Preventing Weight Gain and Diabetes in People with HIV in South Africa

预防南非艾滋病毒感染者体重增加和糖尿病

基本信息

批准号：
10079619
负责人：
Jennifer Manne-Goehler
金额：
$ 19.98万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-14 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10079619
关键词：
Acquired Immunodeficiency Syndrome Address Adopted Africa Africa South of the Sahara Anthropometry Area Behavioral Behavioral Model Body Weight Changes Cardiovascular system Caring Chronic Chronic Disease Clinical Clinical Trials Cohort Studies Collaborations Communicable Diseases Conduct Clinical Trials Data Data Analyses Demographic and Health Surveys Diabetes Mellitus Diabetes prevention Dietary Practices Disease Educational Status Epidemic Epidemiologic Methods Epidemiology Feasibility Studies Feedback Foundations Funding General Hospitals Glucose Intolerance Glycosylated hemoglobin A Goals HIV HIV therapy Health Health system Home environment Intake International Intervention Intervention Studies Intervention Trial Interview Lead Massachusetts Measures Medicine Mentors Mentorship Metabolic Metabolic Diseases Morbidity - disease rate Obesity Obesity Epidemic Observational Study Overweight Paper Pharmaceutical Preparations Physical activity Physicians Pilot Projects Population Positioning Attribute Preventive Public Health Publications Publishing Randomized Regimen Reporting Research Research Institute Research Priority Risk Factors Scientist South Africa Testing Time Training Treatment Efficacy Trust United States National Institutes of Health Weight Weight Gain Woman antiretroviral therapy arm base behavioral pharmacology care systems career clinical trial analysis cohort design diabetes risk efficacy testing experience fast food global health glucose tolerance glycosylated serum albumin improved increased appetite low and middle-income countries men mortality multidisciplinary nutrition obesity prevention prevent prospective prototype public health relevance skills standard of care sugar sweetened beverage therapy design therapy development treatment as usual treatment program

项目摘要

PROJECT SUMMARY Background: Obesity and diabetes are important risk factors for morbidity and mortality in people with HIV (PWH), especially in sub-Saharan Africa where health systems are already grappling with a rapid rise in metabolic disease. Dolutegravir (DTG)-based antiretroviral therapy (ART) has recently been adopted as the first-line regimen in most of the region, despite evidence that it is associated with excess weight gain. While the HIV care system offers a capable health systems platform, obesity and diabetes prevention is not a current focus of care paradigms. Candidate: I am a Clinical Fellow in Infectious Diseases at Massachusetts General Hospital and a physician-scientist with doctoral-level training in global health epidemiology and a strong track record of published observational research. However, my recent experiences caring for PWH have led to a desire to gain new skills in the design and execution of interventional trials to prevent metabolic disease in this population. My overarching career goal is to become an independent, NIH-funded physician-scientist with expertise in the metabolic complications of treated HIV, and in developing and testing clinical interventions to prevent these complications. Training: To achieve research independence, I will require additional training in 1) obesity medicine and diabetes prevention, 2) behavioral model-based intervention design, and 3) the conduct and analysis of clinical trials to prevent metabolic complications of HIV. Mentors: My training and research plans will be overseen by my primary mentor Dr. Mark Siedner, who has extensive mentoring experience and conducts both observational cohort studies and clinical trials in South Africa. Drs. Janet Lo (obesity medicine and diabetes prevention), Christina Psaros (behavioral model-based intervention design), and Deborah Wexler (the conduct and analysis of clinical trials) will serve as co-mentors to provide additional focused expertise. I will also receive annual feedback from my Scientific Advisory Board, which includes Drs. Rochelle Walensky, Naomi Levitt, Robert Parker, and Till Bärnighausen. Research: With guidance from my team of mentors, I will explore the metabolic effects of DTG among PWH in South Africa and develop and pilot an intervention to mitigate these complications through three specific aims: 1) To determine the behavioral correlates of weight change and glucose intolerance for PWH transitioning to DTG-based ART in South Africa; 2) To develop an acceptable and contextually appropriate intervention to prevent weight gain and diabetes in PWH on DTG-based ART in South Africa; and 3) To conduct a factorial-randomized feasibility study of interventions to prevent weight gain and diabetes among PWH on DTG-based ART versus usual care. We will carry out this research through existing collaborations with the Wellcome Trust-funded Africa Health Research Institute (AHRI). Through this period of training and research, I will be well positioned to achieve research independence and plan to submit an NIH R01 application in the fourth year of this project to test the efficacy of an intervention to prevent weight gain and diabetes in PWH in South Africa.

项目摘要背景：肥胖和糖尿病是艾滋病毒患者发病和死亡率的重要危险因素（PWH），尤其是在撒哈拉以南非洲，卫生系统已经在努力迅速上升代谢疾病。基于Dolutegravir（DTG）的抗逆转录病毒疗法（ART）最近被用作在该地区大多数地区的一线方案，目的地证据表明它与体重增加有关。而艾滋病毒护理系统提供功能强大的卫生系统平台，肥胖和糖尿病预防并不是当前护理范式的重点。候选人：我是马萨诸塞州传染病的临床研究员医院和身体科学家接受了全球健康流行病学的博士学位培训和良好的轨道已发表的观察研究记录。但是，我最近照顾PWH的经历导致了渴望在设计和执行介入试验中获得新技能，以防止代谢性疾病人口。我的总体职业目标是成为一名独立的，由NIH资助的身体科学家治疗艾滋病毒的代谢并发症以及开发和测试临床干预措施的专业知识防止这些并发症。培训：为了实现研究独立性，我将需要额外的培训 1）肥胖医学和糖尿病预防，2）基于行为模型的干预设计，3）进行和分析临床试验以防止HIV代谢并发症。导师：我的培训和我的主要导师马克·西德纳（Mark Siedner）将监督研究计划，他拥有广泛的指导南非的经验和进行观察队列研究和临床试验。博士。珍妮特·罗（肥胖医学和糖尿病预防），克里斯蒂娜·帕罗斯（Christina Psaros）（基于行为模型的干预设计），和黛博拉·韦克斯勒（Deborah Wexler）（临床试验的行为和分析）将作为同事集中专业知识。我还将收到包括DRS在内的科学顾问委员会的年度反馈。 Rochelle Walensky，Naomi Levitt，Robert Parker和TillBärnighausen。研究：在我的指导下导师团队，我将探索DTG在南非PWH中的代谢作用以及开发和飞行员通过三个特定目的来减轻这些并发症的干预措施：1）确定行为 PWH过渡到南非基于DTG的艺术的重量变化和葡萄糖intlerance的相关性； 2）开发可接受且适当的干预措施，以防止体重增加和糖尿病南非基于DTG的艺术的PWH； 3）进行一项阶乘随机可行性研究在基于DTG的ART与通常的护理中，PWH中预防体重增加和糖尿病的干预措施。我们将通过与惠康信托基金资助的非洲健康研究的现有合作进行这项研究研究所（AHRI）。在这段培训和研究时期，我将有能力实现研究独立并计划在该项目的第四年提交NIH R01申请，以测试一种干预措施，以防止南非PWH体重增加和糖尿病。