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

乌干达接受抗逆转录病毒治疗的老年人的口腔疾病和生活质量 (ODQoL-UG)

• 批准号: 10696977
• 负责人: Steffany Chamut Villarreal
• 金额: $ 17.07万
• 依托单位: MBARARA UNIVERSITY/SCIENCE/ TECHNOLOGY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-18 至 2025-09-17
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10696977
• 关键词: Administrator; Adult; Affect; Africa; Africa South of the Sahara; African; Age; Area; Behavioral; Biochemistry; Biological; Caring; Clinical; Clinical Research; Clinical Trials; Communities; Dental Epidemiology; Dental caries; Development; Disease Progression; Early Diagnosis; Elderly; Epidemiology; Foundations; Funding; Future; Gender; Goals; Guidelines; HIV; HIV Infections; HIV/AIDS; Health; Health Disparities Research; Health Services; Health system; Healthcare; Impaired cognition; Incidence; Individual; Intervention; Intervention Studies; Interview; Investigation; Knowledge; Longevity; Longitudinal cohort; Measures; Mental Depression; Mental Health; Modeling; Mouth Diseases; National Institute of Dental and Craniofacial Research; Neurocognition; Neurocognitive Deficit; Oral; Oral Examination; Oral health; Outcome; Periodontal Diseases; Personal Satisfaction; Persons; Physicians; Policy Maker; Population; Population Heterogeneity; Positioning Attribute; Prevalence; Prevention; Preventive; Provider; Psyche structure; Public Health; Quality of life; Questionnaires; Research; Research Infrastructure; Research Methodology; Research Priority; Resource-limited setting; Risk; Risk Factors; Rural; Scientist; Services; Social Functioning; Syndrome; Uganda; United States National Institutes of Health; Xerostomia; age effect; aged; antiretroviral therapy; burden of illness; care recipients; care systems; clinical care; co-infection; cohort; comorbidity; design; frailty; health care service; health disparity; health related quality of life; high risk; high risk population; improved; informant; mild cognitive impairment; multidisciplinary; multiple chronic conditions; neglect; permanent tooth; programs; social culture; therapy design; treatment strategy; years lived with disability

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.

抽象的 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，并且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 牙齿健康仍然是艾滋病毒和相关临床护理领域中一个被忽视的研究领域，并且 撒哈拉以南非洲地区几乎所有艾滋病毒临床指南均未提及。已证实的互惠关联 老年综合症与口腔健康状况不佳之间的关系会影响艾滋病毒感染者老年人的生活质量 在美国等发达国家已经得到了很好的描述，但在资源有限的环境中却没有得到很好的描述 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 导致老年人艾滋病毒感染者口腔健康和生活质量较差的因素。我们的目标是确定 老年综合症（虚弱、抑郁和认知能力下降）对口腔健康和生活质量的影响 艾滋病毒感染者，并探索将口腔卫生服务纳入艾滋病毒日常护理的机制 撒哈拉以南非洲农村地区的背景。本研究的具体目标是： 1a) 确定贡献 虚弱、神经认知和抑郁症对牙周病、龋齿、 和乌干达感染和未感染艾滋病毒的老年人中的口干症，1b) 来估计以下因素的贡献： 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) 探讨乌干达将口腔保健服务纳入常规艾滋病毒护理的障碍和促进因素。到 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 岁及以上感染艾滋病毒的老年人进行的研究 乌干达西南部及其年龄和性别匹配的艾滋病毒未感染者对照。我们提出的研究是 其独特之处在于： a) 第一个描述口腔健康流行病学、艾滋病毒的贡献、 和老年综合症对乌干达口腔健康的影响，b) 重点关注老年人的生活质量和福祉 弱势、多样化人群中的人们，以及 c) 使用混合方法研究来描述 健康状况不佳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。我们拥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 美国在口腔、精神和艾滋病毒护理和研究方面拥有广泛的专业知识；流行病学、生物化学、 和全球人口公共卫生，以实现本应用程序设定的独立拟议目标。这 研究结果将显示乌干达老年人最常见的口腔和牙齿健康问题 艾滋病毒感染者及其对生活质量的影响，以及最重要的是其决定因素。结果，我们将 能够更好地在乌干达西南部设计一项干预措施，以评估将口头和 牙科健康预防和促进计划纳入常规艾滋病毒护理。研究结果将构成我们的基础 申请 R01 资助的临床试验来设计和研究这种干预措施。