Mentoring Patient Oriented Adherence Research in Uganda

指导乌干达以患者为导向的依从性研究

基本信息

批准号：
8115077
负责人：
DAVID Roy BANGSBERG
金额：
$ 15.52万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2004
资助国家：
美国
起止时间：
2004-09-27 至 2014-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8115077
关键词：
Adherence Advisory Committees Africa South of the Sahara African Anti-Retroviral Agents Award Behavior Therapy Behavioral Behavioral Sciences Communication Country Data Dose Drug Exposure Drug resistance Economics Educational process of instructing Electronics Enrollment Faculty Failure Future Goals Grant HIV HIV drug resistance Health Health Services Accessibility Home environment Hour Individual Interruption Intervention Interview Link Manuscripts Marketing Massachusetts Mentors Monitor Patients Postdoctoral Fellow Prevention Productivity Research Research Infrastructure Research Methodology Research Personnel Resistance Resources Risk Rural Science Students System Technology Testing Time Treatment Failure Treatment outcome Uganda United States National Institutes of Health Universities Validation Viral Viral Load result Wireless Technology Writing antiretroviral therapy base behavioral/social science career cohort cost cost effective design efficacy testing improved non-nucleoside reverse transcriptase inhibitors novel novel strategies patient oriented patient oriented research pill prevent programs response social success therapy adherence tool treatment adherence treatment duration treatment response viral RNA

项目摘要

DESCRIPTION (provided by applicant): The overarching goal of this Mid-Career Investigator Award in HIV-related Patient-Oriented Research (K- 24) application is to make meaningful contributions to social and behavioral science research aimed at improving HIV treatment outcomes in sub-Saharan Africa. My specific goals are to 1) mentor students, post- doctoral fellows, and junior faculty in social-behavioral HIV research who will 2) conduct patient-based research to improve antiretroviral therapy adherence in a rural African setting. My mentoring activities will be primarily based at Mbarara University of Science and Technology (MUST) in Mbarara, Uganda, and Harvard University in Cambridge, Massachusetts. The mentoring program will leverage research and teaching infrastructure at these universities and will consist of direct one-on-one mentoring in the conduct of social-behavioral HIV research, as well as formal seminars on research methods, manuscript writing, and grant writing. A mentoring advisory committee will formally evaluate mentored junior investigators, on the basis of their productivity. The research program will test the feasibility of preventing antiretroviral therapy interruptions through novel real-time wireless adherence monitoring. This new direction is based on our finding that incomplete adherence, to the extent that it occurs in rural Uganda, is manifested as treatment interruptions due to structural and/or economic barriers to treatment access. We found that the duration of treatment interruption for patients on non-nucleoside reverse transcriptase inhibitor antiretroviral therapy is directly related to the risk of virologic rebound. While an interruption of 4 days poses little risk of virologic rebound, an interruption of 15 days poses a 50% risk of virologic rebound. These data suggest that there is a 3-5 day window to intervene after missed doses but before virologic failure. Because adherence is so closely associated with viral suppression, accurate adherence monitoring can provide a strategy to strategically limit viral RNA monitoring only to those patients at a defined risk for viral rebound. Novel wireless adherence monitoring tools combined with the well developed wireless communications network in many Sub-Saharan African countries creates the potential for a new paradigm of HIV treatment defined by strategic viral RNA monitoring and the proactive prevention rather than the reactive response to virologic failure.

描述（由申请人提供）：该中期研究者研究员奖的总体目标是与HIV相关患者的研究（K-24）申请，旨在为旨在改善撒哈拉以南非洲艾滋病毒治疗结果的社会和行为科学研究做出有意义的贡献。我的具体目标是1）指导学生，博士后研究员和社会行为艾滋病毒研究的初级教师，他们将2）进行基于患者的研究以改善非洲农村地区的抗逆转录病毒疗法的依从性。我的指导活动将主要设在马萨诸塞州剑桥市Mbarara，乌干达Mbarara和哈佛大学的Mbarara科学技术大学（必须）。该指导计划将利用这些大学的研究和教学基础设施，并包括在社会行为艾滋病毒研究中进行直接一对一的指导，以及有关研究方法，手稿写作和授予写作的正式研讨会。指导咨询委员会将根据其生产力正式评估受过指导的初级调查人员。该研究计划将通过新型的实时无线依从性监测来测试防止抗逆转录病毒疗法中断的可行性。这个新的方向是基于我们的发现，即在乌干达农村地区发生的不完全依从性被表现为由于治疗通道的结构和/或经济障碍而导致的治疗中断。我们发现，非核苷逆转录酶抑制剂抗逆转录病毒疗法的患者治疗持续时间与病毒学反弹的风险直接相关。虽然4天的中断几乎没有病毒学反弹的风险，但15天的中断会带来50％的病毒回弹风险。这些数据表明，在错过剂量但在病毒衰竭之前，有一个3-5天的窗口可以进行干预。由于依从性与病毒抑制密切相关，因此，准确的依从性监测可以提供一种策略性地限制病毒RNA监测的策略，仅向那些患有病毒反弹风险的患者限制病毒RNA监测。新型的无线依从性监测工具与许多撒哈拉以南非洲国家中发达的无线通信网络相结合，为通过战略性病毒RNA监测和主动预防而定义的新的HIV治疗范式创造了潜力，而不是对病毒学衰竭的反应性反应。