Technology-based adaptive treatment strategies for antiretroviral adherence

基于技术的抗逆转录病毒依从性适应性治疗策略

• 批准号: 8410021
• 负责人: Parya Saberi
• 金额: $ 17.76万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-06-15 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8410021
• 关键词: AIDS clinical trial group; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; African American; Age; Age-Years; Anti-Retroviral Agents; Area; Behavior Therapy; Biometry; British; Caring; Cessation of life; Characteristics; Clinical; Clinical Investigator; Clinical Pharmacists; Data; Development; Devices; Diagnosis; Disease Progression; Effectiveness; Effectiveness of Interventions; Electronics; Epidemiology; Evaluation; Female; Focus Groups; Foundations; Goals; Grant; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health behavior; Incidence; Individual; Informatics; Intervention; Interview; K-Series Research Career Programs; Knowledge; Latino; Lead; Learning; Medical Informatics; Memory; Mental Depression; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Minority Groups; Participant; Patients; Persons; Pharmacy facility; Pilot Projects; Population; Public Health; Qualitative Methods; Qualitative Research; Questionnaires; Research; Research Design; Research Personnel; Research Project Grants; Resources; Risk; Risk Factors; Role; Series; Social support; Source; Stigmata; Technology; Testing; Time; Training; Treatment Efficacy; Treatment Failure; United States Dept. of Health and Human Services; Update; Woman; Work; World Health Organization; Youth; antiretroviral therapy; base; career; clinically significant; demographics; drug resistant virus; empowered; evidence base; forgetting; improved; lifetime risk; male; men; prototype; response; sex; skills; social stigma; therapy development; transmission process; treatment adherence; treatment strategy; young man; young woman

DESCRIPTION (provided by applicant): The Achilles heel of successful HIV treatment is adherence to antiretroviral (ARV) therapy, as non-adherence remains one of the strongest predictors of progression to AIDS and death. The recognition of the supportive role of technology for ARV adherence by the U.S. Department of Health and Human Services underscores the importance of the need for stronger evidence of the effectiveness of these interventions. As a result, several studies have examined the efficacy of electronic reminder devices on ARV adherence. However, most of these studies have not revealed clinically significant improvements in adherence; which may be because they have primarily investigated the role of a single method, irrespective of patient-specific reasons for non-adherence. Thus, instead of using tailored technology-based methods to address distinct non-adherence reasons, most studies compel the participant to "fit" the technology. Therefore, to most effectively use technology to improve adherence, customized interventions that focus on the patients' specific non-adherence reasons need to be considered. With protected time, training, and mentoring during this K23 career development award, I propose to acquire the skills needed to address these issues and to achieve my long-term career goal of becoming an independent clinical researcher. My training to date has provided me with a strong and basic foundation of research and affirmed my decision of becoming a clinical investigator. However, I require further training in the use of technology and informatics to improve ARV adherence, conducting focus groups and advanced training in qualitative research, designing and implementing behavioral interventions, advanced training in biostatistics, and creating and testing rules for adaptive treatment strategies. I have identified Dr. Mallory Johnson as my primary mentor, who is an expert in the area of treatment adherence and has an outstanding record of mentorship. Drs. Nicolas Sheon, Ida Sim, Michael Silverberg, and Eric Vittinghoff will serve as co-mentors. Through mentorship and training, I plan to pursue four interconnected career goals: 1) become an expert in technology-based methods of improving ARV adherence; 2) acquire expertise in adaptive treatment strategies; 3) become proficient in the use of mixed methods (qualitative and quantitative) research for the design and evaluation of behavioral interventions; and 4) move the field of clinical pharmacy forward by researching evidence-based HIV clinical pharmacist-led initiatives in advancing HIV care. The overarching objective of my research is to identify and develop individually-tailored technology-based approaches that have the potential to overcome specific reasons for non-adherence in HIV+ youth. The advanced training I will receive during this K23 award will fill the gaps in my knowledge and enable me to successfully compete for an R34 grant to conduct a pilot study of technology-based adaptive interventions to improve adherence in young HIV+ men and women; which will lead to an R01 to evaluate the efficacy of this intervention. PUBLIC HEALTH RELEVANCE: The research proposed in this K23 award is relevant because: 1) it will identify and evaluate interventions that may improve ARV adherence and thereby decrease the risk of treatment failure, disease progression, and the emergence and transmission of drug resistant virus; 2) it has the potential to identify technologies that may empower HIV-positive individuals and be used across settings and populations; 3) it has a secondary focus on a population that is disproportionately affected by HIV/AIDS and is in line with national HIV research objectives.

描述（由申请人提供）：成功治疗艾滋病毒的致命弱点是坚持抗逆转录病毒（ARV）治疗，因为不坚持治疗仍然是进展为艾滋病和死亡的最强预测因素之一。美国卫生与公众服务部认识到技术对抗逆转录病毒药物依从性的支持作用，强调需要更有力的证据来证明这些干预措施的有效性。因此，多项研究检验了电子提醒装置对抗逆转录病毒药物依从性的功效。然而，大多数这些研究并未显示出临床依从性的显着改善；这可能是因为他们主要研究了单一方法的作用，而不考虑患者不依从的具体原因。因此，大多数研究强迫参与者“适应”技术，而不是使用基于技术的定制方法来解决明显的不遵守原因。因此，为了最有效地利用技术来提高依从性，需要考虑针对患者特定的不依从原因的定制干预措施。通过在 K23 职业发展奖期间获得受保护的时间、培训和指导，我建议获得解决这些问题所需的技能，并实现成为独立临床研究员的长期职业目标。迄今为止的培训为我提供了坚实而基础的研究基础，并坚定了我成为一名临床研究者的决定。然而，我需要进一步培训使用技术和信息学来提高抗逆转录病毒药物的依从性，开展焦点小组和定性研究方面的高级培训，设计和实施行为干预，生物统计学方面的高级培训，以及制定和测试适应性治疗策略的规则。我已指定 Mallory Johnson 博士为我的主要导师，他是治疗依从性领域的专家，并且拥有出色的指导记录。博士。 Nicolas Sheon、Ida Sim、Michael Silverberg 和 Eric Vittinghoff 将担任联合导师。通过指导和培训，我计划实现四个相互关联的职业目标：1）成为提高抗逆转录病毒药物依从性的技术方法的专家； 2）获得适应性治疗策略的专业知识； 3）熟练使用混合方法（定性和定量）研究来设计和评估行为干预措施； 4) 通过研究以证据为基础的艾滋病毒临床药剂师主导的推进艾滋病毒护理的举措，推动临床药学领域向前发展。我研究的首要目标是确定和开发基于技术的个性化方法，这些方法有可能克服艾滋病毒阳性青少年不遵守规定的具体原因。我将在 K23 奖项期间接受的高级培训将填补我的知识空白，并使我能够成功竞争 R34 赠款，以开展基于技术的适应性干预措施的试点研究，以提高年轻 HIV+ 男性和女性的依从性；这将导致 R01 来评估该干预措施的功效。 公共卫生相关性：本 K23 奖项中提出的研究具有相关性，因为：1）它将确定和评估可提高抗逆转录病毒药物依从性的干预措施，从而降低治疗失败、疾病进展以及耐药病毒出现和传播的风险； 2) 它有潜力确定可以增强艾滋病毒阳性个体能力并在不同环境和人群中使用的技术； 3) 它的次要重点是受艾滋病毒/艾滋病影响尤为严重的人群，并且符合国家艾滋病毒研究目标。