Research Training for Substance Use Mediated HIV Epidemic in Kazakhstan/Aging Supplement

项目总结/摘要 东欧和中欧艾滋病毒感染者（PLWH）对老龄化的了解有限。 亚洲（EECA）地区，包括哈萨克斯坦（KZ）。老龄化与艾滋病毒护理连续体的交叉点从未 在KZ和EECA中进行了估计，但在活到老年的PLWH和患有艾滋病的PLWH中没有进行评估 药物使用率很高身体表现、日常功能、虚弱、残疾、耻辱、物质 在艾滋病毒护理中，必须对艾滋病毒感染者的使用和弹性因素进行表征和反复评估 以确保随着年龄增长的生活质量。该应用程序是正在进行的Fogarty D43 HIV的补充 KZ物质使用介导的艾滋病毒流行病研究培训补助金。我们将培养一个早期阶段 研究者（ESI）通过实现两个目标。目标1包括艾滋病毒老龄化方面的高级教学培训， 老年学通过两个完善的（一个NIH资助）计划在美国，加上科学会议出席， 每月的期刊俱乐部和研讨会。目标2包括收集关键老化指标的试点数据。ESI将 使用短期身体表现组合评估身体表现，包括：握力， 4米步行，椅子站，和平衡（并排，半串联，串联站）。日常功能和 残疾将通过Lawton日常生活工具活动（IADL）量表进行评估。脆弱将是 根据油炸虚弱表型（FFP）计算，FFP包括握力、4米步行 速度，体力消耗，体力活动少，无意减肥。ESI还将衡量耻辱感 和韧性使用验证的艾滋病毒污名，老化污名和10项Connor-Davidson污名量表， 复原力量表。社会人口统计学和HIV变量，包括HIV病毒载量和CD 4+计数，将 评估。我们的ESI培训计划支持我们的试点研究的实施，假设是， 身体机能和日常功能低下的患病率，FFP的表现，残疾，以及 与高收入的PLWH相比，在KZ PLWH中观察到更高水平的HIV和老化耻辱 国家这种情况在控制不佳、HCV合并感染、注射药物 用户，老年人和男性。我们还假设，非传染性疾病（NCD）合并症和更高的 艾滋病毒和老龄化耻辱的水平将与FFP和残疾的表现有关， 在PLWH中普遍存在，他们的弹性较低。这种先进的教学加上动手的创新组合 在哈萨克斯坦的一个老年艾滋病毒研究所进行的研究培训在KZ和EECA是第一次，在一年内就可以实现。试点 研究结果将告知1）开发干预措施，以解决实足老化以及 KZ的艾滋病毒/非传染性疾病护理连续体，以及2）为前瞻性观察性研究提供基础 旨在比较KZ的PLWH和没有HIV的人之间的衰老过程。

PROJECT SUMMARY/ABSTRACT Limited knowledge exists about aging among people living with HIV (PLWH) in the Eastern European and Central Asia (EECA) region including Kazakhstan (KZ). The intersection of aging with the HIV care continuum has never been estimated in KZ and the EECA, and not evaluated among PLWH who are living to older ages and who have high rates of substance use. Physical performance, daily functioning, frailty, disability, stigma, substance use and resilience factors in PLWH must be characterized and repeatedly assessed across the HIV care continuum to ensure quality of life with aging. This application is a supplement to the ongoing Fogarty D43 HIV Research Training Grant on the Substance Use Mediated HIV Epidemic in KZ. We will train one Early Stage Investigator (ESI) by accomplishing two Aims. Aim 1 includes advanced didactic training in HIV-aging and Gerontology via two well-established (one NIH-funded) programs in the US, plus scientific meeting attendance, a monthly journal club and seminars. Aim 2 includes collecting pilot data on key aging metrics. The ESI will assess physical performance using the Short Physical Performance Battery, which includes: hand grip strength, 4 meter walk, chair stands, and balance (side-by-side, semi-tandem, and tandem stand). Daily functioning and disability will be assessed via the Lawton Instrumental Activities of Daily Living (IADL) scale. Frailty will be calculated according to the Fried Frailty Phenotype (FFP), which is comprised of grip strength, 4 meter walking speed, physical exhaustion, low physical activity, and unintentional weight loss. The ESI will also measure stigma and resilience using validated stigma scales for HIV stigma, aging stigma, and the 10-item Connor-Davidson Resilience Scale. Sociodemographic and HIV variables including HIV viral load and CD4+ count will be assessed. Our ESI training plan supports implementation of our pilot research study, with the hypothesis is that the prevalence of lower physical performance and daily functioning, manifestation of the FFP, disability, and higher levels of HIV and aging stigma will be observed among KZ PLWH compared to PLWH in high income countries. This will be exacerbated among PLWH who are poorly controlled, HCV co-infected, injection drug users, older, and men. We also hypothesize that noncommunicable disease (NCD) co-morbidities and higher levels of HIV and aging stigma will be associated with manifestation of the FFP and disability, and be more prevalent in PLWH who are less resilient. This innovative combination of advanced didactic plus hands-on research training in HIV-aging of one Kazakh ESI is the first in KZ and EECA and achievable in one year. Pilot study results will inform 1) development of interventions to address chronological aging together with the HIV/NCD care continuum among PLWH in KZ, and 2) provide a foundation for prospective observational studies designed to compare aging processes between PLWH and people without HIV in KZ.