Alcohol and ART Adherence: Assessment, Intervention and Modeling in India

描述（由申请人提供）：印度面临着在未来几十年向数百万艾滋病毒/艾滋病感染者或将感染艾滋病毒/艾滋病的人提供抗逆转录病毒治疗（ART）服务的重大挑战。与此同时，易受艾滋病毒感染的人群中不断上升的酒精消费量构成了维持坚持的巨大障碍。这个拟议的项目旨在：提供对目前抗逆转录病毒治疗实施情况以及酒精和其他抗逆转录病毒治疗依从性挑战的基本了解；确定并测试可减少酒精消费的多层次干预措施，将其作为增强依从性的核心因素；并开发用于印度和其他地方的预测模型，为以最具成本效益的方式分配干预资源提供基础，以最大限度地提高依从性，减少因艾滋病毒而损失的寿命和生活质量，并最大限度地减少艾滋病毒传播。感染艾滋病毒/艾滋病的人数目前估计为237万人。随着艾滋病毒感染的增加，印度的酒精消费量在过去十年中急剧上升，艾滋病毒易感人群的问题饮酒率很高。这一拟议项目的重点是艾滋病毒感染者和抗逆转录病毒治疗，因为饮酒在男性中很常见（21%），但在女性中仍然很低（2%），除了性工作者等特殊群体。众所周知，高度坚持（95%以上）抗逆转录病毒治疗（ART）是预防疾病进展和传播的必要条件。随着治疗可及性的增加和患者队列的成熟，管理印度的治疗失败将成为一项核心挑战。已经为高收入国家制定了干预措施，以提高依从性。然而，这些干预措施尚未被系统地纳入中低收入国家的艾滋病毒预防或抗逆转录病毒治疗框架，也没有对它们在避免艾滋病毒病例和改善抗逆转录病毒治疗依从性方面的成本效益进行评估。此外，没有将酒精控制作为改善抗逆转录病毒治疗依从性工作的必要组成部分的传统。因此，本研究的具体目的是：(1)评估目前公共抗逆转录病毒治疗服务的结构、组织和影响，重点是与抗逆转录病毒治疗依从性相关的酒精减少；(2)与公共卫生机构和社区一起制定、实施和测试多层次干预措施，有助于减少酒精摄入、提高抗逆转录病毒治疗依从性和预防疾病进展和传播；(3)基于目标1和目标2中生成的经验数据，利用运筹学建模来估计干预措施对减少艾滋病病毒感染以及艾滋病患者生活质量和数量的影响。拟议中的项目是一个跨学科的印美合作项目；这个拟议项目的地理重点将是马哈拉施特拉邦的主要城市中心（孟买和浦那），马哈拉施特拉邦是印度艾滋病毒/艾滋病感染者最集中的州。

DESCRIPTION (provided by applicant): India faces a major challenge in providing antiretroviral therapy (ART) services in the next decades to several million people who live with or will acquire HIV/AIDS. At the same time, rising levels of alcohol consumption in HIV vulnerable and infected populations constitutes a formidable barrier to maintaining adherence. This proposed project seeks to: provide a baseline understanding of current ART implementation and alcohol and other challenges to ART adherence; identify and test multilevel interventions that can reduce alcohol consumption as a central factor in enhancing adherence; and develop predictive models for use in India and elsewhere that provides a basis for allocating intervention resources in the most cost-effective way to maximize adherence, reduce years and quality of life lost to HIV, and minimize HIV transmission. The number of people with HIV/AIDS is now estimated to be 2.37 million people. Concomitant with increases in HIV infection, India's alcohol consumption has skyrocketed in the past decade, with high rates of problem drinking in HIV vulnerable populations. The focus of this proposed project is on men who are living with HIV, on ART since alcohol consumption is common among men (21%) but continues to be very low (2%) among women except for special groups such as sex workers It has been well established that a high degree of adherence (> 95%) to Anti-Retroviral Therapy (ART) for HIV/AIDS is necessary to prevent disease progression and transmission. As treatment access increases and patient cohorts mature, managing treatment failure in India will emerge as a central challenge. Interventions have been developed for high income countries to improve adherence. However, these interventions have not been systematically integrated into the HIV prevention or ART framework in middle and low income countries, nor have they been evaluated in terms of their cost-benefit in terms of HIV cases averted and ART adherence improved. In addition, there is no tradition of including alcohol control as a necessary component of the effort to improve ART adherence. The specific aims of this study are thus to: (1) assess the current structure, organization and impact of public ART services with emphasis on alcohol reduction associated with ART adherence; (2) Develop, implement and test multilevel interventions with PLWHAs and communities that can contribute to alcohol reduction, increase ART adherence and prevent disease progression and transmission; and (3) utilize operations research modeling, based on empirical data generated in Aims 1 & 2, to estimate the impact of interventions on reduced HIV infections and the quality and quantity of life for PLWHAs. The proposed project is a trans disciplinary, Indo-US collaboration; the geographic focus of this proposed project will be the major urban centers (Mumbai and Pune) in Maharashtra, the state with India's largest concentration of persons living with HIV/AIDS.