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设置具有艾滋病毒相关的恶性肿瘤的最大燃烧，背景很高艾滋病毒和致癌病毒的患病率。与HIV相关的Kaposi的肉瘤（KS）是最常见的撒哈拉以南非洲的艾滋病毒相关疾病。发病率随着更多的宽度使用而降低抗逆转录病毒疗法（ART），但在美国仍然高于前列腺癌。 a 撒哈拉以南非洲的艾滋病毒相关KS的诊断，即使在艺术中，也很差，几乎一半患者死了两年。结果不佳的原因之一是，到患者寻求照顾时皮肤病变，该疾病已经发展到晚期。即使在诊断后，大量患者开始适当治疗时会延迟。我自己的工作表明，17-29％的KS患者确实没有及时开始艺术，几乎有一半的人从未进行过化学疗法收到它。为了最终提高生存，我们首先需要更好地了解KS护理中的差距。 KS Care Cascade包括一个串联时间间隔，该时间间隔由离散事件分开：注意症状，呈现给医疗保健，接受诊断，最后开始并完成治疗。确定个人和健康级联的每个步骤的系统障碍对于设计和实施改善的干预措施至关重要这个脆弱人群的结果。我是一名受过博士学位的流行病学家和董事会认证的皮肤科医生，其职业目标是成为艾滋病毒全球健康流行病学的独立研究者相关的恶性肿瘤和相关的皮肤状况，并实施干预措施以改善在资源贫乏的环境中处理这些条件。我将利用K23的方法学培训授予和利用我的联合主张和合作者的现有研究基础设施来自国际流行病学数据库的赞助艾滋病毒患者的艾滋病毒患者在评估艾滋病（IEDEA）肯尼亚西部实现以下特定目的：（1）评估晚期疾病的决定者在KS诊断和相关属性风险的阶段，以及时间的分布和决定导致诊断的间隔，（2）在新诊断为KS的患者中，评估时间安排和确定艺术倡议，并在诊断后指出化学疗法的倡议和依从性。 KS和（3）开发和试验测试多层干预措施，包括患者和医疗保健提供者 - 以促进KS迅速，适当治疗的中心组件。基于我的定量艾滋病毒流行病学背景，该奖项将提供定性方法，行为理论的培训基于干预设计和实施科学。这种结合，以及来自全球卫生，艾滋病毒流行病学，肿瘤学，全球皮肤病学和全球健康专家的多学科团队实施科学，理想情况下将使我成为艾滋病毒独立调查员的职业 - 相关的恶性肿瘤，重点是改善资源有限设置的结果。

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）

Identifying gaps in global health dermatology: a survey of GLODERM members.

DOI：
10.1111/bjd.19889
发表时间：
2021-07
期刊：
The British journal of dermatology
影响因子：
0
作者：
McMahon DE;Oyesiku L;Amerson E;Beltraminelli H;Chang AY;Forrestel A;Hay R;Knapp A;Kovarik C;Maurer T;Norton SA;Rehmus W;Van Hees C;Wanat KA;Williams VL;Fuller LC;Freeman EE
通讯作者：
Freeman EE

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

Dermatology on the global stage: The role of dermatologists in international health advocacy and COVID-19 research.