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。由于目前正在乌干达开始使用这些药物，我们有一个很小的机会来评估抗逆转录病毒药物对艾滋病毒传播和流行病学、对艾滋病毒阳性和未感染艾滋病毒者的行为以及对社会人口指标的人口影响。还需要关于耐药突变的出现和传播、母体先前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接受和坚持抗逆转录病毒药物的障碍等方面的信息。拉凯健康科学项目获得了总统防治艾滋病紧急救援计划的资金，在乌干达拉凯农村地区启动了一项抗逆转录病毒药物项目。自1994年以来，我们进行了Rakai社区队列研究（RCCS），并获得了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影响提供了基线。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例。

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.