Alcohol and ART Adherence: Assessment, Intervention and Modeling in India

描述（由申请人提供）：印度在未来几十年内向数百万艾滋病毒/艾滋病感染者或将感染艾滋病毒/艾滋病的人提供抗逆转录病毒治疗（ART）服务方面面临着重大挑战。与此同时，易感染艾滋病毒和受感染人群的酒精消费水平不断上升，对保持遵守构成了巨大障碍。该拟议项目旨在：提供对当前抗逆转录病毒疗法实施情况以及酒精和其他对抗逆转录病毒疗法坚持性的挑战的基线了解;确定和测试可以减少酒精消费的多层次干预措施，作为提高坚持性的一个核心因素;并开发可在印度和其他地方使用的预测模型，为以最具成本效益的方式分配干预资源提供基础，以最大限度地提高依从性，减少因艾滋病毒而损失的年数和生活质量，并尽量减少艾滋病毒的传播。 艾滋病毒/艾滋病感染者人数目前估计为237万人。随着艾滋病毒感染的增加，印度的酒精消费量在过去十年中急剧上升，艾滋病毒脆弱人群的饮酒问题率很高。这一拟议项目的重点是感染艾滋病毒的男子和抗逆转录病毒疗法，因为饮酒在男子中很常见（21%），但在妇女中仍然很低（2%），但性工作者等特殊群体除外。随着治疗机会的增加和患者队列的成熟，在印度管理治疗失败将成为一个核心挑战。已为高收入国家制定了干预措施以提高依从性。然而，这些干预措施尚未被系统地纳入中低收入国家的艾滋病毒预防或抗逆转录病毒疗法框架，也没有从避免艾滋病毒病例和提高抗逆转录病毒疗法坚持率的成本效益方面对其进行评估。此外，没有将酒精控制作为提高抗逆转录病毒疗法依从性的必要组成部分的传统。 因此，本研究的具体目的是：（1）评估公共抗逆转录病毒治疗服务的当前结构、组织和影响，重点是与抗逆转录病毒治疗依从性相关的饮酒减少;（2）与艾滋病毒感染者和社区一起制定、实施和测试有助于减少饮酒、增加抗逆转录病毒治疗依从性和预防疾病进展和传播的多层次干预措施;（3）根据目标1和2中产生的经验数据，利用运筹学模型来估计干预措施对减少艾滋病毒感染和艾滋病毒感染者生活质量和数量的影响。拟议项目是一个跨学科的印美合作项目;拟议项目的地理重点将是印度艾滋病毒/艾滋病感染者最集中的马哈拉施特拉邦的主要城市中心（孟买和浦那）。

DESCRIPTION (provided by applicant): India faces a major challenge in providing antiretroviral therapy (ART) services in the next decades to several million people who live with or will acquire HIV/AIDS. At the same time, rising levels of alcohol consumption in HIV vulnerable and infected populations constitutes a formidable barrier to maintaining adherence. This proposed project seeks to: provide a baseline understanding of current ART implementation and alcohol and other challenges to ART adherence; identify and test multilevel interventions that can reduce alcohol consumption as a central factor in enhancing adherence; and develop predictive models for use in India and elsewhere that provides a basis for allocating intervention resources in the most cost-effective way to maximize adherence, reduce years and quality of life lost to HIV, and minimize HIV transmission. The number of people with HIV/AIDS is now estimated to be 2.37 million people. Concomitant with increases in HIV infection, India's alcohol consumption has skyrocketed in the past decade, with high rates of problem drinking in HIV vulnerable populations. The focus of this proposed project is on men who are living with HIV, on ART since alcohol consumption is common among men (21%) but continues to be very low (2%) among women except for special groups such as sex workers It has been well established that a high degree of adherence (> 95%) to Anti-Retroviral Therapy (ART) for HIV/AIDS is necessary to prevent disease progression and transmission. As treatment access increases and patient cohorts mature, managing treatment failure in India will emerge as a central challenge. Interventions have been developed for high income countries to improve adherence. However, these interventions have not been systematically integrated into the HIV prevention or ART framework in middle and low income countries, nor have they been evaluated in terms of their cost-benefit in terms of HIV cases averted and ART adherence improved. In addition, there is no tradition of including alcohol control as a necessary component of the effort to improve ART adherence. The specific aims of this study are thus to: (1) assess the current structure, organization and impact of public ART services with emphasis on alcohol reduction associated with ART adherence; (2) Develop, implement and test multilevel interventions with PLWHAs and communities that can contribute to alcohol reduction, increase ART adherence and prevent disease progression and transmission; and (3) utilize operations research modeling, based on empirical data generated in Aims 1 & 2, to estimate the impact of interventions on reduced HIV infections and the quality and quantity of life for PLWHAs. The proposed project is a trans disciplinary, Indo-US collaboration; the geographic focus of this proposed project will be the major urban centers (Mumbai and Pune) in Maharashtra, the state with India's largest concentration of persons living with HIV/AIDS.