Alcohol and HIV/AIDS - Comorbidities, Coinfections, and Complications Research: Intervention and Cross-Cutting Foundational Research

Kendall Bryant, Ph.D.

Purpose

The future Notice of Funding Opportunity (NOFO, a reissue of RFA AA 16-001) will solicit applications for human studies that will advance operations or implementation research in the context of alcohol and HIV/AIDS by facilitating the development of: (1) broader systems approaches for monitoring complex HIV and alcohol-related morbidity and mortality, and (2) interventions to reduce the impact of alcohol on HIV disease progression and transmission.

Research funded under the NOFO should serve as the foundation for a next generation of intervention studies to address alcohol use from transmission to treatment of HIV. Intervention studies should inform implementation efforts to improve provision of alcohol-related interventions and treatments for people living with HIV (PLWH) in healthcare and community settings.

This proposed research initiative is aligned with the research priorities set forth in the NIH Strategic Plan for HIV and HIV-Related Research.

Background

Harmful alcohol use is common among people living with HIV (PLWH). Patterns of alcohol use impact transmission of HIV, engagement and retention in care, and susceptibility to coinfections (e.g., hepatitis C and tuberculosis). HIV can now be treated effectively with multiple antiretroviral medications, which suppress the virus and result in a longer life. Even after establishing viral control, alcohol use remains a complicating factor with clinical manifestations such as continuing systemic inflammation. Research on patterns of alcohol use is needed to understand how and at what levels alcohol consumption complicates HIV treatment. In addition, more studies are necessary to: (1) elucidate the mechanisms by which alcohol use impacts comorbidities, (2) determine whether decreasing alcohol use improves HIV-relevant outcomes, (3) examine whether state-of-the-art medications used to treat Alcohol Use Disorders and common comorbidities or coinfections are safe for PLWH who drink alcohol, and 4) implement interventions in diverse geographically distributed vulnerable populations.

Research funded by the NOFO will facilitate progress toward the Ending the HIV Epidemic initiative launched by the U.S. Department of Health and Human Services in 2019, and will help achieve the 90-90-90 goals specified in the UNAIDS 2016–2021 Strategy, which includes the objectives that 90% of people with HIV will be diagnosed, 90% with a diagnosis will receive treatment, and 90% of those in treatment will have suppressed viral loads. Alcohol consumption can complicate all three objectives and support for studies using validated biological measurements and self-reports of alcohol use would promote the identification of subgroup variation and ensure better understanding of the risks to particularly vulnerable populations.

Research Topics/Statement of Work

The NOFO will solicit applications that address HIV and alcohol-related morbidity and mortality, and interventions that reduce the impact of alcohol on HIV disease progression and transmission. Examples include studies that seek to:

Develop interventions that combine behavioral and biological strategies leading to significant and sustainable reductions in the impact of alcohol on viral load and the spread of HIV.
Discover innovative approaches to measure and treat HIV and alcohol misuse in diverse populations who continue high-risk patterns of harmful or hazardous drinking across the lifespan and may have Alcohol Use Disorders.
Develop strategies to prevent HIV and common alcohol-associated coinfections (e.g. hepatitis C, tuberculosis) and reduce comorbidities, co-infections, and complications (CCC) that are also common (e.g. tobacco and depression) among PLWH.
Support and advance novel research to address and mitigate underlying alcohol and HIV-associated medical and social inequalities that diminish the health and well-being of PLWH in underserved and marginalized communities in domestic and international settings.
Pursue innovative research methods and the use of new and improved technologies to facilitate advances across the research agenda and to improve the translation of basic behavioral and biological research findings into clinical and community practice.
Use emerging new methodologies focused on analysis and representation of large/complex datasets could also be explored, particularly in relationship to the use of electronic medical records and/or other sources of reliable information related to engagement in care.
Advance the understanding of how the severity of alcohol use (including Alcohol Use Disorders) impacts clinical outcomes for PLWH and identify new ways of engaging and retaining this target population in effective treatment.
Examine the additive or synergistic impact for specific comorbidities in determining clinical outcomes for PLWH who have sustained organ and tissue damage due to past alcohol use (sick quitters) and understand the optimal recovery process.

Outcomes

Health Outcomes for PLWH who continue to drink or have problems associated with past drinking include:

Improving linkage to care and retention in HIV and alcohol care
Accelerating reductions in alcohol use resulting in increased viral suppression,
Identifying mitigating social determinants of poor outcomes (such as homelessness),
Reducing frailty and subsequent mortality,
Reducing the incidence of new infections through Treatment as Prevention (TasP)
Reducing HIV and alcohol disparities in key populations of men and women and in the Southern US and other high-incidence locations.

Suggested Mechanism and NOFO

NIAAA may apply the Program Project mechanism. If substantial involvement by an NIAAA Project Officer is necessary for the successful execution of the project, NIAAA may implement the cooperative agreement activity codes. The NOFO will be either an RFA or a PAR.