Improving the diagnosis and treatment of medication adherence problems in HIV

描述(由申请人提供)：威尔逊博士K24的续期建议建立在该奖项前6年取得的成功的强劲记录的基础上。自2003年开始他的K24课程以来，他已经指导了52个人，其中包括他目前正在指导的19个人。在此期间，他的导师创作了26篇第一作者发表的手稿和19篇第一作者的摘要。8名学员获得了K23的S奖，3名学员获得了R系列奖。塔夫茨医学中心和塔夫茨大学的研究环境非常有利于威尔逊博士以患者为导向的研究，并为受训者提供了几种不同的来源，截至2008年，还包括临床翻译科学奖(CTSA)。威尔逊博士是塔夫茨CTSA的联合主任，也是塔夫茨临床和翻译研究门户网站的主任，这意味着他的指导范围现在是大学范围内的。威尔逊博士和他的受训者以患者为中心的研究重点是艾滋病毒感染者的服药依从性问题。尽管艾滋病毒每天治疗一次，但对艾滋病毒抗逆转录病毒疗法(ART)依从性差显然仍然是全世界艾滋病毒护理提供者的一个问题。同样清楚的是，糖尿病和心血管疾病等非传染性共病在艾滋病毒携带者中越来越常见，针对这些其他疾病所需的药物使患者的坚持努力进一步复杂化。要想在这一重要的全球问题上取得进展，我们需要能够以低廉的成本快速识别存在依从性问题的患者，并针对患者的个人需求实施干预措施。也就是说，我们既需要更好的诊断，也需要更好的治疗。这项研究的长期目标是将对药物依从性问题的准确和及时诊断与针对患者和药物的定制治疗联系起来。K24的总体研究目标是完成一系列5个重要和新颖的目标，所有这些目标都集中在提高艾滋病毒患者药物依从性问题的诊断和治疗质量上。这本K24课程的总体指导目标是培养研究人员，他们不仅拥有开发、实施和发表假说驱动的、以患者为导向的研究的技能，而且了解将多方法、多学科方法引入临床和转化性研究问题的重要性。在他的指导中，威尔逊博士强调了根据感兴趣的问题的性质调整研究方法的重要性，即使这意味着学习新的方法或与熟悉这些方法的其他学科的其他人发展合作。这项拟议的研究与NIH的使命相关，因为它试图提高对患有普遍和严重但高度可治疗的慢性病患者的护理质量，并且因为从这项与艾滋病毒相关的工作中吸取的经验教训直接适用于患有其他慢性病的护理患者。 公共卫生相关性：改善慢性病患者的健康结果通常需要终生坚持有效的药物治疗，这是大多数患者感到困难的。在本K24中提出的以患者为中心的研究主要集中在改善艾滋病毒感染者的药物依从性问题的诊断和治疗上。此外，威尔逊博士将实施的指导计划将有助于培训下一代研究人员，以继续这项重要的多学科工作。虽然这本K24的重点是艾滋病毒，但从这项工作中吸取的经验教训直接适用于患有其他慢性病的护理患者。

DESCRIPTION (provided by applicant): This proposed renewal of Dr. Wilson's K24 builds on the strong record of success achieved during the first 6 years of this award. Since the start of his K24 in 2003 he has mentored 52 individuals, including 19 whom he is currently mentoring. During this time his mentees have produced 26 first author published manuscripts and 19 first author abstracts. Eight mentees have gone on to be awarded K23's, and 3 to receive R-series awards. The research environment at Tufts Medical Center and Tufts University is highly conducive Dr. Wilson's patient-oriented research and provides several different sources for mentees, and as of 2008 includes a Clinical Translational Science Award (CTSA). Dr. Wilson is Co-PI of the Tufts CTSA and a Director of the Tufts Clinical and Translational Research Portal, which means that the scope of his mentoring is now University wide. The patient oriented research of Dr. Wilson and his mentees focuses on problems with medication adherence in persons with HIV. Despite the availability of one pill once daily treatment for HIV, poor adherence with HIV antiretroviral therapy (ART) clearly continues to be a problem for HIV care providers worldwide. It is also clear that non-infectious comorbidity such as diabetes and cardiovascular disease is increasingly common in persons with HIV, and that medications required for these other conditions further complicate patients' adherence efforts. Progress on this important global problem requires that we be able to quickly and inexpensively identify patients with adherence problems, and that we have interventions to implement in response that target patients' individual needs. That is, we need to both better diagnosis and better treatment. The long term goal of this research is to link the accurate and timely diagnosis of medication adherence problems with customized treatments that are patient and medication specific. The overall research objective of this K24 is to complete a series of 5 significant and novel Aims, all of which focus on improving the quality of diagnosis and treatment of medication adherence problems in persons with HIV. The overall mentoring objective of this K24 is to develop researchers who not only have the skills to develop, implement, and publish hypothesis driven, patient-oriented research, but who understand the importance of bringing a multi-method, multi-disciplinary approach to clinical and translational research problems. In his mentoring Dr. Wilson emphasizes the importance of tailoring research methods to the nature of the problem of interest, even if that means learning new methods or developing collaborations with others from other disciplines familiar with those methods. The proposed research is relevant to the NIH's mission because it attempts to improve the quality of care for patients with a prevalent and serious, but highly treatable, chronic condition, and because the lessons learned from this HIV-related work are directly applicable to the care patients with other chronic conditions. PUBLIC HEALTH RELEVANCE: Improving the health outcomes of persons with chronic conditions generally requires lifelong adherence with effective medications, which most patients find difficult. The patient-oriented research proposed in this K24 focuses broadly on improving both the diagnosis and treatment of medication adherence problems in persons with HIV. In addition, the mentoring plan that Dr. Wilson will implement will contribute to the training of the next generation of researchers to continue this important multidisciplinary work. While this K24 focuses on HIV, the lessons learned from this work are directly applicable to the care patients with other chronic conditions.