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

描述(由申请者提供)：印度在未来几十年向数百万感染或将感染艾滋病毒/艾滋病的人提供抗逆转录病毒治疗(ART)服务方面面临重大挑战。与此同时，艾滋病毒易感人群和受感染人群中酒精消费水平的上升构成了保持遵守的巨大障碍。这一拟议的项目旨在：提供对当前抗逆转录病毒疗法实施情况和酒精以及遵守抗逆转录病毒疗法面临的其他挑战的基线了解；确定和测试可减少酒精消费的多层次干预措施，将其作为提高遵从性的核心因素；并开发供印度和其他地方使用的预测性模型，为以最具成本效益的方式分配干预资源提供基础，以最大限度地遵守、减少因艾滋病毒而损失的年数和生活质量，并最大限度地减少艾滋病毒的传播。感染艾滋病毒/艾滋病的人数现在估计为237万人。伴随着艾滋病毒感染的增加，印度的酒精消费在过去十年里飙升，易感染艾滋病毒的人群中问题饮酒率很高。这一拟议项目的重点是艾滋病毒携带者，因为酒精消费在男性中很常见(21%)，但在女性中仍然很低(2%)，除了性工作者等特殊群体外。众所周知，高度遵守艾滋病毒/艾滋病的抗逆转录病毒疗法(ART；95%)对于防止疾病进展和传播是必要的。随着治疗机会的增加和患者队列的成熟，在印度管理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，以改善遵守情况。然而，这些干预措施没有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，也没有从避免艾滋病毒病例和改善遵守抗逆转录病毒疗法方面的成本效益方面对其进行评估。此外，没有将控制酒精作为提高艺术依从性的努力的必要组成部分的传统。因此，这项研究的具体目的是：(1)评估公共艺术服务的当前结构、组织和影响，重点是减少与坚持抗逆转录病毒药物有关的酒精；(2)与艾滋病规划署和社区一起制定、实施和测试有助于减少酗酒、增加抗逆转录病毒药物依从性和防止疾病进展和传播的多层次干预措施；以及(3)利用行动研究模型，根据目标1和2产生的经验数据，评估干预措施对减少艾滋病毒感染的影响，以及艾滋病规划署的生活质量和数量。拟议的项目是一个跨学科的印美合作项目；该项目的地理焦点将是马哈拉施特拉邦的主要城市中心(孟买和浦那)，该邦是印度艾滋病毒/艾滋病患者最集中的邦。

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.