Beyond Pill-Counting: Effect of Pharmacist Counseling on Antiretroviral Adherence

描述(由申请人提供)：这是对詹妮弗·科科霍巴博士的K23奖的重新提交，她是加州大学旧金山分校的艾滋病毒药剂师和临床副教授。在面向患者的研究中，科霍巴博士正在确立自己作为一名年轻研究员的地位。她对基于证据的方法感兴趣，通过这些方法，药剂师可以改善慢性病，特别是艾滋病毒患者的用药依从性。这一K23奖项将为Cocohoba博士提供必要的支持，以实现以下目标：(1)进行定量、定性和干预性研究，试图了解和衡量药剂师对抗逆转录病毒依从性的影响；(2)在临床研究中实施先进的生物统计学方法；(3)发展独立的、以患者为导向的研究用药依从性的临床研究生涯。为了实现这些目标，Cocohoba博士组建了一个指导团队，成员包括主要导师Ruth Greenblatt博士，女性机构间艾滋病毒研究旧金山站点的首席调查员，负责研究艾滋病毒对女性的影响；联合导师，加州大学旧金山分校艾滋病预防研究中心副教授Mallory Johnson博士，负责改善抗逆转录病毒依从性的干预研究；以及两名科学顾问：研究设计和最新生物统计学方法专家Peter Bacchetti博士和定性研究专家Megan Comfort博士。科霍巴博士的长期目标是提高药剂师在改善服药依从性方面的影响力。这一应用程序的目的是评估与接受药剂师依从咨询(目标1)相关的多种社会人口学和药房因素；了解药剂师-患者依从性咨询的动态(目标2)；并通过基于信息-动机-行为模型对药剂师提供的电话咨询干预进行试点研究，来衡量咨询对艾滋病毒治疗结果的影响。(目标3)。这项研究将形成一项随机干预试验的基础，该试验将在K奖结束前提交R01拨款申请。 公共卫生相关性：迫切需要开发利用新的人力和物力资源的简单方法，以提高对抗逆转录病毒治疗的依从性。药剂师仍然是艾滋病毒治疗宣传的一个巨大的、尚未开发的资源。聘请药剂师就依从性进行有效的咨询，可能会提高艾滋病毒的治疗效果，减少艾滋病毒的耐药性和传播。

DESCRIPTION (provided by applicant): This is a resubmission for a K23 award for Dr. Jennifer Cocohoba, an HIV Pharmacist and Associate Clinical Professor at the University of California, San Francisco. Dr. Cocohoba is establishing herself as a young investigator in patient-oriented research. She is interested in evidenced-based methods by which pharmacists can improve medication adherence for chronic diseases, particularly for patients with HIV. This K23 award will provide Dr. Cocohoba with the necessary support to accomplish the following goals: (1) to conduct quantitative, qualitative, and interventional studies that seek to understand and measure the impact pharmacists have on antiretroviral adherence; (2) to implement advanced biostatistical methods in clinical studies; and (3) to develop an independent, patient-oriented, clinical research career studying medication adherence. To achieve these goals, Dr. Cocohoba has assembled a mentoring team comprised of a primary mentor, Dr. Ruth Greenblatt, principal investigator of the San Francisco site of the Women's Interagency HIV Study, who conducts research on the effects of HIV on women; a co-mentor, Dr. Mallory Johnson, Associate Professor at the UCSF Center for AIDS Prevention Studies who conducts interventional studies to improve antiretroviral adherence; and two scientific advisors: Dr. Peter Bacchetti, an expert on study design and state- of-the-art biostatistical methods, and Dr. Megan Comfort, an expert in qualitative research. Dr. Cocohoba's long-term goal is to enhance the impact pharmacists have on improving adherence to medications. The objective of this application is to assess the multiple sociodemographic and pharmacy factors associated with receipt of pharmacist adherence counseling (Aim 1); to understand the pharmacist- patient adherence counseling dynamic (Aim 2); and to measure the impact counseling has on HIV treatment outcomes by conducting a pilot study of a pharmacist-delivered, telephone counseling intervention based on the Information-Motivation-Behavior model. (Aim 3). This research will form the basis of a randomized interventional trial that will be submitted in an R01 grant application before the end of the K award. PUBLIC HEALTH RELEVANCE: There is a critical need to develop simple methods that utilize novel human and physical resources to improve adherence to antiretroviral therapy. Pharmacists remain a large, untapped resource for HIV treatment advocacy. Engaging pharmacists to effectively counsel on adherence may result in an improvement in HIV treatment effectiveness and reduction in HIV viral resistance and transmission.