HIV and HIV Interventions to Promote Healthy Aging

项目3：艾滋病毒和艾滋病毒干预措施以促进健康老龄化--摘要 在过去大规模艾滋病毒治疗和预防倡议的推动下，艾滋病毒在亚洲区的流行 撒哈拉非洲(SAA)正在迅速老龄化。目前与老龄化和艾滋病毒有关的三个持久的知识差距 阻碍艾滋病毒治疗和预防对策的长期成功。首先，动态 关于艾滋病毒在老年人中的级联治疗和预防，人们知之甚少。第二，非常大 有比例的老年人不知道自己的艾滋病毒状况，目前尚不清楚 在老年人中增加艾滋病毒检测和方案联系。第三，艾滋病毒的长期因果影响 在SSA的老年成年人中的治疗是未知的，特别是关于痴呆症和生理和 情感功能。长期目标是确保“现实生活”大规模艾滋病毒的全部潜在影响 实现了SSA的治疗和预防策略。此应用程序的目标是识别 改善SSA老年人艾滋病毒反应的方法。我们的中心假设是 目前，在SSA，老年人未能从艾滋病毒治疗和预防中充分受益，但 这些失误可以通过以人口和卫生系统为基础的干预措施成功解决。 这项拟议研究的基本原理是，一旦知道老年人是如何几乎普遍地和 成功地实现艾滋病毒检测和方案联系，以及艾滋病毒的长期影响是什么 在SSA的老年人口中进行治疗，常规的卫生政策和干预策略可以是 旨在确保老年人充分受益于该区域的艾滋病毒应对措施。建立在强大的基础上 基于之前NIH/NIA P01(P01-AG041710)资助的工作的初步数据，这一假设将是 通过追求三个具体目标进行测试： 目标1：量化艾滋病毒预防和治疗的纵向发展和决定因素 在南非农村，老年人之间的疾病层出不穷。 目标2：在以人口为基础的随机现场试验中建立替代家园的影响-- 基于艾滋病毒状况知识和干预吸收的艾滋病毒检测战略。 目标3：通过以人口为基础的准实验确定艾滋病毒对人口的长期影响 痴呆症和身体功能的治疗。 这种方法是创新的，因为它利用了基于人群的纵向健康研究 基于人口的实验和准实验的基础设施。拟议的研究是 意义重大，因为它有望促进我们理解如何更好地接触老年人，并 由有效的艾滋病毒干预措施服务。归根结底，这一理解将确保 SSA中的HIV反应。

Project 3: HIV and HIV Interventions to Promote Healthy Aging—Abstract Driven by the large-scale HIV treatment and prevention initiatives of the past, the HIV epidemic in sub- Saharan Africa (SAA) is aging rapidly. Three persistent knowledge gaps related to aging and HIV currently stand in the way of the long-term success of the HIV treatment and prevention response. First, the dynamics of the HIV treatment and prevention cascades in older adults are poorly understood. Second, very large proportions of older adults are unaware of their HIV status and it is currently unknown which approaches increase HIV testing and programmatic linkage in older adults. Third, the long-term causal impacts of HIV treatment among aging adults in SSA are unknown, in particular regarding dementia and physical and emotional functioning. The long-term goal is to ensure that the full potential impact of `real life' mass HIV treatment and prevention strategies in SSA is realized. The objective in this application is to identify approaches to improve the HIV response for older adults in SSA. Our central hypothesis is that large proportions of older adults are currently failing to benefit fully from HIV treatment and prevention in SSA, but that these failures can be successfully addressed through population- and health systems-based interventions. The rationale for the proposed research is that once it is known how older adults can be near-universally and successfully reached for HIV testing and programmatic linkage, and what the long-term impacts of HIV treatment among aging populations in SSA are, routine health policy and intervention strategies can be designed to ensure that older adults are fully benefiting from the HIV response in the region. Building on strong preliminary data based on work funded by a previous NIH/NIA P01 (P01-AG041710), this hypothesis will be tested by pursuing three specific aims: AIM 1: Quantify the longitudinal developments and determinants of the HIV prevention and treatment cascades among older adults in rural South Africa. AIM 2: Establish in a population-based randomized field experiment the impacts of alternative home- based HIV testing strategies on HIV status knowledge and intervention uptake. AIM 3: Establish through population-based quasi-experiments the long-term population impacts of HIV treatment on dementia and physical functioning. The approach is innovative, because it utilizes a longitudinal population-based health research infrastructure for population-based experiments and quasi-experiments. The proposed research is significant, because it is expected to advance our understanding how older adults can be better reached and served by effective HIV interventions. Ultimately, this understanding will ensure the long-term success of the HIV response in SSA.