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Improving the Care Cascade for HIV-associated Kaposi's Sarcoma in sub-Saharan Africa

改善撒哈拉以南非洲地区与艾滋病毒相关的卡波西肉瘤的护理梯级

基本信息

批准号：
10433922
负责人：
Esther E Freeman
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：
2018
资助国家：
美国
起止时间：
2018-07-19 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10433922
关键词：
AIDS related cancer AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adherence Africa Africa South of the Sahara Area Award Behavior Behavioral Behavioral Sciences Belief Biometry Caring Clinic Collaborations Databases Dermatologist Dermatology Development Diagnosis Diagnostic Disease Doctor of Philosophy Early Diagnosis Epidemiologist Epidemiology Event Evidence based treatment Foundations Goals HIV Health Health Personnel Health system Healthcare Incidence International Intervention K-Series Research Career Programs Kaposi Sarcoma Kenya Length Malignant Neoplasms Malignant neoplasm of prostate Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methodology Methods Modeling Motivation Newly Diagnosed Oncogenic Viruses Oncology Outcome Patient-Focused Outcomes Patients Persons Population Population Attributable Risks Positioning Attribute Prevalence Primary Health Care Provider Public Health Qualitative Methods Qualitative Research Quality of Care Randomized Research Research Infrastructure Research Methodology Research Personnel Resource-limited setting Resources Risk Series Skin Stage at Diagnosis Symptoms Time Training Treatment outcome United States United States National Institutes of Health Ursidae Family Viral Vulnerable Populations Work acceptability and feasibility advanced disease antiretroviral therapy base care seeking career chemotherapy clinical epidemiology cohort data standards design disparity reduction global health health care availability implementation intervention implementation science improved improved outcome malignant breast neoplasm mortality multidisciplinary novel optimal treatments pilot test prospective prototype provider intervention skin lesion theories therapy design time interval treatment disparity

项目摘要

PROJECT SUMMARY Resource-poor settings bear the greatest burden of HIV-associated malignancies, with high background prevalence of HIV and oncogenic viruses. HIV-associated Kaposi’s sarcoma (KS) is one of the most common HIV-associated malignancies in sub-Saharan Africa. Incidence has decreased with more widespread use of antiretroviral therapy (ART), but remains higher than prostate cancer in the United States. Survival after a diagnosis with HIV-associated KS in sub-Saharan Africa, even in the ART era, remains poor, with almost half of patients dead by two years. One reason for poor outcomes is that by the time patients seek care for their skin lesions, the disease has progressed to an advanced stage. Even after diagnosis, a substantial number of patients have delays in starting appropriate treatment. My own work has shown that 17-29% of KS patients do not receive timely initiation of ART and that nearly half of those with indications for chemotherapy never receive it. In order ultimately to improve survival, we first need to better understand the gaps in KS care. The KS care cascade includes a series time intervals separated by discrete events: noting symptoms, presenting to healthcare, receiving a diagnosis, and finally starting and completing treatment. Identifying personal and health system barriers at each step of the cascade is critical to designing and implementing interventions that improve outcomes for this vulnerable population. I am a PhD-trained epidemiologist and board certified dermatologist, with a career goal of becoming an independent investigator in the global health epidemiology of HIV- associated malignancies and associated skin conditions, and implementation of interventions to improve the treatment of these conditions in resource-poor settings. I will draw upon the methodological training of the K23 award and leverage the existing research infrastructure of my co-mentors and collaborators in a large NIH- sponsored cohort of HIV patients from the International Epidemiology Databases to Evaluate AIDS (IeDEA) in western Kenya to accomplish the following specific aims: (1) Evaluate the determinants of advanced disease stage at KS diagnosis and associated attributable risk, as well as the distribution and determinants of time intervals leading up to diagnosis, (2) Among patients newly diagnosed with KS, evaluate the timing and determinants of ART initiation and, where indicated, chemotherapy initiation and adherence after a diagnosis of KS and (3) Develop and pilot test a multi-level intervention including both patient and healthcare provider- centered components to promote prompt, appropriate treatment for KS. Building on my quantitative background in HIV epidemiology, this award will provide training in qualitative methods, behavioral theory based in intervention design, and implementation science. This combination, along with mentorship from a multidisciplinary team of experts in global health, HIV epidemiology, oncology, global dermatology, and implementation science, will ideally position me to launch my career as an independent investigator in HIV- associated malignancies with a focus on interventions to improve outcomes in resource-limited settings.

项目摘要资源贫乏的环境承受着艾滋病毒相关恶性肿瘤的最大负担，艾滋病毒和致癌病毒的流行。艾滋病相关的卡波西肉瘤（KS）是最常见的撒哈拉以南非洲的艾滋病毒相关恶性肿瘤。发病率随着更广泛地使用抗逆转录病毒治疗（ART），但在美国仍然高于前列腺癌。生存后，在撒哈拉以南非洲地区，即使在ART时代，艾滋病毒相关KS的诊断仍然很差，几乎一半患者死亡率下降了结果不佳的一个原因是，当患者寻求治疗时，皮肤损伤，疾病已发展到晚期。即使在诊断后，患者在开始适当的治疗方面会出现延迟。我自己的研究表明，17-29%的KS患者没有及时开始ART，近一半有化疗指征的人从未接受过为了最终提高生存率，我们首先需要更好地了解KS护理的差距。的 KS护理级联包括由离散事件分隔的一系列时间间隔：注意症状，医疗保健，接受诊断，最后开始并完成治疗。识别个人和健康级联中每一步的系统障碍对于设计和实施干预措施至关重要，为这一弱势群体带来的影响。我是一个博士训练的流行病学家和委员会认证的皮肤科医生，职业目标是成为全球艾滋病流行病学的独立调查员- 相关的恶性肿瘤和相关的皮肤病，并实施干预措施，以改善在资源贫乏的环境中治疗这些疾病。我将借鉴K23的方法论培训，奖励和利用我的共同导师和合作者在一个大型NIH的现有研究基础设施，来自国际流行病学数据库的艾滋病患者赞助队列，以评估艾滋病（IEDEA），肯尼亚西部，以实现以下具体目标：（1）评估晚期疾病的决定因素 KS诊断阶段和相关归因风险，以及时间分布和决定因素间隔导致诊断，（2）在新诊断的KS患者中，评估时间和开始ART治疗的决定因素，以及在有指征的情况下，诊断后开始化疗和坚持化疗的决定因素（3）制定并试点测试包括患者和医疗保健提供者在内的多层次干预措施- 中心组件，以促进及时，适当的治疗KS。根据我的定量分析在艾滋病毒流行病学背景，该奖项将提供定性方法，行为理论，基于干预设计和实施科学。这种结合，沿着从一个全球卫生、艾滋病毒流行病学、肿瘤学、全球皮肤病学和执行科学，将理想地定位我开始我的职业生涯作为一个独立的调查员在艾滋病毒- 相关的恶性肿瘤，重点是干预措施，以改善在资源有限的情况下的结果。

项目成果

期刊论文数量（8）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Modernizing clinical practice guidelines for the American Academy of Dermatology.

DOI：
10.1016/j.jaad.2019.12.075
发表时间：
2020-06
期刊：
Journal of the American Academy of Dermatology
影响因子：
13.8
作者：
Freeman EE;McMahon DE;Fitzgerald M;Robinson S;Frazer-Green L;Hariharan V;McMillen A;Malik S;Cornelius L;Pak HS;Cronin TA;Bordeaux JS;Cooper KD;American Academy of Dermatology Ad Hoc Task Force on Modernizing Clinical Guidance
通讯作者：
American Academy of Dermatology Ad Hoc Task Force on Modernizing Clinical Guidance

Skin Biopsy Equipment Availability Across 7 Low-Income Countries: A Cross-Sectional Study of 6053 Health Facilities.