Developing Clinical Prediction Tools to Define Strategies for Differentiated Service Delivery in Children and Adolescents Living with HIV in sub-Saharan Africa.

开发临床预测工具，以确定为撒哈拉以南非洲地区艾滋病毒感染儿童和青少年提供差异化​​服务的策略。

• 批准号: 10472593
• 负责人: Alexander William Kay
• 金额: $ 13.37万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-18 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10472593
• 关键词: 5 year old; AIDS related cancer; Acquired Immunodeficiency Syndrome; Adherence; Adolescent; Adult; Africa South of the Sahara; Age; Alcohol consumption; Area; Award; Biometry; Botswana; Caring; Cessation of life; Child; Child Care; Child Health; Childhood; Clinic; Clinical; Clinical Data; Clinical Informatics; Clinical Research; Communicable Diseases; Complement; Country; Data; Data Science; Data Set; Derivation procedure; Development; Disease; Drug usage; Enrollment; Epidemic; Epidemiology; Foundations; Future; Goals; Guidelines; HIV; HIV Seropositivity; HIV/TB; Health Services Accessibility; Health system; Healthcare; Immunosuppression; Incidence; International; Internist; Intervention; Knowledge; Laboratories; Lesotho; Malawi; Master' s Degree; Measures; Mental Depression; Mentored Research Scientist Development Award; Mentors; Mentorship; Modeling; Morbidity - disease rate; Opportunistic Infections; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Physicians; Policies; Population; Positioning Attribute; Preventive therapy; Prospective Studies; Psychosocial Factor; Public Health; Qualitative Methods; Regimen; Research; Research Personnel; Resource-limited setting; Resources; Risk; Risk Estimate; Risk Factors; Risk Reduction; Scientist; Statistical Data Interpretation; Subgroup; Supervision; Surveys; Tanzania; Technical Expertise; Testing; Time; Tuberculosis; Uganda; Validation; Viral; Work; World Health Organization; adverse outcome; age group; antiretroviral therapy; base; career; clinical implementation; cohort; comorbidity; data management; design; evidence base; experience; follow-up; health literacy; high risk; improved outcome; isoniazid; low and middle-income countries; mortality; mortality risk; pediatric human immunodeficiency virus; pediatrician; prospective; psychosocial; public health research; research study; risk stratification; screening; service delivery; skills; social stigma; therapy adherence; tool

SUMMARY STATEMENT The International Research Scientist Development Award affords an ideal mentorship opportunity to support the transition to independence of the candidate, an internist, pediatrician and pediatric infectious diseases physician with expertise caring for children and adults with HIV and tuberculosis (TB). The candidate’s long-term goal is to become an independent investigator, generating much needed evidence to inform child HIV and TB policy and practice. The candidate is based full-time in Eswatini and will work across the Baylor International Pediatric AIDS Initiative (BIPAI) network of clinics in Eswatini, Lesotho, Botswana, Malawi, Tanzania and Uganda to implement this multinational research study and accomplish the stated aims. The proposed research will guide implementation of differentiated service delivery for children and adolescents living with HIV (CALHIV) at both high and low risk of adverse HIV and HIV associated TB outcomes. Aim 1 will derive and validate a mortality clinical prediction tool for CALHIV to predict the risk of death 12 months after the initiation of antiretroviral therapy. This tool will be derived and validated using retrospective data from across the BIPAI network. Aim 2 of the proposal will develop a clinical prediction tool for viral non-suppression 12 months from study enrollment using prospectively collected clinical data and considering additional psychosocial variables, describing the myriad of factors impacting antiretroviral therapy adherence. Aim 3 will also harness the strength of the BIPAI network to retrospectively determine TB incidence and mortality rates in CALHIV associated with the different isoniazid preventive therapy (IPT) strategies implemented according to evolving national guidelines across the BIPAI network. This data is urgently needed to i) inform evidence-based implementation of IPT in children receiving antiretroviral therapy, and ii) design prospective studies of new shorter-course tuberculosis preventive therapy regimens. Complementing the described research, the candidate will take courses in data science, data management, epidemiology, and clinical informatics, culminating in a master’s degree in epidemiology. Further, the candidate will benefit from direct supervision and guidance from a strong mentorship team that will be led by Dr. Mandalakas and Dr. Chiao (co-primary mentors). Dr. Mandalakas has over two decades of experience mentoring young physician scientists in global child health research and Dr. Chiao is an internationally recognized expert in the epidemiology of HIV associated malignancies. Dr. Lukhele (LMIC mentor and Executive Director at the Baylor Children’s Foundation-Eswatini) has extensive experience implementing public health research in Eswatini. Dr. Kirchner (co-mentor) will supervise the statistical analysis employed in this proposal, Dr. Skinner (co-mentor) will guide qualitative methods, and Dr. Maldonado (co-mentor) will provide technical expertise gathered from a career devoted to pediatric HIV epidemiology.

摘要报表 国际研究科学家发展奖提供了一个理想的指导机会 支持候选人向独立的过渡，包括内科医生、儿科医生和儿科感染科医生 疾病医生，具有治疗儿童和成人艾滋病毒和结核病(TB)的专业知识。候选人的 长期目标是成为一名独立的调查者，产生急需的证据来告知儿童艾滋病毒 以及结核病政策和实践。候选人全职在埃斯瓦蒂尼工作，将在贝勒各地工作 国际儿科艾滋病倡议(BIPAI)在莱索托、博茨瓦纳、马拉维、埃斯瓦蒂尼的诊所网络 坦桑尼亚和乌干达执行这项多国研究研究并实现所述目标。 拟议的研究将指导为儿童实施差异化服务交付和 艾滋病毒携带者(CALHIV)的青少年，艾滋病毒和艾滋病毒相关结核病预后不良的高风险和低风险。 目标1将推导和验证CALHIV的死亡率临床预测工具，以预测12个月的死亡风险 在开始抗逆转录病毒治疗后。此工具将使用以下来源的追溯数据进行派生和验证 通过BIPAI网络。该提案的目标2将开发一种病毒非抑制的临床预测工具 从研究登记之日起12个月，使用预期收集的临床数据并考虑其他 心理社会变量，描述了影响抗逆转录病毒治疗依从性的无数因素。目标3将 还利用BIPAI网络的力量，追溯确定#年结核病发病率和死亡率 与不同的异烟肼预防治疗(IPT)策略相关的CALHIV 在整个BIPAI网络中不断演变的国家指南。这些数据是迫切需要的，以便i)提供基于证据的信息 在接受抗逆转录病毒治疗的儿童中实施IPT，以及ii)设计新的前瞻性研究 较短疗程的结核病预防治疗方案。 作为对上述研究的补充，候选人将选修数据科学、数据 管理学、流行病学和临床信息学，最终获得流行病学硕士学位。此外， 候选人将受益于一个强大的指导团队的直接监督和指导，该团队将由 曼达拉卡斯博士和焦立中博士(共同小学导师)。曼达拉卡斯博士有二十多年的经验 在全球儿童健康研究领域指导年轻的内科科学家，焦立中博士是一位国际 艾滋病毒相关恶性肿瘤流行病学方面的公认专家。Lukhele博士(LMIC导师兼高管 贝勒儿童基金会-埃斯瓦蒂尼主任)拥有丰富的实施公共卫生的经验 在埃斯瓦蒂尼的研究。基什内尔博士(共同导师)将监督这项提案中使用的统计分析， 斯金纳博士(共同导师)将指导定性方法，马尔多纳多博士(共同导师)将提供技术支持 从致力于儿科艾滋病毒流行病学的职业生涯中积累的专业知识。