疗违约的干预措施，包括专门针对使用艾滋病毒患者的阿拉伯茶项目。这项研究的数据将被用于开发包含教育、患者支持和动机咨询的社区干预措施。这项研究将为我们提供坚实的证据基础，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部进行，将评估艾滋病毒阳性者中使用阿拉伯茶的流行率和预测因素，阿拉伯茶是一种通常被滥用的植物，具有刺激作用。我们还将评估使用阿拉伯茶对艾滋病毒护理和治疗违约的影响，调整其他潜在的混杂因素，包括酒精使用。

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.