URBAN ARCH (5/5) Boston Cohort - Alcohol and HIV-associated comorbidity and complications: Frailty, Functional impairment, Falls, and Fractures (the 4F study)

这项提案是一项紧急的竞争性修订，旨在补充NIH资助的现有研究，以评估 新冠肺炎大流行对酒精和其他药物使用的影响，以及关键的用药依从性 用于在艾滋病毒携带者(PLWH)中预防艾滋病毒疾病的进展。新冠肺炎大流行已经 深刻地影响了世界各地的生活。除了感染本身的影响外，PLWH可能会 更容易受到影响的是，新冠肺炎已经影响了就业、获得医疗保健的机会，而且很可能会影响到 和其他健康状况的后果，限制获得保健的机会，并通过执行 身体(社交)距离。PLWH可能面临更高的社会孤立后果风险，而那些患有 上瘾、失业和无家可归的风险甚至更高，因为限制措施会影响食物 可获得性、卫生(例如洗手)、住所和其他传统支持现在已经不存在了 脆弱的社会安全网。 这项提案的总体目标是评估新冠肺炎大流行的影响和 实际(社会)疏远和其他缓解战略(统称为“大流行风险暴露”) 物质使用(大量饮酒和/或其他药物使用，包括非医疗处方药使用) 和艾滋病患者对艾滋病药物的依从性。 在一个持续的、特征良好的艾滋病毒/艾滋病患者队列中(现有的波士顿拱门 家长队列研究)，该项目将： 目标1：确定大流行风险暴露与酒精(和其他 药物)使用(主要)和艾滋病毒抗逆转录病毒(ARV)药物不依从性(次要)。 目标2：确定大流行风险暴露与次级应激源之间的联系，特别是食物 不安全感、孤独和疼痛干扰(与活动)；以及这些应激源与 酒精(和其他药物)使用的变化和艾滋病毒抗逆转录病毒药物的不遵守。 目标3：通过检查大流行之间关联的主持人来确定谁受大流行影响最大 大流行暴露和物质使用的变化以及艾滋病毒抗逆转录病毒药物的不遵守。 为了实现这些目标，将对参与者进行补充的新冠肺炎专项评估 在两个时间点(相隔6个月)。关于药物使用、抑郁和虚弱的基线数据，收集于 作为家长研究的一部分，疫情前评估将与通过以下方式收集的数据进行比较 针对COVID的补充评估。实现这项提案的目标是确定 预防药物使用增加和HIV疾病进展的干预措施的可修改目标 新冠肺炎等极端事件。

This proposal is an urgent competitive revision designed to supplement an existing NIH-funded study to assess the impact of the COVID-19 pandemic on alcohol and other drug use, and medication adherence that is critical for preventing HIV disease progression, among people living with HIV (PLWH). The COVID-19 pandemic has profoundly affected lives around the world. In addition to the effects of infection itself, to which PLWH may be more susceptible, COVID-19 has affected employment, access to healthcare, and very likely, the incidence and consequences of other health conditions, by limiting access to healthcare, and through the implementation of physical (social) distancing. PLWH may be at higher risk of consequences of social isolation, and those with addiction, unemployment and homelessness are at an even higher risk with restrictions that affect food availability, hygiene (e.g. handwashing), shelter, and other traditional supports now absent from the already fragile societal safety net. The over-arching goal of this proposal is to assess the impact of the COVID-19 pandemic and the effects of physical (social) distancing and other mitigation strategies (collectively termed “pandemic exposure”) on substance use (heavy alcohol use and/or other drug use including nonmedical prescription medication use) and HIV medication adherence among PLWH. Among an ongoing, well-characterized cohort of people living with HIV/AIDS (the existing Boston ARCH Cohort parent study), this project will: Aim 1: Determine prospective associations between pandemic exposure and changes in alcohol (and other drug) use (primarily) and HIV antiretroviral (ARV) medication nonadherence (secondarily). Aim 2: Identify associations between pandemic exposure and secondary stressors, specifically, food insecurity, loneliness, and pain interference (with activities); and associations between those stressors and changes in alcohol (and other drug) use and HIV ARV medication nonadherence. Aim 3: Determine who is most affected by the pandemic by examining moderators of the associations between pandemic exposure and changes in substance use and HIV ARV nonadherence. To achieve these aims, a supplemental COVID-19 specific assessment will be administered to participants at two time points (6 months apart). Baseline data on substance use, depression, and frailty, collected during pre-pandemic assessments as part of the parent study will be compared against data collected via supplemental COVID-specific assessments. Achieving this proposal’s aims is an important step to identifying modifiable targets for interventions to prevent increased substance use and HIV disease progression after an extreme event such as COVID-19.