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: 8259204
• 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/8259204
• 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）：这项艾滋病毒相关的以患者为导向的研究（K- 24）应用的中期职业研究者奖的总体目标是为旨在改善艾滋病毒治疗结果的社会和行为科学研究做出有意义的贡献在撒哈拉以南非洲。我的具体目标是1）指导学生，博士后研究员，以及社会行为HIV研究的初级教师，他们将2）进行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。指导计划将利用这些大学的研究和教学基础设施，包括在社会行为艾滋病毒研究中进行直接一对一的指导，以及关于研究方法，手稿写作和赠款写作的正式研讨会。一个指导咨询委员会将根据初级调查员的工作效率，对接受指导的初级调查员进行正式评价。该研究计划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。这一新的方向是基于我们的发现，即不完全遵守，在某种程度上，它发生在乌干达农村，表现为治疗中断，由于结构和/或经济障碍，治疗的机会。我们发现，非核苷类逆转录酶抑制剂抗逆转录病毒治疗患者的治疗中断时间与病毒学反弹的风险直接相关。虽然中断4天几乎没有病毒学反弹的风险，但中断15天会造成50%的病毒学反弹风险。这些数据表明，在漏服剂量后但在病毒学失败前有3-5天的干预窗口。由于依从性与病毒抑制密切相关，因此准确的依从性监测可以提供一种策略，仅将病毒RNA监测策略性地限制在病毒反弹风险确定的患者中。新的无线依从性监测工具与许多撒哈拉以南非洲国家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，这种模式由战略性病毒RNA监测和主动预防而不是对病毒学失败的反应性反应定义。