Improving Measurement of Antiretroviral Adherence in Current and Former Drug User

改进当前和前吸毒者抗逆转录病毒依从性的测量

• 批准号: 7167571
• 负责人: KARINA M BERG
• 金额: $ 15.19万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-15 至 2010-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7167571
• 关键词: clinical research; gold; measurement; model

DESCRIPTION (provided by applicant): HIV-infected current and former drug users have received disproportionately less benefit from antiretroviral therapy than non-drug users, in part because of sub-optimal adherence. Despite the clinical importance of adherence assessments and a large body of recent literature on antiretroviral adherence, there is no single adherence measure that is universally accepted in clinical or research settings. The lack of methodogical rigor in adherence measurement is particularly significant in intervention trials and may lead investigators to draw erroneous conclusions. Composite adherence measures may become the gold standard for assessing the complex and dynamic behavior of medication adherence in research studies, but such measures are only beginning to be evaluated. In clinical settings, imprecise adherence estimates can result in inaccurate targeting of interventions and poor clinical outcomes. Self-report is the most feasible, flexible, and widely used measure, but the relative validity of different self-report measures is unknown. To address these issues, I propose to study adherence measurement in current and former drug users. The specific aims of this proposal are: (1) to develop a composite antiretroviral adherence measurement model that incorporates four methods of measurement (self-report, pill count, pharmacy refill records, and MEMS), and to compare the correlation with HIV viral load of the composite model with the correlation of each single method; (2) to examine the agreement between common antiretroviral adherence self-report measures, and to determine the validity of each measure by assessing its correlation with a new adherence measurement gold standard (composite antiretroviral adherence model) and an adherence surrogate (HIV viral load); and (3) to describe the cognitive processes undertaken by current and former drug users to answer self-report antiretroviral adherence questions, including question interpretation, ability to remember medication taking, and answer editing. My major goal is to become an independent clinical investigator with expertise in behavioral substance abuse research. The career development plan I have proposed includes mentorship in antiretroviral adherence, behavioral research methods, and substance abuse research, coupled with formal coursework and participation in local interactive seminars and national scientific meetings.

描述（由申请人提供）：感染艾滋病毒的现任和前任吸毒者从抗逆转录病毒治疗中获得的益处比非吸毒者少得多，部分原因是依从性不佳。尽管依从性评估具有临床重要性，并且最近有大量关于抗逆转录病毒治疗依从性的文献，但没有一种单一的依从性测量方法在临床或研究环境中得到普遍接受。依从性测量缺乏方法严谨性在干预试验中尤其重要，可能导致研究人员得出错误的结论。综合依从性测量可能成为评估研究中复杂且动态的药物依从性行为的黄金标准，但此类测量才刚刚开始评估。在临床环境中，不精确的依从性估计可能会导致干预措施目标不准确和临床结果不佳。自我报告是最可行、最灵活、应用最广泛的措施，但不同自我报告措施的相对有效性尚不清楚。为了解决这些问题，我建议研究当前和以前吸毒者的依从性测量。该提案的具体目标是：（1）开发一种综合抗逆转录病毒依从性测量模型，包含四种测量方法（自我报告、药丸计数、药房续药记录和MEMS），并将复合模型与HIV病毒载量的相关性与每种单一方法的相关性进行比较； (2) 检查常见的抗逆转录病毒依从性自我报告测量之间的一致性，并通过评估其与新的依从性测量金标准（复合抗逆转录病毒依从性模型）和依从性替代指标（HIV病毒载量）的相关性来确定每项测量的有效性； (3) 描述当前和以前的吸毒者在回答自我报告的抗逆转录病毒依从性问题时所采取的认知过程，包括问题解释、记住服药的能力和答案编辑。我的主要目标是成为一名独立的临床研究者，具有行为药物滥用研究的专业知识。我提出的职业发展计划包括抗逆转录病毒治疗依从性、行为研究方法和药物滥用研究方面的指导，以及正式课程和参加当地互动研​​讨会和国家科学会议。