Research Training for Substance Use Mediated HIV Epidemic in Kazakhstan

关于心血管健康和心血管疾病（CVD）的知识有限 东欧和东欧艾滋病毒感染者（PLWH）中的艾滋病和老龄化 中亚（EECA）地区，包括哈萨克斯坦（KZ）。CVD与HIV的交叉点 在KZ和EECA中从未估计过护理连续性，也没有在 活在“危险”年龄的PLWH。减轻心血管疾病对艾滋病毒的不良影响 在PLWH中，心血管疾病和其他与衰老相关的风险因素的患病率必须 在整个艾滋病毒护理连续体中进行估计和描述。本申请是 补充正在进行的福格蒂艾滋病毒研究培训赠款。我们会提前训练一个- 阶段调查员（ESI）通过实现两个目标。目标1包括先进的教学 流行病学、生物统计学和数据管理及数据输入平台方面的培训， 重点是心血管疾病和老龄化流行病学和实施科学。目标2包括 动手实施一项横断面试点研究，以衡量心血管疾病的风险，艾滋病毒因素， 艾滋病毒+非传染性疾病的激增， 疾病（NCD）的护理连续体在KZ。试点研究有两个次级目标。目标2a估计数 HIV相关变量（病毒载量、CD 4+计数、VACS指数）和CVD风险的患病率 在KZ的150名>40岁的PLWH样本中。CVD风险包括超重和 肥胖、高血压、2型糖尿病、高脂血症、吸烟、饮酒， 以及心脑血管和外周血管事件史。目标2b评估CVD风险 按HIV严重程度、HCV合并感染、注射吸毒、年龄、出生性别分层， 性别，并考虑CVD风险评分。我们的假设是， 与高收入国家的PLWH相比，哈萨克斯坦的PLWH中存在这种风险， 在HCV合并感染者、注射吸毒者、年龄较大者和男性中较高。 这种先进的教学加上动手研究培训的创新组合之一 哈萨克ESI是KZ和EECA地区的第一个。在老化的PLWH中，我们将使用 评估CVD的标准化和经验证的临床和基于血液的生物标志物方法 风险与艾滋病毒相关因素相结合。这种训练可以在一年内完成。试点 研究结果将为干预措施的发展提供信息，以减少与以下相关的CVD风险因素： KZ艾滋病毒携带者和非传染性疾病患者的连续护理，以及前瞻性观察研究 旨在比较艾滋病毒感染者和非艾滋病毒感染者之间的衰老过程。的 哈萨克斯坦ESI将在传染病和非传染性疾病方面获得高度战略性的研究技能。

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.