ARV effects on HIV epidemiology and behaviors in Rakai, Uganda

描述（由申请人提供）：在非洲提供艾滋病毒抗逆转录病毒（ARV）治疗将产生有益的健康和社会影响，但也会带来许多挑战。由于这些药物现在正在乌干达启动，我们有一个狭窄的机会来评估ARV对HIV传播和流行病学，对HIV+和HIV未感染者的行为以及社会人口指标的人口水平影响。还需要关于耐药性突变的出现和传播、先前母亲使用奈韦拉平对随后抗逆转录病毒药物有效性的影响以及抗逆转录病毒药物接受和坚持的障碍的信息。Rakai健康科学方案收到了总统艾滋病紧急救援计划的资金，在乌干达Rakai农村地区启动了一个抗逆转录病毒方案。自1994年以来，我们进行了Rakai社区队列研究，并拥有关于艾滋病毒流行病学、社区危险行为、健康和社会人口特征的纵向人口信息。这些数据为评估抗逆转录病毒药物的效果提供了基线。 Rakai是一种成熟的、广泛的流行病，患病率为15%，发病率约为1.4/100 py。 根据拟议的R 01（PEPFAR的补充），我们计划在RCCS社区（n= 12，000名成人和约600名儿童）和非RCCS比较社区（n = 1，000名成人）进行综合定量和定性研究。我们建议研究抗逆转录病毒药物的流行病学影响（艾滋病毒的发病率和流行率;耐药艾滋病毒的出现和传播、治疗的接受程度和有效性、按亚型分列的艾滋病毒母婴传播[A、D、AD重组体];以及行为、社会和人口统计学影响（行为抑制解除、使用艾滋病毒咨询和检测、使用其他预防服务、避孕药具使用、死亡率、生育率，婚姻的稳定和幸福）。我们还将研究对抗逆转录病毒药物的知识和态度，以及污名化对抗逆转录病毒药物使用的影响。这项研究将提供独特的数据，以指导非洲的艾滋病毒护理，并预测在抗逆转录病毒药物时代艾滋病的流行过程。

DESCRIPTION (provided by applicant): The provision of HIV antiretroviral (ARV) therapy in Africa will have beneficial health and social effects, but will present many challenges. Since the drugs are now being initiated in Uganda, we have a narrow window of opportunity to assess the population-level impact of ARVs on HIV transmission and epidemiology, on behaviors in both HIV+ and HIV uninfected persons, and on sociodemographic indicators. Information is also needed on the emergence and transmission of drug resistance mutations, the effects of prior maternal nevirapine use on subsequent ARV effectiveness, and on barriers to ARV acceptance and adherence. The Rakai Health Sciences Program has received PEPFAR funds to initiate an ARV program in rural Rakai District, Uganda. Since 1994, we have conducted the Rakai Community Cohort Study (RCCS) and have longitudinal population-based information on HIV epidemiology, and on community risk behaviors, health and sociodemographic characteristics. These data provide a baseline for the assessment of ARV effects. Rakai has a mature, generalized epidemic, with a prevalence of 15% and an incidence of approximately 1.4/100 py. Under the proposed R01 (complementary to PEPFAR), we plan to conduct integrated quantitative and qualitative research in RCCS communities (n= 12,000 adults and approximately 600 children) and in non-RCCS comparison communities (n = 1,000 adults). We propose to examine epidemiological effects of ARVs (HIV incidence and prevalence; emergence and transmission of drug-resistant HIV, treatment acceptance and effectiveness, mother-to-child HIV transmission by subtype [A, D, AD recombinant]; as well as behavioral, social and demographic effects (behavioral disinhibition, use of HIV counseling and testing, use of other prevention services, contraceptive use, mortality, fertility, marital stability and orphanhood). We will also examine knowledge and attitudes towards ARVs, and the effects of stigma on ARV use. The study will provide unique data to guide HIV care in Africa and for projecting the course of the epidemic in the ARV era.