The HIV and Alcohol Research center focused on Polypharmacy (HARP)

艾滋病毒和酒精研究中心专注于复方用药 (HARP)

• 批准号: 10686377
• 负责人: Amy Caroline Justice
• 金额: $ 118.01万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-10 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10686377
• 关键词: Address; Aging; Alcohol consumption; Alcoholic Liver Diseases; Alcohols; Anti-Retroviral Agents; Behavior Therapy; Behavioral; Big Data; Biological Markers; Collaborations; Communication; Complex; Consumption; Data; Data Analytics; Department of Energy; Dose; Effectiveness; Electronic Health Record; Elements; Family; Funding; Genetic; Goals; HIV; Health; Health behavior change; Healthcare; High Performance Computing; Individual; Intervention; Intervention Studies; Laboratories; Learning; Link; Literature; Liver Cirrhosis; Liver diseases; Measures; Medical; Metformin; Modeling; Motivation; National Institute on Alcohol Abuse and Alcoholism; Outcome; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Pharmacists; Physiological; Pioglitazone; Polypharmacy; Prazosin; Predisposition; Provider; Risk; Risk Assessment; Risk Factors; Safety; Selection for Treatments; Series; Systems Biology; Toxic effect; United States Food and Drug Administration; Variant; Verapamil; Veterans; alcohol abuse therapy; alcohol measurement; alcohol misuse; alcohol prevention; alcohol research; alcohol response; alcohol risk; alcohol use disorder; behavior change; candidate identification; cohort; design; drinking; drug repurposing; experience; frailty; motivational enhancement therapy; patient response; personalized intervention; personalized medicine; phosphatidylethanol; response; skills; substance use; theories; treatment response

HARP OVERALL PROJECT SUMMARY The goal of the HIV and Alcohol Research center focused on Polypharmacy (HARP) is to design and implement effective personalized interventions for people aging with HIV (PAH) experiencing medical harm from unhealthy alcohol use (at risk and Alcohol Use Disorder [AUD]) and polypharmacy (5+ medications). Using large scale, national Veterans Healthcare Administration Electronic Health Record data (EHR data), we have shown strong independent, dose-response, associations between polypharmacy (medication count and A-PIMS), alcohol use, and adverse health outcomes. In HARP Project 1, we further explore alcohol and polypharmacy (AP) risks using a direct alcohol biomarker (Phosphatidylethanol [PEth]), considering genetic liability, and exploring associations with decompensated liver cirrhosis as a manifestation of alcohol-associated liver disease (AALD). Polypharmacy and genetic liability also complicate selection of treatment for AUD. In HARP Project 2, we use genetic liability and real-world data to identify and evaluate candidate medications in the context of polypharmacy. Further, AP risks, especially genetic liability, are complex and challenging to summarize. Both summarizing effects of multiple risk factors and using genetic data to identify medications for repurposing requires large-scale, real-world data, high performance computing and sophisticated analytics. With support from our Administrative/Data Analytic (ADA) Core, the Department of Energy (DOE), an extended VA family of EHR cohorts (VACo Family), and an expanded network of experts, we are uniquely poised to harness “big” data to personalize AP risks for PAH and evaluate medications for AUD. Finally, effective communication of AP risk messages needs to be integrated into a comprehensive, theory-based behavior change intervention. We have assembled a Risk Communication Core (RCC) of experts to facilitate risk communication and motivational interviewing (MI) in our pilot intervention studies. The core includes Dr. Jeffrey Fisher, co-developer of the Information-Motivation-Behavioral Skills (IMB) model of health behavior change. In collaboration with Dr. Fisher, this core will guide our application of the IMB-MI model to communicate personalized risk and other elements required for health behavior change in a linked series of pharmacist- delivered pilot interventions. Project 1 pilots will compare patient’s responses to AP risk messages (employing different measures of exposure and outcomes) delivered in the larger context of an IMB-MI intervention for PAH who are at risk drinkers; Project 2 pilots will incorporate lessons learned in Project 1 and adapt the IMB- MI intervention to target PAH with AUD, adding a candidate repurposed medication for AUD.

HARP 总体项目概要 专注于复方用药 (HARP) 的艾滋病毒和酒精研究中心的目标是设计和 对遭受医疗伤害的艾滋病毒（PAH）老年患者实施有效的个性化干预措施 来自不健康的饮酒（有酒精使用障碍 [AUD] 的风险）和多重用药（5 种以上药物）。 使用大规模的国家退伍军人医疗保健管理局电子健康记录数据（EHR 数据），我们 已显示出很强的独立性、剂量反应以及多重用药之间的关联（药物计数和 A-PIMS）、酒精使用和不良健康后果在 HARP 项目 1 中，我们进一步探索和分析酒精。 考虑到遗传因素，使用直接酒精生物标记物（磷脂酰乙醇 [PEth]）的多重用药 (AP) 风险 责任，并探讨与失代偿性肝硬化（酒精相关性肝硬化的表现）的关系 肝病（AALD）的多重用药和遗传倾向也使 AUD 的治疗选择变得复杂。 HARP 项目 2，我们使用遗传责任和真实世界数据来识别和评估候选药物 此外，AP 风险，尤其是遗传责任，是复杂且具有挑战性的。 总结多种风险因素的影响并使用遗传数据来识别治疗药物。 重新利用需要大规模的真实数据、高性能计算和复杂的分析。 在我们的行政/数据分析 (ADA) 核心、能源部 (DOE) 的支持下， VA 电子病历群组 (VACo Family) 家族以及扩大的专家网络，我们拥有独特的优势 利用“大”数据个性化 PAH 的 AP 风险并评估 AUD 的药物治疗效果。 AP风险信息的传达需要整合到全面的、基于理论的行为中 我们组建了风险沟通核心 (RCC) 专家来促进风险管理。 我们的试点干预研究中的沟通和动机访谈（MI）核心包括 Jeffrey 博士。 Fisher，健康行为改变信息-动机-行为技能（IMB）模型的共同开发者。 与Fisher博士合作，这个核心将指导我们应用IMB-MI模型进行通信 在一系列相关的药剂师中，个性化风险和健康行为改变所需的其他要素- 项目 1 试点将比较患者对 AP 风险信息的反应（采用 在 IMB-MI 干预的更大背景下提供不同的暴露和结果测量） 属于危险饮酒者的 PAH；项目 2 试点将吸收项目 1 中的经验教训并调整 IMB- MI 干预以 AUD 为目标 PAH，添加了一种针对 AUD 的候选药物。