Mentoring Patient Oriented Adherence Research in Uganda

指导乌干达以患者为导向的依从性研究

• 批准号: 8115077
• 负责人: DAVID Roy BANGSBERG
• 金额: $ 15.52万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-27 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8115077
• 关键词: Adherence; Advisory Committees; Africa South of the Sahara; African; Anti-Retroviral Agents; Award; Behavior Therapy; Behavioral; Behavioral Sciences; Communication; Country; Data; Dose; Drug Exposure; Drug resistance; Economics; Educational process of instructing; Electronics; Enrollment; Faculty; Failure; Future; Goals; Grant; HIV; HIV drug resistance; Health; Health Services Accessibility; Home environment; Hour; Individual; Interruption; Intervention; Interview; Link; Manuscripts; Marketing; Massachusetts; Mentors; Monitor; Patients; Postdoctoral Fellow; Prevention; Productivity; Research; Research Infrastructure; Research Methodology; Research Personnel; Resistance; Resources; Risk; Rural; Science; Students; System; Technology; Testing; Time; Treatment Failure; Treatment outcome; Uganda; United States National Institutes of Health; Universities; Validation; Viral; Viral Load result; Wireless Technology; Writing; antiretroviral therapy; base; behavioral/social science; career; cohort; cost; cost effective; design; efficacy testing; improved; non-nucleoside reverse transcriptase inhibitors; novel; novel strategies; patient oriented; patient oriented research; pill; prevent; programs; response; social; success; therapy adherence; tool; treatment adherence; treatment duration; treatment response; viral RNA

DESCRIPTION (provided by applicant): The overarching goal of this Mid-Career Investigator Award in HIV-related Patient-Oriented Research (K- 24) application is to make meaningful contributions to social and behavioral science research aimed at improving HIV treatment outcomes in sub-Saharan Africa. My specific goals are to 1) mentor students, post- doctoral fellows, and junior faculty in social-behavioral HIV research who will 2) conduct patient-based research to improve antiretroviral therapy adherence in a rural African setting. My mentoring activities will be primarily based at Mbarara University of Science and Technology (MUST) in Mbarara, Uganda, and Harvard University in Cambridge, Massachusetts. The mentoring program will leverage research and teaching infrastructure at these universities and will consist of direct one-on-one mentoring in the conduct of social-behavioral HIV research, as well as formal seminars on research methods, manuscript writing, and grant writing. A mentoring advisory committee will formally evaluate mentored junior investigators, on the basis of their productivity. The research program will test the feasibility of preventing antiretroviral therapy interruptions through novel real-time wireless adherence monitoring. This new direction is based on our finding that incomplete adherence, to the extent that it occurs in rural Uganda, is manifested as treatment interruptions due to structural and/or economic barriers to treatment access. We found that the duration of treatment interruption for patients on non-nucleoside reverse transcriptase inhibitor antiretroviral therapy is directly related to the risk of virologic rebound. While an interruption of 4 days poses little risk of virologic rebound, an interruption of 15 days poses a 50% risk of virologic rebound. These data suggest that there is a 3-5 day window to intervene after missed doses but before virologic failure. Because adherence is so closely associated with viral suppression, accurate adherence monitoring can provide a strategy to strategically limit viral RNA monitoring only to those patients at a defined risk for viral rebound. Novel wireless adherence monitoring tools combined with the well developed wireless communications network in many Sub-Saharan African countries creates the potential for a new paradigm of HIV treatment defined by strategic viral RNA monitoring and the proactive prevention rather than the reactive response to virologic failure.

描述（由申请人提供）：HIV相关患者导向研究（K- 24）中期职业研究者奖申请的总体目标是为旨在改善撒哈拉以南非洲HIV治疗结果的社会和行为科学研究做出有意义的贡献。我的具体目标是：1)指导学生、博士后研究员和从事艾滋病社会行为研究的初级教师，他们将开展以患者为基础的研究，以提高非洲农村地区抗逆转录病毒治疗的依从性。我的指导活动将主要在乌干达姆巴拉拉的姆巴拉拉科技大学（MUST）和马萨诸塞州剑桥的哈佛大学进行。该指导计划将利用这些大学的研究和教学基础设施，并将包括在艾滋病毒社会行为研究方面进行直接一对一的指导，以及关于研究方法、手稿写作和拨款撰写的正式研讨会。指导咨询委员会将根据他们的工作效率正式评估受指导的初级调查人员。该研究项目将测试通过新型实时无线依从性监测来预防抗逆转录病毒治疗中断的可行性。这个新方向是基于我们的发现，即在乌干达农村发生的不完全依从性表现为由于获得治疗的结构性和/或经济障碍而导致的治疗中断。我们发现，接受非核苷类逆转录酶抑制剂抗逆转录病毒治疗的患者治疗中断的时间与病毒学反弹的风险直接相关。中断4天病毒学反弹的风险很小，而中断15天病毒学反弹的风险为50%。这些数据表明，在错过剂量后，在病毒学失败之前，有3-5天的干预窗口期。由于依从性与病毒抑制密切相关，准确的依从性监测可以提供一种策略，将病毒RNA监测仅限于那些具有病毒反弹风险的患者。在许多撒哈拉以南非洲国家，新型无线依从性监测工具与发达的无线通信网络相结合，创造了一种新的艾滋病毒治疗模式的潜力，这种治疗模式由战略性病毒RNA监测和主动预防定义，而不是对病毒学失败作出反应性反应。