Research Training for Substance Use Mediated HIV Epidemic in Kazakhstan/Aging Supplement

项目摘要/摘要 东欧和中欧艾滋病毒携带者(PLWH)对老龄化的了解有限 亚洲(EECA)地区，包括哈萨克斯坦(KZ)。老龄化与艾滋病毒护理连续体的交叉从未 在KZ和EECA进行了估计，而没有在活到较高年龄的PLWH中进行评估 有很高的物质使用率。身体表现、日常功能、虚弱、残疾、耻辱、物质 必须在整个HIV护理中表征和反复评估PLWH的使用和复原力因素 确保随年龄增长的生活质量。此应用程序是对正在进行的Fogarty D43 HIV的补充 KZ药物使用介导性HIV流行研究培训补助金。我们将在早期阶段进行培训 调查员(ESI)通过实现两个目标。目标1包括艾滋病毒-老龄化和艾滋病毒-老龄化方面的高级教学培训 老年学通过美国两个成熟的(一个由NIH资助的)项目，加上参加科学会议， 月刊俱乐部和研讨会。目标2包括收集关键老化指标的试点数据。ESI将 使用短物理性能电池评估身体性能，包括：握手力量， 4米步行、椅子站立和平衡(并排、半双列和双列站立)。日常运作和 残疾程度将通过劳顿日常生活工具活动(IADL)量表进行评估。脆弱将会是 根据油炸脆弱表型(FFP)计算，包括握力、4米步行 速度快、身体疲惫、体力活动少，以及无意中减肥。ESI还将测量污名 使用艾滋病毒污名、老化污名和10项Connor-Davidson污名的验证污名量表和弹性 弹性量表。包括艾滋病毒病毒载量和CD4+计数在内的社会人口和艾滋病毒变量将 评估过了。我们的ESI培训计划支持我们的先导研究研究的实施，假设是 体能和日常功能低下的患病率、FFP的表现、残疾和 与高收入的PLWH相比，KZ PLWH的HIV水平和老龄化耻辱程度更高 国家。在控制不佳、丙型肝炎合并感染、注射毒品的PLWH患者中，这种情况将会加剧 用户、老年人和男性。我们还假设，非传染性疾病(NCD)的并存和更高 艾滋病毒水平和衰老污名将与FFP的表现和残疾相关，并且更多 普遍存在于复原力较差的PLWH中。这是先进的教学和实践的创新组合 一名哈萨克ESI的艾滋病毒老化研究培训在KZ和EECA是第一次，并可在一年内完成。引航员 研究结果将为1)制定应对按时间顺序老龄化的干预措施以及 2)为前瞻性观察性研究提供了基础 旨在比较KZ的PLWH和未感染HIV的人的衰老过程。

PROJECT SUMMARY/ABSTRACT Limited knowledge exists about aging among people living with HIV (PLWH) in the Eastern European and Central Asia (EECA) region including Kazakhstan (KZ). The intersection of aging with the HIV care continuum has never been estimated in KZ and the EECA, and not evaluated among PLWH who are living to older ages and who have high rates of substance use. Physical performance, daily functioning, frailty, disability, stigma, substance use and resilience factors in PLWH must be characterized and repeatedly assessed across the HIV care continuum to ensure quality of life with aging. This application is a supplement to the ongoing Fogarty D43 HIV Research Training Grant on the Substance Use Mediated HIV Epidemic in KZ. We will train one Early Stage Investigator (ESI) by accomplishing two Aims. Aim 1 includes advanced didactic training in HIV-aging and Gerontology via two well-established (one NIH-funded) programs in the US, plus scientific meeting attendance, a monthly journal club and seminars. Aim 2 includes collecting pilot data on key aging metrics. The ESI will assess physical performance using the Short Physical Performance Battery, which includes: hand grip strength, 4 meter walk, chair stands, and balance (side-by-side, semi-tandem, and tandem stand). Daily functioning and disability will be assessed via the Lawton Instrumental Activities of Daily Living (IADL) scale. Frailty will be calculated according to the Fried Frailty Phenotype (FFP), which is comprised of grip strength, 4 meter walking speed, physical exhaustion, low physical activity, and unintentional weight loss. The ESI will also measure stigma and resilience using validated stigma scales for HIV stigma, aging stigma, and the 10-item Connor-Davidson Resilience Scale. Sociodemographic and HIV variables including HIV viral load and CD4+ count will be assessed. Our ESI training plan supports implementation of our pilot research study, with the hypothesis is that the prevalence of lower physical performance and daily functioning, manifestation of the FFP, disability, and higher levels of HIV and aging stigma will be observed among KZ PLWH compared to PLWH in high income countries. This will be exacerbated among PLWH who are poorly controlled, HCV co-infected, injection drug users, older, and men. We also hypothesize that noncommunicable disease (NCD) co-morbidities and higher levels of HIV and aging stigma will be associated with manifestation of the FFP and disability, and be more prevalent in PLWH who are less resilient. This innovative combination of advanced didactic plus hands-on research training in HIV-aging of one Kazakh ESI is the first in KZ and EECA and achievable in one year. Pilot study results will inform 1) development of interventions to address chronological aging together with the HIV/NCD care continuum among PLWH in KZ, and 2) provide a foundation for prospective observational studies designed to compare aging processes between PLWH and people without HIV in KZ.