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

了解并减轻极端天气事件对艾滋病毒感染结果的影响：一项全球调查

• 批准号: 10762607
• 负责人: Denis Nash
• 金额: $ 79.2万
• 依托单位: GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-21 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762607
• 关键词: Address; Adolescent; Affect; Africa South of the Sahara; African; Age; Agriculture; Back; Caring; Cessation of life; Cholera; Chronic; Climate; Clinic; Clinical; Clinical Data; Collaborations; Communicable Diseases; Communities; Country; Cross-Sectional Studies; Data; Data Analyses; Data Set; Databases; Development; Disease; Disparity; Documentation; Droughts; Enrollment; Epidemiology; Event; Exposure to; Floods; Food; Funding; Future; Geographic Locations; Geography; HIV; HIV/AIDS; Health; Health Services Accessibility; Heat Waves; Household; Hurricane; Incidence; Income; International; Intervention; Investigation; Kenya; Knowledge; Link; Literature; Malaria; Malnutrition; Mathematics; Mental Health; Methods; Monitor; Outcome; Pathway interactions; Patients; Persons; Philippines; Policies; Policy Maker; Population; Prevalence; Process; Public Health; Quasi-experiment; Rain; Research; Research Personnel; Resolution; Resources; Risk; Rural; Rwanda; Severities; Shapes; Subgroup; Temperature; Testing; Time; Treatment outcome; Viral; Viral Load result; Vulnerable Populations; Work; advanced disease; antiretroviral therapy; care outcomes; climate change; climate data; climate impact; climate-related health; cohort; extreme weather; follow-up; food insecurity; global health; health data; implementation barriers; insight; interest; migration; multidisciplinary; novel; pandemic disease; pregnant; programs; public repository; resilience; resilience factor; rural health clinic; sex; spatiotemporal; stem; therapy adherence; therapy development; tool

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.

项目总结/摘要 干旱、洪水和重大灾害等极端天气事件带来的健康挑战 风暴（例如，飓风、台风）越来越常见和严重，威胁到公众的安全， 在过去的世纪里，卫生事业取得了很大的进步。关于EWE如何影响护理结果的证据有限 在3700万艾滋病毒/艾滋病感染者中，特别是在最脆弱的地理区域， 到EWE。横截面研究表明，干旱和降雨过多都与较高的 艾滋病毒流行率。然而，关于EWE如何影响短期和长期艾滋病毒护理的知之甚少 成果。我们对11个撒哈拉以南非洲国家数据的初步分析发现， 可能会延迟抗逆转录病毒治疗（ART）的及时启动，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研究表明， 通过减少粮食供应和坚持抗逆转录病毒疗法， 传染病发病率。缺乏对相关性和因果关系的严格纵向评估 EWE暴露和艾滋病毒护理结果之间的途径仍然是知识和障碍方面的一个关键差距 干预发展。全球IeDEA队列合作，超过200万艾滋病毒感染者参与艾滋病毒护理 在44个国家的长期（2004年至今）提供了一个无与伦比的机会， EWE对艾滋病毒护理结果的影响，在几个地理环境和亚人群， PLWH（例如，患有晚期疾病的人、青少年、怀孕的人等）。 拟议的5年混合方法研究将结合联合收割机的高分辨率每日温度数据， 降雨量来自五个公开的气候数据集与全球IeDEA队列数据，从2004年至今， 纵向评估EWE对HIV护理结果的影响（及时启动ART HIV病毒载量 监测和HIV病毒抑制）（目标1）。在目标2中，我们将使用混合方法来探索 在艾滋病毒/艾滋病感染者、影响机制和适应方面， 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 传播国家级公共使用气候数据集，其中包含经过地理编码的温度和降雨量数据 到1984年，供其他研究人员、项目实施者和政策制定者使用。我们期待这部小说 研究报告，为气候减缓和适应战略提供信息，并为制定 其他有针对性的（针对特定人群和区域的）干预措施，以解决EWE对健康的有害影响。 此外，我们希望我们的研究对全球卫生计划，政策， 数学建模者和资助者，为气候数据集创建新的健康相关应用程序。