Oral diseases and quality of life in older adults on anti-retroviral therapy in Uganda (ODQoL-UG)

摘要 口腔疾病(牙周病、龋齿和口干症)对长期健康有重大有害影响。 和生活质量，并被认为在感染艾滋病毒的老年人中更为普遍。尽管如此，口头和 在艾滋病毒和相关临床护理领域，牙齿健康仍然是一个被忽视的研究领域，而且 在撒哈拉以南非洲几乎所有的艾滋病毒临床指南中都没有。已证明的互惠关系 影响老年HIV感染者生活质量的老年综合征和口腔健康不良之间的关系 在美国等发达国家得到了很好的描述，但在资源有限的情况下，如 乌干达。我们假设艾滋病毒、虚弱、抑郁和认知能力下降的综合影响是风险。 艾滋病毒携带者老年人口腔健康和生活质量较差的因素。我们的目标是确定 老年综合征(虚弱、抑郁和认知衰退)对口腔健康和生活质量的影响 ，并探索将口腔保健服务纳入艾滋病毒常规护理的机制 撒哈拉以南非洲农村的背景。这项研究的具体目的是：1)确定 虚弱、神经认知和抑郁是牙周病、龋齿、 在乌干达艾滋病毒携带者和非艾滋病毒携带者中患有口干症和口干症，1b)以评估 牙周病、龋齿和口干症对口腔和整体健康相关生活质量的影响，以及2) 探索乌干达将口腔健康服务纳入常规艾滋病毒护理的障碍和促进者。至 为了实现这一目标，我们将利用现有的临床研究基础设施/NIH支持的纵向队列 (UGANDAC，R01 AG059504，Pi Mark Siedner)对50岁及以上艾滋病毒携带者的研究 乌干达西南部和他们的年龄和性别匹配的艾滋病毒未感染对照。我们建议的研究是 其独特之处在于：a)它将是最早描述口腔健康流行病学、艾滋病毒的贡献、 和老年综合症对口腔健康的影响，b)重点关注老年人的生活质量和福祉 和c)使用混合研究方法来描述 健康不良的决定因素，并制定干预措施，以满足改善口腔健康的公共卫生需求 在高危人群中。我们有一支由来自非洲的专业医生和科学家组成的多学科团队 和美国，带来了口腔、心理和艾滋病毒护理和研究方面的广泛专业知识；流行病学、生化、 并为实现全球人口公共卫生这一应用的既定独立目标提出了建议。这个 研究结果将显示乌干达老年人中最常见的口腔和牙齿健康问题 艾滋病毒携带者及其对生活质量的影响，最重要的是，它们的决定因素。因此，我们将成为 更好地在乌干达西南部设计干预措施，以评估纳入口腔和 口腔健康预防和促进计划，以常规的艾滋病毒护理。这些发现将成为我们 申请R01资助的临床试验，以设计和研究这种干预措施。

ABSTRACT Oral diseases (periodontal disease, caries, and xerostomia) have major deleterious effects on long-term health and quality of life, and are thought to be more prevalent in older adults living with HIV. Despite this, oral and dental health remains a neglected area of research within the field of HIV and associated clinical care, and is absent from nearly all HIV clinical guidelines in Sub-Saharan Africa. A demonstrated reciprocal association between geriatric syndromes and poor oral health that affects quality of life among older people living with HIV has been well described in the developed world such as the US but not in resource limited settings such as Uganda. We hypothesize that the combined effects of HIV, frailty, depression, and cognitive decline are risk factors for poorer oral health and quality of life among older people living with HIV. Our goal is to determine the impacts of the geriatric syndromes (frailty, depression, and cognitive decline) on oral health and quality of life in people with HIV, and to explore the mechanisms of integration of oral health services into routine HIV care in the context of rural Sub-Saharan Africa. The specific aims for this study are: 1a) to determine the contributions of frailty, neurocognition, and depression as risks to the epidemiology of periodontal disease, dental caries, and xerostomia among older adults living with and without HIV in Uganda, 1b) to estimate the contributions of periodontal disease, dental caries and xerostomia to oral and overall health-related quality of life, and 2) to explore the barriers to and facilitators of integration of oral health services into routine HIV care in Uganda. To achieve this goal we will leverage the existing clinical research infrastructure/NIH-supported longitudinal cohort (UGANDAC, R01 AG059504, PI Mark Siedner) study of older adults aged 50 and older living with HIV in southwestern Uganda and their age and gender-matched HIV uninfected controls. Our proposed research is unique in that it will be: a) among the first to describe the epidemiology of oral health, the contributions of HIV, and geriatric syndromes on oral health in Uganda, b) focuses on quality of life and well-being among older people in a vulnerable, diverse population, and c) uses mixed methods research to both describe the determinants of poor health and develop interventions to respond to a public health need to improve oral health in a high-risk population. We have a multidisciplinary team of professional physicians and scientists from Africa and the US that brings broad expertise in oral, mental, and HIV care and research; epidemiology, biochemistry, and global population public health to achieve the set independent proposed aims of this application. The study's findings will show the most frequent oral and dental health problems among Ugandan older individuals living with HIV, their effects on quality of life, and, most importantly, their determinants. As a result, we will be in a better position to design an intervention in southwestern Uganda to assess the inclusion of an oral and dental health preventive and promotion program to routine HIV care. The findings will form the basis for our applications for an R01 funded clinical trial to design and study this intervention.