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：
10239235
负责人：
Jennifer Manne-Goehler
金额：
$ 19.69万
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/10239235
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 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 acceptability and feasibility antiretroviral therapy arm base behavioral pharmacology care systems career clinical trial analysis cohort design diabetes risk efficacy testing excessive weight gain experience fast food feasibility testing 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.

项目概要背景：肥胖和糖尿病是艾滋病毒感染者发病和死亡的重要危险因素 (PWH)，特别是在撒哈拉以南非洲地区，那里的卫生系统已经在努力应对感染率迅速上升的问题基于多替拉韦（DTG）的抗逆转录病毒疗法（ART）最近被采用作为治疗代谢性疾病的方法。尽管有证据表明它与体重过度增加有关，但大多数地区仍将其作为一线治疗方案。艾滋病毒护理系统提供了一个强大的卫生系统平台，肥胖和糖尿病的预防不是当前的问题候选人：我是马萨诸塞州综合医院传染病临床研究员。医院和一位接受过全球健康流行病学博士级培训并拥有强大跟踪能力的医师科学家然而，我最近照顾 PWH 的经历导致了渴望获得设计和执行介入试验的新技能，以预防代谢疾病我的首要职业目标是成为一名独立的、由 NIH 资助的医师科学家。在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方面拥有专业知识培训：为了实现研究独立性，我需要额外的培训。 1) 肥胖医学和糖尿病预防，2) 基于行为模型的干预设计，以及 3) 进行和分析预防艾滋病毒代谢并发症的临床试验导师：我的培训和研究计划将由我的主要导师 Mark Siedner 博士监督，他拥有广泛的指导 Janet Lo 博士在南非拥有丰富的经验并进行了观察性队列研究和临床试验。（肥胖医学和糖尿病预防），Christina Psaros（基于行为模型的干预设计）， Deborah Wexler（临床试验的实施和分析）将作为共同导师，提供额外的帮助我还将收到我的科学顾问委员会的年度反馈，其中包括博士。 Rochelle Walensky、Naomi Levitt、Robert Parker 和 Till Bärnighausen 研究：在我的指导下。我将与导师团队一起探索 DTG 对南非 PWH 的代谢影响，并进行开发和试点通过三个具体目标来减轻这些并发症的干预措施：1）确定行为南非 PWH 过渡到基于 DTG 的 ART 时体重变化和葡萄糖耐受不良的相关性； 2) 制定可接受且适合具体情况的干预措施，以预防体重增加和糖尿病南非 PWH 基于 DTG 的 ART；以及 3) 开展析因随机化可行性研究与常规护理相比，基于 DTG 的 ART 预防感染者体重增加和糖尿病的干预措施。通过与威康信托基金会资助的非洲健康研究的现有合作来开展这项研究通过这段时间的培训和研究，我将能够很好地实现研究目标。独立性，并计划在该项目的第四年提交NIH R01申请，以测试其功效一项旨在预防南非感染者体重增加和糖尿病的干预措施。