Quality of Life and Aging with HIV in Rural Uganda

乌干达农村地区艾滋病毒感染者的生活质量和老龄化

• 批准号: 10685962
• 负责人: MARK J SIEDNER
• 金额: $ 74.75万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10685962
• 关键词: Acquired Immunodeficiency Syndrome; Address; Affect; Africa; Africa South of the Sahara; Age; Aging; Area; Behavior; Caring; Carotid Atherosclerotic Disease; Cause of Death; Cessation of life; Characteristics; Chronic; Chronic Disease; Conceptions; Country; Data; Development; Diagnostic; Disease; Educational workshop; Elderly; Environmental Exposure; Europe; Evaluation; Exhibits; Goals; HIV; HIV Infections; HIV Seronegativity; Health; Health Priorities; Hypertension; Individual; Inflammation; Infrastructure; Intervention; Interview; Investigation; Investments; Letters; Life; Life Expectancy; Life Style; Measures; Medical; Mental Depression; Modeling; Morbidity - disease rate; National Institute on Aging; Neurocognitive; Obstructive Lung Diseases; Older Population; Opportunistic Infections; Outcome Measure; Participant; Pattern; Personal Satisfaction; Persons; Physical Function; Population; Public Health; Qualitative Methods; Quality of life; Questionnaires; Research; Research Personnel; Resources; Risk; Rural; Science; Social Functioning; State Government; Structure; Technology; Training; Uganda; United States; United States National Institutes of Health; Universities; Viral Load result; acceptability and feasibility; antiretroviral therapy; arterial stiffness; cognitive function; cohort; comorbidity; effective intervention; family structure; functional improvement; functional status; improved; insight; medical schools; meetings; mortality; next generation; population based; preference; programs; sample collection; sex; social; social determinants; social factors; social stigma

! ABSTRACT The United States government has contributed over $50 billion to expand antiretroviral therapy (ART) access in sub-Saharan Africa. As people living with HIV (PLWH) in the region realize the medical benefits of these initiatives, their AIDS-related mortality is declining and their life expectancy is increasing. Yet, these programs typically apply a narrow focus on AIDS-related health, which overlooks the drivers of quality of life for this population, and risks losing the tremendous gains achieved through investments in HIV care programs. Consequently, there is a need to identify determinants of quality of life for older PLWH in sub-Saharan Africa, and evaluate interventions to sustain wellbeing. To date, most studies of aging with HIV in the region have been cross-sectional and have focused on single morbidity domains (e.g. hypertension). There is remarkably little data about regional preferences for and determinants of quality of life for older PLWH. Our preliminary data among older PLWH in Uganda demonstrate meaningfully different biomedical, social and HIV-specific risk profiles, and outsized effects of HIV stigma on social functioning and wellbeing, compared to western settings. Similarly, we and others have shown that alterations to family structures caused by deaths due to HIV might undermine quality of life in the region. Thus, our scientific premise is that the social, biomedical, and HIV- disease specific determinants of quality of life for older PLWH in rural sub-Saharan Africa will be different from those in the United States. Our overarching goal is to elucidate the determinants of quality of life for older PLWH in rural Uganda, and how HIV contributes to them, to ultimately develop effective interventions to improve quality of life for this population. In the current proposal, we will address important gaps in the field by: 1) using qualitative methods to develop a conceptual framework for how HIV impacts quality of life among older PLWH in Uganda, and inform measure selection for this proposal, 2) demonstrating how HIV infection affects trajectories of functioning and quality of life in rural Uganda; and 3) identifying intervention targets and assessing the acceptability and feasibility of interventions to address poor quality of life. Our proposal is relevant to Office of AIDS Research high-priority topics and responds to multiple National Institute of Aging topic areas through its focus on: 1) interactions between HIV, social determinants, functional status and wellbeing; 2) relationships between HIV infection and cognitive functioning; and 3) geriatric approaches to assessment of older adults with HIV. While addressing these high-priority areas of investigation, our study will build research capacity by providing a platform for junior investigators at the Mbarara University of Science and Technology, as part of a training initiative with Harvard Medical School (NIH D43 TW010128). Our study is anticipated to have significant public health impact by informing selection and evaluation of interventions to improve quality of life among the large and growing population of older PLWH in rural sub-Saharan Africa. !

！ 抽象的 美国政府已拨款超过 500 亿美元扩大抗逆转录病毒治疗 (ART) 的普及 在撒哈拉以南非洲。随着该地区艾滋病毒感染者 (PLWH) 认识到这些药物的医疗益处 通过这些举措，他们与艾滋病相关的死亡率正在下降，预期寿命正在延长。然而，这些计划 通常狭隘地关注与艾滋病相关的健康，忽视了生活质量的驱动因素 人口，并有可能失去通过投资艾滋病毒护理项目所取得的巨大成果。 因此，有必要确定撒哈拉以南非洲地区老年感染者生活质量的决定因素， 并评估维持福祉的干预措施。迄今为止，该地区大多数关于艾滋病毒导致的老龄化研究 是横断面的，重点关注单一发病领域（例如高血压）。值得注意的是 关于老年感染者生活质量的区域偏好和决定因素的数据很少。我们的初步 乌干达老年感染者的数据表明，生物医学、社会和艾滋病毒特定风险存在显着差异 与西方环境相比，艾滋病毒耻辱对社会功能和福祉的巨大影响。 同样，我们和其他人已经表明，因艾滋病毒死亡而导致的家庭结构的改变可能 损害该地区的生活质量。因此，我们的科学前提是社会、生物医学和艾滋病毒- 撒哈拉以南非洲农村老年 PLWH 生活质量的疾病特定决定因素将不同于 那些在美国的人。我们的首要目标是阐明老年人生活质量的决定因素 乌干达农村地区的艾滋病毒感染者以及艾滋病毒如何影响他们，最终制定有效的干预措施 提高该人群的生活质量。在当前的提案中，我们将通过以下方式解决该领域的重要差距： 1) 使用定性方法制定艾滋病毒如何影响人们生活质量的概念框架 乌干达的老年艾滋病患者，并为本提案选择措施提供信息，2) 展示艾滋病毒感染如何 影响乌干达农村地区的功能轨迹和生活质量； 3) 确定干预目标和 评估解决低生活质量问题的干预措施的可接受性和可行性。我们的建议是 与艾滋病研究办公室高度优先的主题相关，并对多个国家老龄化研究所做出回应 其重点关注以下主题领域：1）艾滋病毒、社会决定因素、功能状态和 福利; 2）HIV感染与认知功能之间的关系； 3) 老年治疗方法 对感染艾滋病毒的老年人进行评估。在解决这些高度优先的调查领域的同时，我们的研究将 通过为姆巴拉拉科技大学的初级研究人员提供平台来培养研究能力 技术，作为哈佛医学院培训计划的一部分 (NIH D43 TW010128)。我们的研究是 通过告知干预措施的选择和评估，预计将产生重大的公共卫生影响 提高撒哈拉以南非洲农村地区数量庞大且不断增长的老年感染者和艾滋病患者的生活质量。 ！

项目成果

Associations of the COVID-19 pandemic with quality of life: A cross-sectional study of older-age people with and without HIV in rural Uganda.

• DOI: 10.7189/jogh.13.06003
• 发表时间: 2023-01-20
• 期刊: Journal of global health
• 影响因子: 7.2
• 作者: Olivieri-Mui B;Hoeppner SS;Tong Y;Kohrt E;Quach LT;Saylor D;Seeley J;Tsai AC;Reynolds Z;Okello S;Asiimwe S;Flavia A;Sentongo R;Tindimwebwa E;Meyer AC;Nakasujja N;Paul R;Ritchie C;Greene M;Siedner MJ
• 通讯作者: Siedner MJ