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）受艾滋病毒影响的青少年和年轻人（AYA）经历的压力因素， 增加他们酗酒的风险，这反过来又会导致艾滋病毒感染或传播， 艾滋病毒结果，包括与护理和抗逆转录病毒疗法依从性的联系。为解决艾滋病毒流行病而作出的努力 因此，撒南非洲的青少年和年轻人在一定程度上把重点放在治疗危险的酒精使用上。然而 绝大多数受艾滋病毒影响的AYA在SSA谁需要酒精服务没有得到他们，导致 巨大的治疗差距。AYA和AYA之间准确筛查危险酒精使用的关键障碍 提供适当的治疗是缺乏针对艾滋病毒护理环境中饮酒的客观措施， 主要依靠自我报告。K 01指导的研究科学家发展提案旨在 研究生物标志物在改善艾滋病毒AYA患者酒精筛查和治疗转诊中的作用 预防和治疗诊所。具体来说，该提案将调查一种基于尿液的生物标志物， 葡萄糖醛酸苷（UEtG），它已显示出作为基于临床的即时诊断工具的潜力。 但尚未被调查为艾滋病毒护理环境中的有效和可行的方法 在AYA。这项建议的研究活动将在赞比亚进行，赞比亚是世界上人口最多的国家之一。 世界艾滋病毒流行率估计数。这项研究将利用赞比亚十多年的艾滋病毒研究， 约翰霍普金斯大学和传染病研究中心的长期合作， 赞比亚（CIDRZ），当地执行伙伴。建议的具体目标是：1）评估测试 赞比亚受艾滋病毒影响的AYA中UEtG的特点; 2）制定快速UEtG使用协议 在AYA艾滋病预防和治疗中嵌入浸卡检测;以及3）试点制定UEtG协议 并通过形成性评价过程完善程序。调查结果将为执行工作提供信息 可以在后续研究中进行测试的策略。该研究旨在成为一个不可分割的组成部分， 严格的培训和职业发展计划，重点是艾滋病毒/艾滋病，酒精生物标志物和实施 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，他们被广泛认为是 在各自领域的专家。专业发展计划的目标是促进候选人的 转变为酒精流行病学和实施科学的独立调查员， 艾滋病毒和生物标志物方面的专业知识。该提案直接符合目标2（“改进对艾滋病毒/艾滋病的诊断和跟踪”）。 酒精滥用”）和目标5c（“促进循证做法的传播和实施 诊断酒精滥用”）的NIAAA战略计划2017-2021。该提案与NIH一致 高度优先重视艾滋病毒研究，以解决“艾滋病毒新感染发生率方面的健康差距”， “对从事高度优先的艾滋病毒/艾滋病或艾滋病毒/艾滋病相关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.”