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

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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.