Novel Measures and Theory of Pediatric Antiretroviral Therapy Adherence in Uganda

项目总结(见说明)： 在资源有限的环境中，感染艾滋病毒的儿童不能可靠地实现对 抗逆转录病毒疗法(ART)见于桑那地区的成人，因此代表了优先人群 用于研究。儿童的艺术依从性评估因自我报告和缺席的限制而变得复杂 切实可行的客观措施。此外，现有的遵守措施没有检测到遵守失效 并提供在病毒学失败之前提高依从性的机会。新的遵从性监测策略 在资源有限的情况下，需要更好地理解和干预儿科ART的坚持。在……里面 这个为期五年的K23职业发展奖申请，我建议获得所需的技能，以解决 为了实现我长期的职业目标，提高儿科ART的依从性和治疗水平 在资源有限的情况下取得的成果。我对儿科艾滋病毒/艾滋病的治疗有很好的了解 通过我之前在中国克林顿基金会的工作，我得到了关怀。我还有一个健康硕士学位 服务研究，我是正在进行的多项ART测量的R21研究的首席研究员 乌干达儿童的坚持。然而，我需要更好地理解定量分析，以便 遵守措施，新的遵守措施，儿童发展和心理健康，以及混合- 方法分析开发和测试新的行为干预措施，以提高儿科ART的依从性。我 大卫·邦斯伯格博士是我的主要导师。他是一位国际坚守方面的专家 从事研究，并有出色的导师记录。朱利叶斯·基瓦努卡博士和史蒂夫·萨夫伦博士将 在儿科艾滋病毒/艾滋病治疗和护理以及行为科学领域担任共同导师， 分别进行了分析。使用这些技巧，我建议1)检查新的遵守措施的表现 基于乌干达五岁以下艾滋病毒感染儿童照顾者的无线技术；2) 对这些新的遵守措施的可行性和可接受性进行混合方法评估； 3)构建了基于社会资本的幼儿艺术依附行为理论模型 资源有限的设置。这种模式可能适合幼儿，因为他们在很大程度上遵守了 反映了他们的照顾者的行为。拟议的培训和指导将为我提供技能 以及成为一名成功的独立研究人员所必需的经验。颁奖临近尾声 在此期间，我将提交投资回报申请，以测试基于无线技术和 可能改善感染艾滋病毒的乌干达儿童的依从性和病毒抑制的理论模型。

PROJECT SUMMARY (See instructions): HIV-infected children in resource-limited settings do not reliably achieve the high levels of adherence to antiretroviral therapy (ART) seen in adults in the sanne setting and therefore represent a priority population for research. ART adherence assessment in children is complicated by limitations in self-report and absence of feasible objective measures. Moreover, existing adherence measures do not detect adherence lapses and offer opportunities to improve adherence before virologic failure. Novel adherence monitoring strategies are needed to better understand and intervene on pediatric ART adherence in resource-limited settings. In this five-year K23 career development award application, I propose to acquire the skills needed to address these issues and to achieve my long-term career goal of improving pediatric ART adherence and treatment outcomes in resource-limited settings. I have a good understanding of pediatric HIV/AIDS treatment and care through my prior work with the Clinton Foundation in China. I also have a master's degree in Health Services Research and am the principal investigator of an ongoing R21 study of multiple measures of ART adherence in Ugandan children. I, however, need a better understanding of quantitative analysis for adherence measures, novel adherence measurements, child development and mental health, and mixed- methods analysis to develop and test novel behavioral intervenfions to improve pediatric ART adherence. I have identified Dr. David Bangsberg as my primary mentor. He is an international expert in adherence research and has an outstanding track record of mentorship. Dr. Julius Kiwanuka and Dr. Steve Safren will serve as co-mentors in the areas of pediatric HIV/AIDS treatment and care and behavioral science, respectively. Using these skills, I propose to 1) examine the performance of novel adherence measures based on wireless technology among caregivers of HIV-infected children under age five in Uganda; 2) perform mixed method assessments of the feasibility and acceptability of these novel adherence measures; and 3) develop a theoretic model for ART adherence behavior based on social capital for young children in a resource-limited setting. This model may be appropriate for young children, because their adherence largely reflects the behavior of their caregivers. The proposed training and mentorship will provide me with the skills and experience necessary to become a successful independent researcher. Toward the end of the award period, I will submit an ROI application to test an intervention based on wireless technology and the theoretic model that may improve adherence and viral suppression among HIV-infected Ugandan children.