Research Training for Substance Use Mediated HIV Epidemic in Kazakhstan

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Limited knowledge exists about cardiovascular health and cardiovascular disease (CVD) and aging among people living with HIV infection (PLWH) in the Eastern European and Central Asia (EECA) region including Kazakhstan (KZ). The intersection of CVD with the HIV care continuum has never been estimated in KZ and the EECA, and not evaluated among PLWH who are living to older ‘at risk’ ages. To mitigate adverse effects of CVD on the HIV care continuum, the prevalence of CVD and other aging-related risk factors in PLWH must be estimated and characterized across the HIV care continuum. This application is a supplement to the ongoing Fogarty HIV Research Training Grant. We will train one Early- Stage Investigator (ESI) by accomplishing two Aims. Aim 1 includes advanced didactic training in epidemiology, biostatistics and data management and data entry platforms, with emphases on CVD and aging epidemiology and implementation science. Aim 2 consists of hands-on implementation of a cross-sectional pilot study to measure CVD risk, HIV factors and aging-related factors to improve understanding of the surging ‘HIV + Noncommunicable disease (NCD)’ care continuum in KZ. The pilot study has two sub Aims. Aim 2a estimates the prevalence of HIV-related variables (viral load, CD4+ count, VACS Index) and CVD risk among a sample of 150 PLWH who are >40 years in KZ. CVD risk includes overweight and obesity, hypertension, Type 2 diabetes, hyperlipidemia, cigarette smoking, alcohol intake, and history of cardio-, cerebro-, and peripheral vascular events. Aim 2b evaluates CVD risk with stratification by HIV severity, HCV coinfection, injection drug use, age, sex at birth, gender, and consideration of CVD risk scores. Our hypothesis is that CVD risk is higher among Kazakh PLWH compared to PLWH in high income countries, and that this risk is higher among those who are HCV co-infected, injection drug users, older in age, and male. This innovative combination of advanced didactic plus hands-on research training of one Kazakh ESI is the first in KZ and the EECA region. Among aging PLWH we will use standardized and validated clinical and blood-based biomarker approaches to assess CVD risk in combination with HIV-related factors. This training is achievable in one year. Pilot study results will inform development of interventions to reduce CVD risk factors related to the HIV+NCDs care continuum among PLWH in KZ, and prospective observational studies designed to compare aging processes between PLWH and people without HIV infection. The Kazakh ESI will attain a highly strategic research skillset in both communicable and NCD.