CIHR HIV Comorbidty Research Agenda: Relevant Research Areas

The CIHR HIV/AIDS Research Initiative will provide funding for applications that address the overall goal of the HIV Comorbidity Research Agenda and are determined to be relevant to at least one of the topics of "HIV and Aging" and "HIV, Mental Health and Neurological Conditions".

HIV and Aging

This initiative will support research on the biological, clinical, and psychosocial aspects of aging that are altered by HIV and/or its treatment as well as that focused on the understanding, prevention, detection, and treatment of chronic health conditions, functional decline and frailty across the lifespan of those living with HIV. Within the topic of HIV and Aging, the following areas of research will be supported:

Burden of Disease: More information is required regarding the prevalence, severity and impact of aging and chronic health conditions on morbidity, mortality, quality of life and functional status in people living with HIV. Information is required at various levels, including effects on individuals, specific at-risk populations, and nationally. Both a broad picture of prevalence and outcomes in populations and in-depth investigations of risk factors for specific conditions or multi-morbidities are needed to guide future priorities and interventions.

Disease progression: Research is needed to improve understanding of the biological mechanisms of aging with HIV and the role of HIV and its treatment on the natural aging process in children, youth and adults. A better understanding of the drivers of chronic health conditions and frailty in those infected is required. Research is also required on the effects of co-infections on aging and risk for chronic health conditions and how these processes differ in those co-infected with HIV and other microbes such as Hepatitis C virus. In addition, further evidence on psychosocial and environmental factors associated with HIV and aging and their link to the progression of HIV, functional decline, frailty and comorbid conditions for those infected is needed.

Interventions: Research is needed to provide evidence regarding the most effective interventions for the prevention, detection and treatment of chronic disease, functional decline and frailty in those living with HIV. Interventions may be clinical, socio-behavioural or program/policy oriented in nature and may focus on the individual, community or population level.

Community-Based Primary Healthcare: Community-based primary healthcare (CBPHC) coordinates and provides care along a diversity of continuums: from prevention to palliation, from illness to wellness and back again. It encompasses a broad range of services, including health promotion and disease prevention, the diagnosis, treatment, and management of chronic and episodic illness, rehabilitation support, and end of life care. Research is needed to determine how to best prevent and manage chronic diseases, episodic illness and functional decline in CBPHC settings for people living with HIV. In addition, an understanding of how culturally appropriate CBPHC can be designed to ensure an accessible and smooth continuum of prevention and care and successful transitions from hospital to home to long-term care for people living with HIV, and particularly those that are members of vulnerable populations, is required.

HIV, Mental Health and Neurological Conditions

This initiative will support research focused on enhancing our understanding of the intersection of HIV and its treatment with mental health and neurological conditions. This topic focuses both on the effects of HIV and its treatment on neurological conditions (e.g., cognitive decline, neuropathy) and mental health (e.g., depression, substance use) as well as the impacts of mental health status and neurocognitive functioning on HIV and its management. Within the topic of HIV, Mental Health and Neurological Conditions, the following areas of research will be supported:

Burden of Disease: More information is required regarding the prevalence and severity of mental health and neurological conditions in people living with HIV and the impact of these conditions on morbidity, mortality, quality of life and functional status at the individual and population level. An understanding of the role that biological factors and social and structural determinants of health play on the impact of HIV and these comorbidities in specific populations (e.g., injection drug users, co-infected individuals) is needed to guide policy, program and other interventions.

Disease progression: Further research is needed on the effects of mental health status on HIV treatment and the progression of disease, for example what is the role of depression on adherence to treatments and health outcomes in people living with HIV. In addition, more information is needed regarding the effects of HIV on neurocognitive function, the mechanisms driving these effects, and the role of HIV treatments in their management. The impact of HIV and its treatment on mental health conditions – including the biological, social and structural factors that promote optimal mental health - must also be better understood.

Interventions: Research is needed to provide evidence regarding the most effective interventions for the prevention, detection and management of mental health and neurological conditions in people living with HIV/AIDS and, in particular, for those suffering from multi-morbidities. Interventions at the individual, community and population level are required and may be clinical, socio-behavioural or policy oriented. Interventions for the effective management of HIV in the presence of mental health and neurological conditions are also required.

Community-Based Primary Healthcare: Community-based primary healthcare (CBPHC) coordinates and provides care along a diversity of continuums: from prevention to palliation, from illness to wellness and back again. It encompasses a broad range of services, including health promotion and disease prevention, the diagnosis, treatment, and management of chronic and episodic illness, rehabilitation support, and end of life care. Research is needed to determine how CBPHC settings can best manage the complex needs of people living with HIV/AIDS who are at risk of and/or dealing with mental health and neurological comorbidities. An understanding of how culturally appropriate CBPHC can be designed to ensure an accessible and smooth continuum of services from: prevention of mental health problems and neurological conditions; to their treatment and care; and to successful transitions from hospital to home to long-term care for specific populations affected, is required.

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