Building capacity for patient-centered outcomes research to improve the quality and impact of HIV care in Tanzania

项目总结/摘要 由于广泛获得有效的抗逆转录病毒治疗（ART），在全球范围内， 艾滋病毒感染者（PLWH）的预期寿命大幅增加，接近 一般人口。在坦桑尼亚，据报告目前有170万人感染艾滋病毒。 大约三分之一的人年龄在50岁以上，估计到2010年，这一人口将增长25%。 2040.衰老过程与分子和细胞损伤有关， 增加非艾滋病相关合并症的风险，如心血管疾病（CVD）， 慢性肾病、糖尿病和癌症。持续性慢性免疫 尽管ART有效，但激活和炎症仍然存在，也会增加这些风险。 非传染性疾病糖尿病相关合并症，包括虚弱、ADL受损和认知功能障碍 在老年艾滋病毒携带者和非传染性疾病中也很普遍， 在PLWH的年轻年龄诊断，可以显着影响QOL。在坦桑尼亚， 艾滋病毒/艾滋病感染者对如何预防提出了相当大的挑战， 这些弱势群体的治疗需求。关于目前老年人和医疗保健负担的数据 在坦桑尼亚，老年PLWH中的共病及其对生活质量的影响很少。识别 由于不频繁地使用适于 坦桑尼亚监测衰老相关的合并症，如虚弱和认知功能。 在这个项目中，我们将评估医疗和老年合并症的负担，如虚弱 和认知功能障碍及其与生活质量（QOL）的关系 年龄>50岁，在坦桑尼亚城市使用一些已经在坦桑尼亚验证的工具和类似工具 设置.这些数据将为随后的定性访谈提供信息， 报告较高和较低QoL的老年PLWH，以更好地理解和告知干预措施 需要减轻年龄相关合并症的负担并改善QoL。该项目将 利用现有ALHIV研究队列的资源和参与者， 由Dr. Kazaru（实习生项目负责人）建立，以检查2020年的理想健康和CVD，以及 由家长培训补助金资助。建立一个老年艾滋病毒携带者队列， 对于纵向研究了解合并症的进展很重要， 减轻负担、改善生活质量和告知护理的策略和干预措施的有效性 需要在坦桑尼亚和该地区的老年艾滋病毒携带者。该补充剂符合 母公司D43补助金（1D 43 TWO 10946 - 01 A1，“以患者为中心的成果能力建设 提高坦桑尼亚艾滋病毒护理质量和影响的研究”）， 坦桑尼亚以患者为中心的成果研究能力。这也将提供机会， 对于Dr. Escharu来说，在测量老年合并症方面获得新闻技能，纵向 小组委员会还支持她的计划，争取资金， 成为坦桑尼亚艾滋病和老龄化的独立研究员。

Project Summary/Abstract As a result of widespread access to effective antiretroviral treatments (ART), globally, life expectancy for people living with HIV (PLWH) has increased substantially, nearing that of the general population. In Tanzania, 1.7 million people are reported to be currently living with HIV. About a third are >50 years of age, with estimations that this population will grow by 25% by 2040. The aging process is associated with molecular and cellular damage which subsequently increase the risk for non-AIDs related comorbidities such as cardiovascular disease (CVD), chronic kidney disease, diabetes, and cancer among aging PLWH. Persistent chronic immune activation and inflammation that persists despite effective ART also increases the risk for these NCDs. Age-related comorbidities including frailty, impairment in ADL, and cognitive dysfunction are also prevalent among older PLWH and together with NCDs, which are increasingly diagnosed at a younger age in PLWH, can significantly impact QOL. In Tanzania, the ageing PLWH population is presenting considerable challenges for how to address prevention, and treatment needs in these vulnerable group. Data on the current burden of geriatric and medical co-morbidities among older PLWH and their impact on QOL in Tanzania is sparse. Identification of these conditions is further complicated by infrequent use of screening tools adapted for Tanzania for monitoring ageing-related co-morbidities such as frailty and cognitive functioning. In this project, we will assess the burden of medical and geriatric comorbidities such as frailty and cognitive dysfunction and their association with quality of life (QOL) in a cohort of PLWH age>50 in urban Tanzania using a number of tools already validated in Tanzania and similar settings. These data will inform subsequent qualitative interviews that will be conducted with older PLWH reporting higher and lower QoL, to better understand and inform interventions needed to reduce the burden of age-related co-morbidities and improve QoL. The project will leverage resources and participants from an existing research cohort of ALHIV that was established by Dr. Ottaru (Trainee Project Lead) to examine ideal health and CVD in 2020, and is supported by the parent training grant. The establishment of a cohort of older PLWH will be important for longitudinal research to understand the progression of comorbidities and effectiveness of strategies and interventions to reduce burden, improve QoL and inform the care needed for older PLWH in Tanzania and the region. The supplement meets the goals of the parent D43 grant (1D43TWO10946-01A1, “Building capacity for patient-centered outcomes research to improve the quality and impact of HIV care in Tanzania”) which is designed to build capacity for patient-centered outcomes research in Tanzania. It will also provide the opportunity for Dr. Ottaru to acquire news skills in the measurement of aging comorbidities, longitudinal cohort management, mixed methods and PCOR and support her plans for pursuing funding to become an independent researcher in HIV and aging in Tanzania.