Understanding alcohol misuse and its impact on viral suppression in youth living with HIV in East Africa

项目摘要/摘要 撒哈拉以南非洲(SSA)的年轻人(15-24岁)感染艾滋病毒的比例不成比例，他们是 最有可能在艾滋病毒护理瀑布上结果不佳的群体。青年的发展变化 影响冒险行为并增加他们饮酒的可能性，这可能是导致 糟糕的艾滋病毒结果。然而，在阿尔科的范围、背景和影响方面，仍存在大量的知识空白。 在SSA中使用HOL对艾滋病毒携带者青年(YLWH)的结果以及针对青年的干预的必要性- 应对导致病毒抑制效果差和死亡率高的风险因素的努力。 为这项K23应用程序提出的培训和研究计划将允许Sarah Purear，医学博士，公共卫生硕士， 获得必要的技能，以实现她的职业目标，成为一名独立的临床研究员 在艾滋病毒/酒精定量研究和行为干预设计和实施方面的专业知识，以重新 杜斯饮酒对青少年艾滋病毒结局、传播和共病的负面影响 低资源设置。在一个专门的指导团队的指导下，珀伊尔博士将测试中央HY- 假设青少年儿童饮酒对生命阶段和性别依赖的病毒抑制有负面影响 时尚。她将利用她的发现，为酒精中毒高危青少年开发一种初步的酒精干预措施。 霍尔相关病毒非抑制。这个项目的基本原理是，高质量的流行病学数据可以 被用来在年轻人中建立饮酒和不抑制病毒之间的因果联系，并利用 开发急需的针对年轻人的解决方案，以减少酒精使用，改善病毒抑制，以及 有助于减少传播。核心假设将通过追求两个具体目标来检验：1) 描述青少年儿童中酒精使用的流行率、模式和轨迹，并通过以下方式检查预测因素 生命阶段和性别，以及2)酒精使用如何有助于青少年儿童中的病毒非抑制。这 将应用于第三个目标：(3)开发专门针对年轻人和文化的初步酒精干预- 这是最合适的。这些科学目标将支持1)青少年行为改变理论的培训，2)先进的 生物统计学，包括因果推断和纵向数据分析；3)定性研究。 采取介入发展的姿态。拟议的研究将为进一步的工作奠定流行病学基础 关于东非基督教青年会的酒精使用情况，缩小了一项重要的知识差距。它将指导识别 世卫组织(YLWH为酒精相关病毒非抑制的最高风险)以及何时(生命过程中的时间点， 饮酒模式的转变)到有针对性的干预，它将结合这些发现来制定初步的 针对年轻人的、文化上合适的酒精干预，将在随后的R34中进行改进和试点， 随后的R01随机对照试验。

PROJECT SUMMARY/ABSTRACT Youth (ages 15-24) in sub-Saharan Africa (SSA) are disproportionately affected by HIV and are the most likely group to have poor outcomes along the HIV care cascade. The developmental changes of youth influence risk-taking behavior and increase their likelihood of alcohol use, which may be a key contributor to poor HIV outcomes. However, there are substantial knowledge gaps on the scope, context, and impact of alco- hol use on HIV outcomes among youth living with HIV (YLWH) in SSA and a need for youth-specific interven- tions to address risk factors that contribute to poor viral suppression outcomes and high rates of mortality. The proposed training and research plan for this K23 application will allow Sarah Puryear, MD, MPH, to acquire the necessary skills to achieve her career goal of becoming an independent clinical investigator with expertise in quantitative HIV/alcohol research and behavioral intervention design and implementation, to re- duce the negative impact of alcohol use on HIV outcomes, transmission, and co-morbidities among youth in low-resource settings. Under the guidance of a dedicated mentoring team, Dr. Puryear will test the central hy- pothesis that alcohol use among YLWH negatively impacts viral suppression in a life-stage and sex-dependent fashion. She will utilize her findings to develop a preliminary alcohol intervention for youth at high-risk of alco- hol-associated viral non-suppression. The rationale for this project is that high quality epidemiologic data can be used to establish a causal link between alcohol use and viral non-suppression among youth and leveraged to develop much-needed youth-specific solutions that can reduce alcohol use, improve viral suppression, and contribute to decreasing transmission. The central hypothesis will be tested by pursuing two specific aims: 1) Characterize the prevalence, patterns and trajectories of alcohol use among YLWH and examine predictors by life-stage and sex and 2) Determine how alcohol use contributes to viral non-suppression among YLWH. This will be applied in a third aim to (3) Develop a preliminary alcohol intervention that is youth-specific and cultur- ally appropriate. These scientific aims will support training in 1) youth behavior change theory, 2) advanced biostatistics, including causal inference and longitudinal data analysis, and 3) qualitative research for the pur- pose of intervention development. The proposed research will lay the epidemiologic foundation for further work on alcohol use among YLWH in East Africa, closing a critical knowledge gap. It will guide the identification of who (YLWH at highest risk for alcohol-associated viral non-suppression) and when (point in the life course, shifts in drinking pattern) to target interventions and it will incorporate these findings to develop a preliminary youth-specific, culturally appropriate alcohol intervention that will be refined and piloted in a subsequent R34, and subsequent R01 randomized-controlled-trial.