Improving measurement of alcohol consumption among HIV-affected youth in sub-Saharan Africa: evaluation and implementation of biomarkers

撒哈拉以南非洲(SSA)感染艾滋病毒的青少年和年轻人(Aya)经历的压力源 增加他们有问题饮酒的风险，这反过来可能导致艾滋病毒感染或传播 艾滋病毒结果，包括与护理和坚持抗逆转录病毒治疗的联系。应对艾滋病毒流行的努力包括 因此，SSA的青少年和年轻人在一定程度上专注于治疗高风险的酒精使用。然而， 在需要酒精服务的SSA中，绝大多数感染艾滋病毒的阿雅人没有得到酒精服务，导致 巨大的待遇差距。在Aya和Aya人群中准确筛查危险饮酒的关键障碍 提供适当的治疗是缺乏针对艾滋病毒护理环境中的酒精消费的客观措施， 主要依靠自我报告。这份K01指导型研究科学家发展计划旨在 研究生物标记物在改善酒精筛查和艾滋病毒Aya患者治疗转诊中的作用 预防和治疗诊所。具体地说，该提案将调查一种基于尿液的生物标记物，乙基 葡萄糖醛酸苷(UEtG)，已显示出作为一种潜在的临床点诊断工具 美国人口，但尚未作为艾滋病毒护理环境中有效和可行的方法进行调查 在阿雅中间。这项提案的研究活动将在赞比亚进行，这是世界上最高的国家之一 全球艾滋病毒流行率估计。这项研究将利用赞比亚十多年的艾滋病毒研究成果 约翰霍普金斯大学与传染病研究中心的长期合作 赞比亚(CIDRZ)，当地执行伙伴。该提案的具体目的是：1)评估测试 赞比亚艾滋病毒感染人群UEtG的特征2)制定快速UEtG的使用方案 嵌入Aya HIV预防和治疗的DIP卡测试；以及3)试行开发的UEtG方案 在目标2中，并通过形成性评价过程改进程序。调查结果将为实施提供信息 可以在后续研究中测试的策略。这项研究被设计为一个不可或缺的组成部分 严格的培训和职业发展计划，重点是艾滋病毒/艾滋病、酒精生物标记物和实施 科学。培训将采取课程作业、实验室培训和一对一指导的形式 经验丰富、敬业的多学科导师和顾问团队，被广泛认为是 各自领域的专家。职业发展计划的目标是促进应聘者 转变为酒精流行病学和具体实施科学领域的独立调查者 在艾滋病毒和生物标记物方面的专业知识。这项提议直接符合目标2(“改进对 酒精滥用“)和目标5c(”促进循证做法的传播和实施 《2017-2021年国家酒精滥用诊断战略计划》)。该提议与美国国立卫生研究院一致。 高度优先的艾滋病毒研究，以解决“新艾滋病毒感染发病率的健康差距”和 “对进行高度优先的艾滋病毒/艾滋病研究或与艾滋病毒/艾滋病相关的研究所需的工作人员进行研究培训。”

HIV-affected adolescents and young adults (AYA) in sub-Saharan Africa (SSA) experience stressors that increase their risk for problematic alcohol use, which in turn can lead to HIV infection or transmission and poor HIV outcomes, including linkage to care and ART adherence. Efforts to address the HIV epidemic among adolescents and young adults in SSA have therefore focused, in part, on treating risky alcohol use. Yet, the vast majority of HIV-affected AYA in SSA who need alcohol services do not receive them, resulting in a substantial treatment gap. A critical barrier to the accurate screening for risky alcohol use among AYA and provision of appropriate treatment is a lack of objective measures for alcohol consumption in HIV care settings, which rely primarily on self-report alone. This K01 mentored research scientist development proposal aims to examine the role of biomarkers in improving alcohol screening and treatment referral among AYA in HIV prevention and treatment clinics. Specifically, the proposal will investigate a urine-based biomarker, ethyl glucuronide (UEtG), which has displayed potential as a point-of-care diagnostic tool among clinic-based populations in the U.S. but has not been investigated as a valid and feasible method within HIV care settings among AYA. Research activities for this proposal will take place in Zambia, a country with one of the highest HIV prevalence estimates in the world. The research will leverage over a decade of HIV research in Zambia by Johns Hopkins University and a longstanding collaboration with Centre for Infectious Disease Research in Zambia (CIDRZ), the local implementing partner. Specific aims of the proposal are to: 1) assess the test characteristics of UEtG among HIV-affected AYA in Zambia; 2) develop a protocol for the use of rapid UEtG dip card testing embedded within AYA HIV prevention and treatment; and 3) pilot the UEtG protocol developed in Aim 2 and refine procedures with a formative evaluation process. Findings will inform implementation strategies that can be tested in a follow-up study. The research is designed to be an integral component of a rigorous training and career development plan focused on HIV/AIDS, alcohol biomarkers, and implementation science. Training will take the form of coursework, lab training, and one-on-one mentorship with an experienced and dedicated team of multidisciplinary mentors and consultants who are widely considered to be experts in their respective fields. The goal of the professional development plan is to facilitate the candidate's transition into an independent investigator in alcohol epidemiology and implementation science with specific expertise in HIV and biomarkers. The proposal is directly in line with Goal 2 (“improve diagnosis and tracking of alcohol misuse”) and Objective 5c (“facilitating dissemination and implementation of evidence-based practices for diagnosing alcohol misuse”) of the NIAAA Strategic plan 2017-2021. The proposal is consistent with NIH high priority HIV research in addressing “health disparities in the incidence of new HIV infections” and “research training of the workforce required to conduct high priority HIV/AIDS or HIV/AIDS-related research.”