Health consequences of water insecurity for HIV-infected mothers & their infants

 描述（由申请人提供）：家庭粮食不安全已成为艾滋病毒感染者（PLHIV）健康状况不佳的一个非常有力的预测因素，预测艾滋病毒传播风险增加以及艾滋病毒结果不佳。家庭用水不安全（WI）可能同样或更有力地预测艾滋病毒相关的结果，但引人注目的是，它在艾滋病毒结果中的作用几乎完全被忽视了。事实上，由于目前没有有效的尺度来评估家庭获得足够数量和质量的水，因此无法衡量WI的后果。因此，本申请的科学目的是阐明家庭WI在肯尼亚西部尼扬扎的HIV感染妇女及其婴儿的不良健康结局中的作用。这项研究将进一步实现长期目标，即了解感染艾滋病毒的母亲用来保护自己和婴儿健康的行为和心理应对机制。核心假设是，WI是有害的，这一人口在经济，营养，疾病和心理社会领域，并在不同的方式从粮食不安全。这一假设是由研究者正在进行的尼扬扎K 01资助队列的初步数据指导的，并将通过3个特定目标进行检验。首先，将根据先前在肯尼亚的研究和形成性研究制定家庭WI量表（目标1）。然后将进行试点和验证（目标2）。然后，将使用所得量表评估PI正在进行的队列中360名妇女及其婴儿的HIV状态和WI后遗症的WI差异（目标3）。据推测，WI的患病率将在HIV感染的妇女中更高，并且它将与更差的结果相关，包括更高的病毒载量、腹泻、压力、抑郁和次优的婴儿喂养方法。这项研究具有重要意义，因为a）水资源短缺是一个普遍和日益严重的问题，经常发生在艾滋病毒高流行率的地方; B）妇女承担着获取和使用水资源的主要负担;以及c）对于感染HIV的妇女来说，WI有一些非常合理和严重的健康后果由于艾滋病毒感染者的免疫力受到损害，他们需要更多的水，获得水的能力较低，因此他们的婴儿（例如腹泻）和婴儿（例如不完全母乳喂养）。随着对家庭WI如何有害的更好理解，将有可能设计更有效的干预措施，以改善感染艾滋病毒的母亲及其感染艾滋病毒的婴儿的健康，以及不直接受艾滋病毒影响的人的健康。这项研究是创新的，因为它使用尖端的定性和定量方法来开发第一个经过验证的家庭WI量表，因为它将产生新的数据来测试有关WI可能影响艾滋病毒感染母亲及其婴儿健康的途径的假设。预期成果包括第一个经过验证的家庭层面的WI量表，该量表将准备好在其他人群中进行调整，并增加我们对艾滋病毒感染母亲面临的最佳健康障碍的理解，从而强调最终干预的新方法，以降低艾滋病毒感染者健康状况不佳的风险，并减少艾滋病毒的垂直传播。

 DESCRIPTION (provided by applicant): Household food insecurity has emerged as a very powerful predictor of poor health among people living with HIV (PLHIV), predicting increased risk of HIV transmission as well as poor HIV outcomes. Household water insecurity (WI) may be equally or more powerfully predictive of HIV-related outcomes, but strikingly, its role in HIV outcomes has been almost entirely overlooked. Indeed, because there is currently no validated scale for assessing household access to water in sufficient quantity and quality, it has not been possible to measure the consequences of WI. Therefore, the scientific objective of this application is to elucidate the role of house- hold WI in poor health outcomes among HIV-infected women and their infants in Nyanza, Western Kenya. This research will further the long-term goal of understanding the behavioral and psychological coping mechanisms that HIV-infected mothers use to preserve their health and that of their infants. The central hypothesis is that WI is detrimental to this population in economic, nutritional, disease, and psychosocial domains, and in ways distinct from food insecurity. This hypothesis was guided by preliminary data from the investigators' ongoing K01-funded cohort in Nyanza, and will be tested via 3 specific aims. First, a household WI scale will be developed based on prior research and formative research in Kenya (Aim 1). It will then be piloted and validated (Aim 2). The resultant scale will then be used to assess differences in WI by HIV status and sequelae of WI among 360 women and their infants in the PI's ongoing cohort (Aim 3). It is hypothesized that the prevalence of WI will be greater among HIV-infected women, and that it will be associated with worse outcomes, including greater viral load, diarrhea, stress, depression, and sub-optimal infant feeding practices. This research is highly significant because a) water scarcity is a widespread and growing problem, often occurring in places with high HIV prevalence; b) women bear the major burden of water acquisition and use; and c) there are a number of highly plausible and serious health consequences of WI for HIV-infected women (e.g. diarrhea) and their infants (e.g. less exclusive breastfeeding) given the compromised immunity of PLHIV, their greater water needs, and lesser abilities to access water. With a better understanding of how household WI is deleterious, it will be possible to design more effective interventions to improve the health of HIV-infected mothers and their HIV-ex- posed infants, as well as among people not directly impacted by HIV. This research is innovative for its use of cutting-edge qualitative and quantitative methods to develop the first validated household WI scale and because it will generate novel data to test hypotheses about the pathways by which WI may impact the health of HIV-infected mothers and their infants. The expected outcomes include the first validated household-level WI scale, which will be ready for adaptation among other populations, and an increase in our understanding of the barriers to optimal health faced by HIV-infected mothers, thereby highlighting novel ways to eventually intervene to reduce the risk of poor health outcomes among PLHIV and reduce vertical transmission of HIV.