Targeted Monitoring and Determinants of Adherence in Adolescents with HIV

该K23职业发展奖的候选人旨在成为一名独立的调查员，其工作将导致成功的干预措施，以促进艾滋病毒感染（HIV+）青少年的依从性，特别是在资源有限的环境中。与成人和幼儿相比，艾滋病毒阳性青少年对抗逆转录病毒治疗的依从性较差。这在撒哈拉以南非洲至关重要，那里生活着大约90%的艾滋病毒感染青年，治疗选择有限。对于艾滋病毒阳性青少年，依从性差通常是他们长期治疗成功的最大障碍。此外，低成本的监测策略，如患者自我报告往往是不太可靠的青少年。拟议的研究将确定是否简单地评估青少年的特点，可以用来针对个别青少年的低成本的依从性监测策略的选择。它还将阐明关键的潜在可变风险因素对青少年治疗依从性的影响，展示未来干预性研究的目标，以支持资源有限环境中青少年的依从性。该奖项的候选人在资源有限的环境中的儿科和青少年治疗方面有很强的背景，曾在博茨瓦纳全职工作4年，担任博茨瓦纳贝勒儿童临床卓越中心（COE）的副主任。该中心为2000多名艾滋病毒阳性儿童和青少年提供了护理和治疗，是K23研究的研究地点。除了她在资源有限的环境中的儿科和青少年艾滋病毒护理方面的丰富经验外，该奖项的候选人还接受了临床流行病学培训，并且是CDC公共卫生有效性补助金的PI，该补助金评估了资源有限环境中青少年坚持的其他方面。候选人的主要导师是罗伯特·格罗斯博士。格罗斯博士是艾滋病毒依从性研究方面的国际专家，并拥有出色的指导记录。Steven Feierman博士、Karen Glanz博士、Wei-Ting Hwang博士和Seibourg Mphele博士将分别担任医学人类学、健康行为学、生物统计学和临床心理学领域的共同导师。拟议的培训和指导将为候选人提供必要的技能和经验，以支持她成为一名成功的独立研究人员。K23研究和培训计划将把她的专业知识扩展到行为理论，测试构建和验证，定性和纵向分析以及国际研究伦理等领域。 公共卫生相关性：拟议的研究可能会提高青少年依从性监测的准确性，并导致青少年依从性支持的进步，特别是在资源有限的环境中。这将有助于改善青少年艾滋病毒治疗结果，并限制耐药病毒的传播。

DESCRIPTION (provided by applicant): The candidate for this K23 Career Development Award aims to become an independent investigator whose work will lead to successful interventions to promote adherence among HIV-infected (HIV+) adolescents, particularly in resource-limited settings. HIV+ adolescents have poor adherence to antiretroviral therapy relative to both adults and younger children. This is of paramount importance in sub-Saharan Africa where about 90% of HIV-infected youth live and where treatment options are limited. For HIV+ adolescents, poor adherence is commonly their greatest barrier to long-term treatment success. In addition, low-cost monitoring strategies such as patient self-report are often less reliable in adolescents. The proposed research will determine whether simply assessed adolescent characteristics can be used to target the choice of low-cost adherence monitoring strategies for individual adolescents. It will also clarify the impact of key potentially modifiabl risk factors on treatment adherence in adolescents, demonstrating targets for future interventional studies to support adherence among adolescents in resource-limited settings. The candidate for this award has a strong background in pediatric and adolescent treatment in resource-limited settings, having worked full-time in Botswana for 4 years as the Associate Director of the Botswana-Baylor Children's Clinical Centre of Excellence (COE). The COE has provided care and treatment to over 2000 HIV+ children and adolescents and is the study site for the K23 research. In addition to her extensive experience in pediatric and adolescent HIV care in resource-limited settings, the candidate for this award has undergone training in clinical epidemiology and is the PI for a CDC Public Health Effectiveness Grant evaluating other aspects of adherence among adolescents in a resource-limited setting. The candidate's primary mentor is Dr. Robert Gross. Dr. Gross is an international expert in HIV adherence research and has an outstanding track record of mentorship. Drs. Steven Feierman, Karen Glanz, Wei-Ting Hwang and Seipone Mphele will serve as co-mentors in the areas of medical anthropology, health behavior, biostatistics, and clinical psychology, respectively. The proposed training and mentorship will provide the candidate with the skills and experience necessary to support her development as a successful independent researcher. The K23 research and training plan will expand her expertise into the areas of behavioral theory, test construction and validation, qualitative and longitudinal analyses, and international research ethics. PUBLIC HEALTH RELEVANCE: The proposed research is likely to improve the accuracy of adherence monitoring for adolescents and to lead to advancements in adolescent adherence support, particularly for resource-limited settings. This will help to improve adolescent HIV treatment outcomes and limit the spread of resistant virus.