HIV and HIV Interventions to Promote Healthy Aging

项目3：促进健康老龄化的艾滋病毒和艾滋病毒干预措施-摘要 在过去大规模艾滋病毒治疗和预防举措的推动下， 撒哈拉非洲（SAA）正在迅速老龄化。目前，与老龄化和艾滋病毒有关的三个持续存在的知识差距 阻碍艾滋病毒治疗和预防对策的长期成功。第一，动态 对老年人艾滋病毒治疗和预防级联的了解甚少。第二，非常大 大部分老年人不知道自己的艾滋病毒状况，目前尚不清楚采取何种方法 增加老年人的艾滋病毒检测和方案联系。第三，艾滋病毒的长期因果影响 治疗中老年人在SSA是未知的，特别是关于痴呆症和身体和 情绪功能长期目标是确保“真实的生活”大规模艾滋病毒的全部潜在影响 治疗和预防战略在SSA实现。本申请的目的是确定 改善撒哈拉以南非洲老年人艾滋病毒应对措施的方法。我们的核心假设是， 在撒哈拉以南非洲地区，有相当比例的老年人目前未能从艾滋病毒治疗和预防中充分受益， 这些失败可以通过基于人口和卫生系统的干预措施成功解决。 这项研究的基本原理是，一旦知道老年人如何几乎普遍地 艾滋病毒检测和方案联系的成功实现，以及艾滋病毒的长期影响 治疗中的老年人口在SSA，常规的卫生政策和干预策略， 旨在确保老年人充分受益于本区域的艾滋病毒应对措施。建立在强大的 基于先前NIH/NIA P01（P01-AG 041710）资助的工作的初步数据，该假设将 通过追求三个具体目标进行测试： 目的1：量化艾滋病防治的纵向发展和决定因素 在南非农村的老年人中发生了级联反应。 目的2：在一个基于人群的随机田间实验中， 基于艾滋病毒状况知识和干预措施的艾滋病毒检测策略。 目标3：通过基于人群的准实验确定艾滋病毒对人群的长期影响 治疗痴呆症和身体功能。 该方法是创新的，因为它利用了纵向人口健康研究 基础设施的人口为基础的实验和准实验。拟议的研究是 意义重大，因为它有望促进我们了解如何更好地接触老年人， 有效的艾滋病干预措施。最终，这种理解将确保 撒哈拉以南非洲的艾滋病毒应对。

Project 3: HIV and HIV Interventions to Promote Healthy Aging—Abstract Driven by the large-scale HIV treatment and prevention initiatives of the past, the HIV epidemic in sub- Saharan Africa (SAA) is aging rapidly. Three persistent knowledge gaps related to aging and HIV currently stand in the way of the long-term success of the HIV treatment and prevention response. First, the dynamics of the HIV treatment and prevention cascades in older adults are poorly understood. Second, very large proportions of older adults are unaware of their HIV status and it is currently unknown which approaches increase HIV testing and programmatic linkage in older adults. Third, the long-term causal impacts of HIV treatment among aging adults in SSA are unknown, in particular regarding dementia and physical and emotional functioning. The long-term goal is to ensure that the full potential impact of `real life' mass HIV treatment and prevention strategies in SSA is realized. The objective in this application is to identify approaches to improve the HIV response for older adults in SSA. Our central hypothesis is that large proportions of older adults are currently failing to benefit fully from HIV treatment and prevention in SSA, but that these failures can be successfully addressed through population- and health systems-based interventions. The rationale for the proposed research is that once it is known how older adults can be near-universally and successfully reached for HIV testing and programmatic linkage, and what the long-term impacts of HIV treatment among aging populations in SSA are, routine health policy and intervention strategies can be designed to ensure that older adults are fully benefiting from the HIV response in the region. Building on strong preliminary data based on work funded by a previous NIH/NIA P01 (P01-AG041710), this hypothesis will be tested by pursuing three specific aims: AIM 1: Quantify the longitudinal developments and determinants of the HIV prevention and treatment cascades among older adults in rural South Africa. AIM 2: Establish in a population-based randomized field experiment the impacts of alternative home- based HIV testing strategies on HIV status knowledge and intervention uptake. AIM 3: Establish through population-based quasi-experiments the long-term population impacts of HIV treatment on dementia and physical functioning. The approach is innovative, because it utilizes a longitudinal population-based health research infrastructure for population-based experiments and quasi-experiments. The proposed research is significant, because it is expected to advance our understanding how older adults can be better reached and served by effective HIV interventions. Ultimately, this understanding will ensure the long-term success of the HIV response in SSA.