Development of an Antiretroviral Therapy Adherence Measure for Pediatrics

描述(由申请人提供)：持续坚持抗逆转录病毒疗法(ART)是艾滋病毒管理的核心。对于资源有限的儿童来说，没有经过充分验证的遵守措施。一种可靠、有效的测量工具将为这一弱势群体提供更高效、更有效的艾滋病毒护理。我的长期目标是成为一名临床科学家，在资源有限的情况下开发改进儿科艾滋病毒护理系统的仪器。在短期内，我想重点关注一种可靠、有效、具有成本效益的方法来衡量儿童对ART的坚持程度，因为这是提供长期艾滋病毒管理的挑战的核心。这项应用的目的是开发和测试一种可靠、有效的工具来测量肯尼亚西部0至14岁儿童的儿科ART依从性。开发有效的依从性测量的基本原理是获得准确测量依从性的能力，测试改善依从性的干预措施，并评估治疗是否优化了临床结果。这项工作将在美国-肯尼亚长期合作伙伴关系--提供获得医疗保健的学术模式(AMPATH)--范围内完成。AMPATH在肯尼亚西部为80,000多名成人和儿童艾滋病毒感染者提供护理，其中包括2,800多名接受抗逆转录病毒治疗的儿童。我计划通过追求以下三个具体目标来完成这项应用的研究目标：目的1：制定可靠、有效的综合儿科ART依从性测量问卷(CAMP-儿科综合ART测量)；目标2：开发可靠、有效、简短的儿科ART依从性测量工具(SF-CAMP)版本，用于繁忙的临床护理环境中的依从性筛查；目的S：评估CAMP和SF-cAMP在肯尼亚西部AMPATH HIV临床护理系统中的现场准备情况、实施可行性和临床实用性。我还建议开设一门培训、研究和指导课程，内容包括为国际环境设计和测试健康行为测量工具，使用心理测量学分析来开发和验证临床工具，以及评估儿科艾滋病毒护理。研究工作和我的职业发展计划相结合，将使我成为一名独立的临床医生兼科学家，能够改善儿科艾滋病毒护理服务。公共卫生相关性：这项研究的贡献有望成为在资源有限的情况下衡量儿科艺术依从性的可靠、有效的工具。拟议的研究具有重要意义，因为我们必须准确衡量依从性，以便为感染艾滋病毒的儿童提供长期临床管理，并找到有效的干预措施，以防止病毒耐药性和不良结局。

DESCRIPTION (provided by applicant): Sustaining adherence to antiretroviral therapy (ART) is central to HIV management. For children in resource- limited settings, no well-validated measures of adherence exist. A reliable, valid measurement tool would provide more efficient, effective HIV care for this vulnerable population. My long-term goal is to work as a clinician-scientist who develops instruments to improve pediatric HIV care systems In resource-limited settings. In the near term, I want to focus on a reliable, valid, cost-effective way to measure children's ART adherence because this is central to the challenge of providing long-term HIV management. The objective of this application is to develop and test a reliable, valid instrument to measure pediatric ART adherence for children ages 0 to 14 years in western Kenya. The rationale for developing a validated adherence measure is to gain the ability to measure adherence accurately, test interventions to improve adherence, and assess if therapies optimize clinical outcomes. This work will be done within a long-standing US-Kenya partnership, the Academic Model for Providing Access to Healthcare (AMPATH). AMPATH cares for over 80,000 adult and pediatric HIV-infected patients in western Kenya, including over 2,800 children on ART. I plan to accomplish the research objective of this application by pursuing the following three specific aims: Aim 1: Develop a reliable, valid comprehensive pediatric ART adherence measurement questionnaire (CAMP - Comprehensive ART Measure for Pediatrics); Aim 2: Develop a reliable, valid, short-form version of the pediatric ART adherence measurement tool (SF-CAMP) for use as an adherence screening measure in busy clinical care environments; Aim S: Evaluate the field-readiness, implementation feasibility, and clinical utility of CAMP and SF-CAMP within the AMPATH HIV clinical care system in western Kenya. I also propose a course of training, study, and mentorship in the design and testing of health behavior measurement tools for International settings, the use of psychometric analyses to develop and validate clinical tools, and evaluation of pediatric HIV care. The combination of research work and my career development plan will enable me to become an independent clinician-scientist who can improve pediatric HIV care provision. PUBLIC HEALTH RELEVANCE: The contribution of this study is expected to be a reliable, valid instrument to measure pediatric ART adherence within a resource-limited setting. The proposed research is significant because we must measure adherence accurately to provide long-term clinical management for HIV-infected children and to find effective interventions to prevent viral resistance and poor outcomes.