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: 8841412
• 负责人: Parya Saberi
• 金额: $ 17.83万
• 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 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8841412
• 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; 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.

描述（由申请人提供）：成功的HIV治疗的致命弱点是遵守抗逆转录病毒（ARV）治疗，因为不遵守性仍然是进展到艾滋病和死亡的最强预测指标之一。美国卫生与公共服务部对技术对ARV遵守的支持作用的认可强调了需要更强有力证明这些干预措施的重要性的重要性。结果，一些研究检查了电子提醒设备对ARV依从性的疗效。但是，这些研究大多数尚未揭示依从性的临床显着改善。这可能是因为他们主要研究了一种方法的作用，而不论特定于患者的不遵守原因。因此，大多数研究没有使用量身定制的基于技术的方法来解决不同的不遵守原因，而是迫使参与者“适合”技术。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不遵守原因的定制干预措施。通过受保护的时间，培训和指导在这个K23职业发展奖中，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人员的长期职业目标。迄今为止，我的培训为我提供了强大而基本的研究基础，并确认了我成为临床研究者的决定。但是，我需要在使用技术和信息学方面进行进一步的培训，以提高ARV依从性，进行焦点小组以及定性研究，设计和实施行为干预，生物统计学的高级培训以及为适应性治疗策略创建和测试规则的高级培训。我已经确定Mallory Johnson博士为我的主要导师，他是治疗依从性领域的专家，并具有出色的指导记录。博士。 Nicolas Sheon，Ida Sim，Michael Silverberg和Eric Vittinghoff将担任联合官员。通过指导和培训，我计划追求四个相互联系的职业目标：1）成为改善ARV依从性方法的专家； 2）获得自适应治疗策略方面的专业知识； 3）精通混合方法（定性和定量）研究的设计和评估行为干预措施； 4）通过研究基于证据的艾滋病毒临床药剂师主导的倡议来推进艾滋病毒护理的倡议，转移临床药房的领域。我的研究的总体目的是识别和开发单独限制的基于技术的方法，这些方法有可能克服艾滋病毒+青年不遵守特定原因。我将在此K23奖励期间获得的高级培训将填补我所知的空白，并使我能够成功竞争R34赠款，以对基于技术的自适应干预措施进行试点研究，以提高年轻的HIV+男性和女性的依从性；这将导致R01评估此干预的功效。