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

 描述(由申请人提供)：东非IeDEA联盟(IeDEA-EA)的主要目标是为临床医生、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提供答案。当前全球关注的焦点是 实现艾滋病规划署的90-90-90目标。因此，我们的中心假设是，艾滋病毒护理级联中的保留以及艾滋病毒护理和治疗的结果，受到患者水平的发展和行为因素以及环境卫生保健环境中的因素的影响。我们假设，90-90-90目标的实现将需要检查这些因素，并确定它们在影响护理参与、ART摄取、治疗保留和病毒抑制方面的单独和协同作用。我们将利用我们的优势，包括与艾滋病毒治疗项目的牢固工作关系，大量协调一致的区域数据库，以及在基于抽样的方法和新颖分析方法方面的丰富经验。具体目标(SA)-1：这一应用将继续我们的工作，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临床队列来解决与免疫缺陷水平、合并感染和合并疾病有关的问题，在登记和ART开始时。我们将评估抗逆转录病毒疗法对临床、免疫学和病毒学结果的影响，因为艾滋病毒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Kaposi肉瘤(KS)哨兵部位，我们描述了在ART时代KS的流行病学和结局的变化。我们还将通过分析相关联的临床队列和子宫颈癌筛查数据，开始将子宫颈癌作为一种共同发病率来处理。SA-2：为了扩大我们对影响HIV护理级联中保留和结果的因素的理解，我们将检查发育转变和生命阶段因素的影响。我们将建立一个青少年哨兵队列，重点关注青春期对滞留、病毒抑制、艾滋病毒抵抗力和死亡率的影响，同时在我们的临床队列中探索与妊娠相关的滞留和结果。SA-3：我们将研究行为因素对患者结局的影响，重点放在物质使用和精神疾病的综合征上。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，并将建立哨兵行为队列，在该队列中，我们将评估药物使用和精神健康对患者结果的影响。SA-4：为了理解医疗保健的背景问题，我们将研究医疗保健环境对患者结局的影响。我们将研究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，如青少年服务的可获得性、心理健康和药物滥用。我们将在提供者哨兵队列中追求这一目标，随着时间的推移列举提供者的特征，并确定那些与更好的护理质量和患者结果相关的特征。

 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.