Understand and mitigating the influence of extreme weather events on HIV outcomes: A global investigation

项目摘要/摘要 极端天气事件(母羊)带来的健康挑战，如干旱、洪水和重大 风暴(如飓风、台风)越来越常见和严重，有可能破坏公众 过去一个世纪取得的卫生进步。关于母羊如何影响护理结果的证据有限 在3700万艾滋病毒/艾滋病患者中，特别是在最脆弱的地理区域 敬母羊。横断面研究表明，干旱和过多的降雨都与较高的 艾滋病毒流行率。然而，人们对母羊如何影响短期和长期艾滋病毒护理知之甚少。 结果。我们对11个撒哈拉以南非洲国家的数据进行了初步分析，发现极端降雨 可能会推迟抗逆转录病毒治疗(ART)的及时开始，并增加新患者的随访损失 参加艾滋病护理。我们在肯尼亚的初步定性工作表明，暴露在干旱和洪水中 通过减少食品供应和遵守抗逆转录病毒药物治疗对艾滋病毒结果产生不利影响 传染病发病率。缺乏对关系和因果关系的严格纵向评估 母羊暴露和HIV护理结果之间的途径仍然是知识和障碍的关键差距 干预性发展。全球IeDEA队列协作，&>200万PLWH注册了HIV护理 在44个国家的长期(2004年至今)提供了一个无与伦比的机会来描述 绵羊在不同地理环境和亚群中对艾滋病毒护理结果的影响 PLWH(例如，患有晚期疾病的人、青少年、怀孕的人等)。 拟议的为期5年的混合方法研究将结合关于温度和 使用全球IeDEA队列数据的五个公开气候数据集的降雨量，从2004年至今 纵向评估母羊对艾滋病毒护理结果的影响(及时启动艾滋病毒病毒载量 监测和抑制艾滋病毒病毒)(目标1)。在目标2中，我们将使用混合方法来探索 PLWH中母羊的脆弱性和复原力亚组，影响机制，适应和 在特定社区采用缓解战略，为干预措施提供信息。在目标3中，我们将创建和 发布国家一级公众使用的气候数据集，其中包含回溯的地理编码温度和降雨数据 到1984年，供其他调查人员、计划实施者和政策制定者随时使用。我们期待着这本小说 研究为气候缓解和适应战略提供信息，并为制定 其他有针对性的(人口和区域具体)干预措施，以解决母羊对健康的有害影响。 此外，我们预计我们的研究将对全球卫生计划、政策、 数学模型师和资助者，为气候数据集创建与健康相关的新应用程序。

Project Summary/Abstract The health challenges arising from extreme weather events (EWEs), such as droughts, floods, and major storms (e.g., hurricanes, typhoons) are increasingly common and severe, threatening to undermine public health progress made over the past century. There is limited evidence on how EWEs affect care outcomes among the 37 million people living with HIV/AIDS (PLWH), particularly in geographic regions most vulnerable to EWEs. Cross-sectional studies have shown both drought and excess rainfall to be associated with higher HIV prevalence. However, very little is known about how EWEs impact short- and long-term HIV care outcomes. Our preliminary analysis of data from 11 sub-Saharan African countries found that extreme rainfall may delay the timely initiation of antiretroviral therapy (ART) and increase loss to follow-up among those newly enrolling in HIV care. Our preliminary qualitative work in Kenya suggests that exposure to drought and flooding adversely affects HIV outcomes through decreased food availability and ART adherence and increased infectious disease incidence. The absence of rigorous longitudinal assessments of the relationships and causal pathways between EWE exposures and HIV care outcomes remains a crucial gap in knowledge and obstacle to intervention development. The global IeDEA cohort collaboration, with >2 million PLWH enrolled in HIV care in 44 countries over a long time horizon (2004-present) provides an unparalleled opportunity to characterize the influence of EWEs on HIV care outcomes across several geographic contexts and sub-populations of PLWH (e.g., those with advanced disease, adolescents, those who are pregnant, etc). The proposed 5-year, mixed methods study will combine high resolution daily data on temperature and rainfall from five publicly available climate datasets with the global IeDEA cohort data from 2004-present to longitudinally assess the impacts of EWEs on HIV care outcomes (timely ART initiation HIV viral load monitoring, and HIV viral suppression) (Aim 1). In Aim 2, we will use a mixed methods approach to explore subgroups of vulnerability and resilience to EWEs among PLWH, mechanisms of impact, and adaptation and mitigation strategies employed in specific communities to inform interventions. In Aim 3, we will create and disseminate a country-level public use climate dataset with geocoded temperature and rainfall data going back to 1984 for ready use by other investigators, program implementers, and policymakers. We expect this novel study to inform climate mitigation and adaptation strategies, and lay the groundwork for the development of other targeted (population and region-specific) interventions to address deleterious health effects of EWEs. Moreover, we expect our study to have significant implications for global health programs, policies, mathematical modelers and funders, creating new health-related applications for climate datasets.