DOT-HARRT for HIV-Infected South African Adults

联合抗逆转录病毒疗法（ART）时代的早期， in the incidence发病率and mortality死亡associated关联with HIV HIV感染in industrialized工业化countries国家and recently最近， 国际和地方倡议使发展中国家能够获得高效抗逆转录病毒疗法。的初步数据 我以前的工作和其他人的工作表明，在资源有限的情况下，良好的坚持是可行的，但它是 目前尚不清楚这些结果是否可在规模化的ART项目中重现，以及可能的干预措施 在这种情况下，有效地最大限度地提高依从性。同伴倡导者被用来改善 在各种环境中坚持医学治疗。为了研究peer的潜在效用， 在南非的倡导者，我建议进行一项随机试验，其中300名患者将被分配到 无论是同行DOT-HAART或自我管理的司他夫定，拉米夫定和 依法韦仑24个月。本研究的具体目的是：1）评估同伴DOT HAART的影响 通过病毒载量和CD 4 T细胞计数测量的病毒负荷控制和免疫恢复; 2） 评价DOT-HAART对治疗依从性的影响; 3）确定 基因型HAART耐药在同行DOT与自我管理HAART武器; 4）比较， 新的或复发的机会性感染的发病率在同行DOT与自我管理的HAART。我 一个假设是，对等DOT-HAART组的患者将具有高水平的治疗依从性， 因此更有效地控制病毒负荷，从而限制病毒学失败的可能性，药物 抵抗力和疾病进展。这项研究将产生一个替代社区的关键数据- 提供HAART的一种基于基础的方法，可能成为整个撒哈拉以南非洲的护理标准 和发展中国家。我的职业发展计划是基于研究生培训计划， 包括约翰霍普金斯大学和开普敦大学的综合课程， 结构化的指导和论文委员会的指导。我的职业规划和研究计划是 这与我成为一名有效的独立调查员的长期目标一致， 撒哈拉以南非洲艾滋病毒感染者的治疗结果。

The early years of the combination antiretroviral therapy (ART) era have brought about dramatic reductions in the morbidity and mortality associatedwith HIV infection in industrialized countries and recently, international and local initiative have allow access to HAART in the developing world. Preliminary data from my prior work and other have shown that good adherence is feasible in resource-limited settings, but it is unclear whether these results are reproducible in scaled ART programs and what interventions would likely be effective at maximizing adherence in such settings. Peer advocates have been used to improve adherence with medical therapies in a variety of settings. In order to investigate the potential utility of peer- advocates in South Africa, I propose to conduct a randomized trial in which 300 patients will be assigned to either peer-DOT-HAART or self-administration of a twice daily combination of Stavudine, Lamivudine and Efavirenz for 24 months. The specific aims of this study are: 1) to evaluate the impact of peer-DOT HAART on control of viral burden and immune restoration as measured by viral load and CD4 T cell counts; 2) to evaluate the impact of DOT-HAART on treatment adherence; 3) the determination the proportion of genotypic HAART resistance in the peer-DOT vs. self-administered HAART arms; 4) to compare the incidence of new or recurrent opportunistic infection in the peer-DOT vs. self-administered HAART. My hypothesis is that the patients in the peer-DOT-HAART arm will have high levels of treatment adherence and hence more effective in controlling viral burden, thereby limiting the likelihood of virologic failure, drug resistance, and disease progression. This study will generate critical data on an alternative community- based approach of delivering HAART which may become a standard of care throughout sub-Saharan Africa and the developing world. My career development plan is based on a post-graduate training program, which includes comprehensive coursework at the Johns Hopkins University and University of Cape Town, structured mentoring, and guidance from a thesis committee. My career plan and research proposal are consistent with my long-term goals of becoming an effective independent investigator, and optimizing treatment outcomes in HIV-infected in sub-Saharan Africa.