East Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA) Regional Consortium

 东非IeDEA联盟（IeDEA-EA）的主要目标是回答临床医生、项目以及政府和国际组织认为对其长期艾滋病毒护理和治疗策略的演变和可持续性至关重要的问题。目前全球关注的焦点是 实现联合国艾滋病规划署的90-90-90目标。因此，我们的中心假设是，保留在艾滋病毒护理级联，以及艾滋病毒护理和治疗的结果，是受患者水平的发展和行为因素沿着的因素在周围的医疗环境。我们认为，实现90-90-90目标将需要检查这些因素，并确定其在影响护理参与，ART吸收，治疗保留和病毒抑制方面的单独和协同作用。我们将充分利用我们的优势，包括与艾滋病毒治疗项目的强大工作关系，大量协调的区域数据库，以及在基于采样的方法和新的分析方法方面的丰富经验。具体目标（SA）-1：该应用程序将继续我们的工作，以描述艾滋病毒护理和治疗的进展和结果。我们将继续利用我们的诊所队列来解决与免疫缺陷水平、合并感染和合并症相关的问题，包括入组时和ART启动时。我们将评估ART对临床、免疫学和病毒学结局的影响，因为HIV护理级联的最终目的是降低发病率和死亡率。利用已建立的卡波西肉瘤（KS）哨兵网站，我们描述了不断变化的流行病学和结果KS在ART时代。我们还将开始通过对相关诊所队列和宫颈癌筛查数据的分析，将宫颈癌作为一种合并症来处理。SA-2：为了扩大我们对影响艾滋病毒护理级联中的保留和结果的因素的理解，我们将研究发展过渡和生命阶段因素的影响。我们将建立一个青少年哨兵队列，重点是青春期对保留，病毒抑制，艾滋病毒抵抗和死亡率的影响，同时探索保留和我们的诊所队列内与怀孕有关的结果。SA-3：我们将研究行为因素对患者结局的影响，重点关注物质使用和精神疾病的综合征。我们将在酒精使用评估队列中完成对酒精对治疗结果影响的评估，并将建立一个哨兵行为队列，我们将在其中评估物质使用和心理健康对患者结果的影响。SA-4：为了了解护理的背景问题，我们将研究医疗环境对患者结局的影响。我们将着眼于临床层面的因素和结果之间的相互作用，并开始绘制系统层面的特征，如青少年服务的可用性，心理健康和药物滥用。我们将在提供者哨兵队列中实现这一目标，以随着时间的推移列举提供者的特征，并确定与更好的护理质量和患者结局相关的特征。

 DESCRIPTION (provided by applicant): The primary goal of the East African IeDEA Consortium (IeDEA-EA) is the provision of answers to questions that clinicians, programs, as well as governmental and international organizations consider fundamental to the evolution and sustainability of their long term HIV care and treatment strategies. The current global focus is on achieving the UNAIDS 90-90-90 targets. As such, our central hypothesis is that retention in the HIV care cascade, as well as outcomes of HIV care and treatment, are influenced by patient-level developmental and behavioral factors along with factors within the ambient healthcare environment. We posit that achievement of the 90-90-90 targets will require examination of these factors and identification of their individual and synergistic roles in influencing engagement in care, ART uptake, retention on treatment and viral suppression. We will leverage our strengths, including robust working relationships with HIV treatment programs, a substantial harmonized regional database, plus extensive experience in sampling-based methodologies and novel analytical approaches. Specific Aim (SA)-1: This application will continue our work to describe the movement through and outcomes of HIV care and treatment. We will continue to utilize our Clinic Cohort to address questions related to the level of immunodeficiency, co-infections and co-morbidities at enrollment and at ART initiation. We will assess the impact of ART on clinical, immunologic, and virologic outcomes, as the ultimate purpose of the HIV care cascade is to reduce morbidity and mortality. Utilizing established Kaposi's Sarcoma (KS) Sentinel Sites, we describe the changing epidemiology and outcomes of KS in the ART era. We will also begin to address Cervical Cancer as a co-morbidity through an analysis of linked Clinic Cohort and Cervical Cancer screening data. SA-2: To expand our understanding of the factors impacting retention in and outcomes of the HIV care cascade, we will examine the impact of developmental transitions and life stage factors. We will establish an Adolescent Sentinel Cohort, focusing on the impact of adolescence on retention, viral suppression, HIV resistance and mortality while exploring retention and outcomes related to pregnancy within our Clinic Cohort. SA-3: We will examine the impact of behavioral factors on patient outcomes concentrating on the syndemics of substance use and mental illness. We will complete our assessment on the impact of alcohol on treatment outcomes in our Alcohol Use Assessment Cohort and will establish a Sentinel Behavioral Cohort in which we will assess the impact of substance use and mental health on patient outcomes. SA-4: To understand contextual issues of care, we will examine the impact of the health care environment on patient outcomes. We will look at the interactions between clinic-level factors and outcomes and begin to map system-level characteristics, such as the availability of services for adolescents, mental health, and substance abuse. We will pursue this aim within a Provider Sentinel Cohort to enumerate provider characteristics over time and identify those associated with better quality of care and patient outcomes.