Unhealthy alcohol use, other drug use, and mental health disorders: comorbidity burden in people with HIV, gaps in treatment, and impact on the HIV care continuum

不健康的饮酒、其他药物使用和精神健康障碍：艾滋病毒感染者的合并症负担、治疗差距以及对艾滋病毒护理连续性的影响

• 批准号: 9925957
• 负责人: Catherine Lesko
• 金额: $ 18.24万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-25 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9925957
• 关键词: Accounting; Acquired Immunodeficiency Syndrome; Address; Alcohol abuse; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Antidepressive Agents; Anxiety; Bayesian Method; Bayesian Modeling; Caring; Clinic; Clinical; Clinical Data; Clinical Management; Clinical assessments; Cocaine; Comorbidity; Continuity of Patient Care; Data; Diagnosis; Disease; Drug Use Disorder; Drug usage; Ensure; Epidemic; Epidemiologist; Face; Feedback; Geography; Goals; Grant; HIV; Healthcare; Heroin; High Prevalence; Individual; Intervention; Lead; Long-Term Effects; Longterm Follow-up; Major Depressive Disorder; Measurement; Medical Records; Mental Depression; Mental Health; Mental disorders; Mentored Research Scientist Development Award; Mentors; Methods; Minority; Modernization; Outcome; Outcome Measurement Error; Patient Outcomes Assessments; Patient Self-Report; Patients; Pattern; Persons; Pharmacological Treatment; Pharmacology; Prevalence; Prevention; Psychiatric epidemiology; Regimen; Reporting; Research; Research Personnel; Resources; Sampling; Screening procedure; Site; Symptoms; System; Time; Training; Treatment Effectiveness; Validation; Viral; Viral Load result; Work; Writing; alcohol abuse therapy; alcohol and other drug; alcohol intervention; alcohol misuse; alcohol use disorder; antiretroviral therapy; care outcomes; career; clinical Diagnosis; clinical care; clinically relevant; cocaine use; depressive symptoms; experience; heroin use; improved; innovation; insight; multiple chronic conditions; opioid use; opioid use disorder; reduced alcohol use; scale up; symposium

PROJECT SUMMARY The overall goal of this K01 application is to examine the impact of unhealthy alcohol use, cocaine use, non- prescribed opioid use, depression, and anxiety on HIV care outcomes. Despite the durability of modern antiretroviral therapy (ART) regimens, there is still a substantial minority of patients who have trouble maintaining viral suppression. Unhealthy alcohol use, other drug use, and mental health disorders have all been identified as drivers of viral non-suppression among people with HIV (PWH), yet these conditions have typically been considered independently from one another. Furthermore, the impact of these conditions is difficult to describe because symptoms are likely underreported and they are largely undertreated. Pharmacologic treatments for alcohol use disorder (AUD), opioid use disorder, depression, and anxiety are available but their long-term effects, particularly in people with comorbid substance use and mental health disorders, and particularly on HIV care continuum outcomes has been insufficiently studied. The goal of this K01 is to train the recipient to study the intersection of unhealthy alcohol use, other drug use, and mental health disorders in people with HIV, accounting for challenges in identifying these conditions. Research aims of this project are to: (1) describe the prevalence, co-occurrence, and durability of unhealthy alcohol use, cocaine use, non-prescribed opioid use, depression, and anxiety among PWH in care, accounting for underreporting of these conditions; (2) describe the care continua for AUD, opioid use disorder, cocaine use, depression, and anxiety – that is, rates of clinical diagnoses, initiation on, and retention on pharmacologic treatment for these disorders; and (3) estimate long-term effects of pharmacologic interventions on alcohol consumption, other drug use, and mental health symptoms, and ultimately retention in HIV care and viral load. The training aims of this project are to: (1) gain understanding of current and best practices for the prevention and clinical management of unhealthy alcohol use, other drug use, and mental health disorders for PWH; (2) apply innovative methods for handling measurement error in these conditions; (3) explore Bayesian methods for one means of handling measurement error in the absence of validation data; and (4) obtain the research, writing, and administrative expertise, and preliminary data, to submit a successful R01 grant in the penultimate year of the K01 award period. Training aims will be accomplished through rigorous coursework, seminar participation, mentored and collaborative research, and conference participation. Research aims will be conducted using data from the Center for AIDS Research Network of Integrated Clinical Systems, which includes medical record data and patient reported outcomes from over 34,000 PWH engaged in clinical care from 1995-present at eight US HIV clinics. This project will address a critical gap in our understanding of how alcohol and other drug use and mental health comorbidities co-occur to impact HIV outcomes, and give clues to the potential impact that scaling up pharmacologic treatment of these comorbidities could have on ending the HIV epidemic.

项目概要 该 K01 应用程序的总体目标是检查不健康的酒精使用、可卡因使用、非 处方阿片类药物的使用、抑郁和焦虑对艾滋病毒护理结果的影响。尽管现代的耐用性 抗逆转录病毒治疗（ART）方案中，仍有相当少数患者遇到困难 维持病毒抑制。不健康的饮酒、其他药物的使用以及精神健康障碍都导致了 已被确定为艾滋病毒感染者 (PWH) 病毒不被抑制的驱动因素，但这些情况已经 通常被认为是相互独立的。此外，这些条件的影响是 很难描述，因为症状可能没有得到充分报告，而且在很大程度上没有得到充分治疗。 酒精使用障碍 (AUD)、阿片类药物使用障碍、抑郁症和焦虑症的药物治疗包括 可用，但其长期影响，特别是对于患有药物滥用和心理健康问题的人 疾病，特别是艾滋病毒护理连续结果尚未得到充分研究。此举的目标 K01 是训练接受者研究不健康的饮酒、其他药物使用和精神疾病的交叉点 艾滋病毒感染者的健康障碍，解释了识别这些疾病的挑战。研究目的 该项目旨在：(1) 描述不健康饮酒、可卡因的流行率、同时发生和持续时间 护理中的感染者的使用、非处方阿片类药物使用、抑郁和焦虑，是漏报的原因 这些条件； (2) 描述 AUD、阿片类药物使用障碍、可卡因使用、抑郁症和 焦虑——即临床诊断率、药物治疗的开始率和保留率 疾病； (3) 估计药物干预对饮酒、其他药物的长期影响 吸毒和心理健康症状，并最终保留艾滋病毒护理和病毒载量。培训目标 该项目的目的是：（1）了解预防和临床的当前和最佳实践 管理感染者不健康的饮酒、其他药物使用和精神健康障碍； (2)申请 在这些条件下处理测量误差的创新方法； (3)探索贝叶斯方法 在没有验证数据的情况下处理测量误差的方法； (4) 获得研究、写作、 和行政专业知识以及初步数据，以在倒数第二年成功提交 R01 拨款 K01颁奖期。培训目标将通过严格的课程作业、研讨会参与、 指导和合作研究以及会议参与。研究目标将使用 数据来自艾滋病研究中心网络综合临床系统，其中包括医疗 记录 1995 年至今从事临床护理的 34,000 多名 PWH 的数据和患者报告的结果 美国八家艾滋病毒诊所。该项目将解决我们对酒精和其他物质如何影响理解的一个关键差距。 吸毒和心理健康合并症同时发生会影响艾滋病毒的结果，并为潜在的潜在风险提供线索 扩大这些合并症的药物治疗可能对结束艾滋病毒流行产生影响。