Assessing the role of alcohol and intimate partner violence on HIV care and viral suppression in Uganda

评估酒精和亲密伴侣暴力对乌干达艾滋病毒护理和病毒抑制的作用

• 批准号: 10078540
• 负责人: Amanda Pearl Miller
• 金额: $ 3.13万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10078540
• 关键词: Achievement; Address; Affect; Africa; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Area; Behavior; Behavioral; Biological; Biological Markers; Blood; CD4 Lymphocyte Count; Caring; Cohort Studies; Communities; Conflict (Psychology); Continuity of Patient Care; Country; Data; Data Analyses; Data Collection; Detection; Development; Disease; Disease Progression; Dose; Enrollment; Failure; Foundations; Funding; Goals; HIV; HIV Infections; Health; Heavy Drinking; Immunologic Monitoring; Incidence; Income; Intervention; Knowledge; Light; Link; Literature; Longevity; Longitudinal Studies; Measures; Mediation; Mediator of activation protein; Mental disorders; Methods; Monitor; NIH Office of AIDS Research; National Institute of Allergy and Infectious Disease; National Institute of Child Health and Human Development; National Institute of Mental Health; National Institute on Alcohol Abuse and Alcoholism; Outcome; Parents; Patient Self-Report; Persons; Population; Prevalence; Public Health; Reporting; Research; Research Personnel; Resources; Risk; Role; Rural; Strategic Planning; Testing; Time; Training; Treatment Failure; Treatment outcome; Uganda; Unsafe Sex; Violence; Viral; Viral Load result; Virus Diseases; Woman; Work; alcohol effect; antiretroviral therapy; base; care outcomes; care seeking; career; co-infection; cohort; comorbidity; condoms; evidence base; experience; high risk population; high risk sexual behavior; improved; interest; intimate partner violence; men; milliliter; outcome prediction; public health priorities; response; theories; violence victimization; virology

Project Summary Human immunodeficiency virus (HIV) infection, alcohol use and intimate partner violence (IPV) are critical interrelated public health issues in Rakai district, Uganda. In Rakai, HIV prevalence is three times the national average (19.7% versus 6.2%). Alcohol use is also common among persons living with HIV (PLWH); recently collected data form Rakai found that the majority (57%) of PLWH consume alcohol with heavy drinking common amongst those who drink. There is a growing evidence base that suggests that alcohol use adversely impacts engagement and retention in care throughout the HIV care continuum. Findings regarding the effects of alcohol use on viral suppression have been less conclusive and in resource constrained settings like Uganda, are largely informed by immunologic monitoring (CD4 count) which is less sensitive to treatment failure than virologic monitoring. Similarly, experiencing IPV is also associated with delayed and decreased engagement throughout the HIV care continuum, although most of the research on this topic has been conducted in high income countries. Although IPV often occurs in the context of alcohol use, the combined effects of these two exposures on care and treatment outcome has not been explored. The proposed study aims to address these gaps by assessing how alcohol use (aim 1), IPV (aim 2) and co-occurring alcohol use and IPV (aim 3) are associated with engagement in HIV care, use of antiretroviral therapy and achievement of viral suppression among PLWH participating in the Rakai Community Cohort Study (RCCS), one of the oldest and most established community-based HIV surveillance cohorts in the world. Secondary data analysis on the two most recent rounds of collected RCCS data will facilitate the achievement of the specific research aims. Aims 2 and 3 will focus on experiences of IPV among women living with HIV because the overwhelming majority of IPV is experienced by women and perpetrated by men. The rationale of the proposed work, is that once the effects of alcohol use alone, IPV alone and IPV and co-occurring alcohol use on engagement and retention in care and HIV disease progression are better understood, it will be known if (i) research is needed to assess if there is a dose response relationship between these variables and HIV disease progression and (ii) if intervening on alcohol use and IPV among PLWH should be a public health priority in this setting. Furthermore, if co-occurring IPV and alcohol use has an additive effect on engagement and retention in HIV care and treatment and disease progression, this will inform whether IPV should be addressed in alcohol use interventions targeting PLWH in this setting. The opportunities afforded through this F31 mechanism (protected time to pursue advanced training in subject areas identified by the applicant and her sponsor as critical to professional advancement and a successful research career) will significantly contribute to the applicant’s advancement towards her long term goal of being an independent, academic public health researcher who specializes in applying advanced quantitative methods to understand the relationship between substance use, HIV and other common co-morbidities in high- risk populations such as persons living with HIV.

项目摘要 人类免疫缺陷病毒（HIV）感染、酗酒和亲密伴侣暴力（IPV）是相互关联的 乌干达Rakai区的公共卫生问题。在Rakai，艾滋病毒流行率是全国平均水平的三倍（19.7%， 6.2%）。酗酒在艾滋病毒感染者（PLWH）中也很常见;最近从Rakai收集的数据发现， 大多数（57%）艾滋病毒携带者饮酒，酗酒者中常见。人们越来越 有证据表明，在整个艾滋病毒护理过程中，酒精使用对护理的参与和保留产生不利影响 连续体关于酒精使用对病毒抑制的影响的研究结果还不太确定， 在乌干达等受限制的环境中，免疫监测（CD 4计数）在很大程度上是知情的， 治疗失败比病毒学监测。同样，经历IPV也与延迟和减少 参与整个艾滋病毒护理的连续性，虽然大多数关于这一主题的研究已经进行了高 收入国家。虽然IPV经常发生在饮酒的情况下，但这两种暴露的综合影响对 护理和治疗结果尚未探索。这项拟议中的研究旨在通过评估酒精如何 使用（目的1）、IPV（目的2）以及同时使用酒精和IPV（目的3）与参与艾滋病毒护理、使用 参与Rakai社区队列的艾滋病毒携带者接受抗逆转录病毒治疗并实现病毒抑制 RCCS是世界上最古老和最成熟的社区艾滋病毒监测队列之一。二次 对最近两轮收集到的区域协调系统数据进行数据分析，将有助于完成具体的研究 目标。目标2和3将侧重于感染艾滋病毒的妇女的IPV经历，因为绝大多数妇女 IPV是女性经历的，是男性犯下的。拟议工作的基本原理是，一旦 单独使用酒精、单独使用IPV和IPV以及同时使用酒精对护理参与和保留以及艾滋病毒疾病的影响 更好地理解进展，将知道（i）是否需要研究来评估是否存在剂量反应关系 这些变量与艾滋病毒疾病进展之间的关系，以及（ii）是否应在PLWH中干预酒精使用和IPV 在这种情况下成为公共卫生的优先事项。此外，如果同时发生的IPV和饮酒对 参与和保留艾滋病毒护理和治疗以及疾病进展，这将告知是否应该 在这一背景下，针对艾滋病毒携带者的酒精使用干预措施得到了解决。通过F31提供的机会 机制（在申请人及其担保人确定为关键的学科领域进行高级培训的保护时间 专业发展和成功的研究生涯）将大大有助于申请人的进步 她的长期目标是成为一名独立的学术公共卫生研究人员，专门应用先进的 定量方法，以了解物质使用，艾滋病毒和其他常见的并发症之间的关系，在高， 高危人群，如艾滋病毒感染者。

项目成果

Exploring the impact of COVID-19 on women's alcohol use, mental health, and experiences of intimate partner violence in Wakiso, Uganda.

• DOI: 10.1371/journal.pone.0263827
• 发表时间: 2022
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Miller AP;Mugamba S;Bulamba RM;Kyasanku E;Nkale J;Nalugoda F;Nakigozi G;Kigozi G;Nalwoga GK;Kagaayi J;Watya S;Wagman JA
• 通讯作者: Wagman JA

Not Enough Money and Too Many Thoughts: Exploring Perceptions of Mental Health in Two Ugandan Districts Through the Mental Health Literacy Framework.

• DOI: 10.1177/1049732320986164
• 发表时间: 2021-04
• 期刊: Qualitative health research
• 影响因子: 3.2
• 作者: Miller AP;Ziegel L;Mugamba S;Kyasanku E;Wagman JA;Nkwanzi-Lubega V;Nakigozi G;Kigozi G;Nalugoda F;Kigozi G;Nkale J;Watya S;Ddaaki W
• 通讯作者: Ddaaki W

Construct validity and internal consistency of the Patient Health Questionnaire-9 (PHQ-9) depression screening measure translated into two Ugandan languages.

• DOI: 10.1016/j.psycom.2021.100002
• 发表时间: 2021-12-01
• 期刊: Psychiatry research communications
• 作者: Miller, Amanda P;Espinosa da Silva, Cristina;Kigozi, Godfrey
• 通讯作者: Kigozi, Godfrey