Development of an Antiretroviral Therapy Adherence Measure for Pediatrics

描述（由申请人提供）：坚持抗逆转录病毒治疗（ART）是艾滋病毒管理的核心。在资源有限的环境中，没有行之有效的依从性措施存在。一个可靠、有效的测量工具将为这一弱势群体提供更高效、更有效的艾滋病毒护理。我的长期目标是作为一名临床医生兼科学家，在资源有限的情况下开发工具来改善儿科艾滋病毒护理系统。在短期内，我想把重点放在一种可靠、有效、具有成本效益的方法上，以衡量儿童坚持抗逆转录病毒治疗的情况，因为这是提供长期艾滋病毒管理的核心挑战。这项申请的目的是开发和测试一种可靠、有效的工具，以衡量肯尼亚西部0至14岁儿童的抗逆转录病毒治疗依从性。开发有效的依从性测量的基本原理是获得准确测量依从性的能力，测试干预措施以提高依从性，并评估治疗是否优化临床结果。这项工作将在美国与肯尼亚的长期伙伴关系——提供医疗保健学术模式（AMPATH）框架内进行。该方案在肯尼亚西部照顾80,000多名成人和儿童艾滋病毒感染者，其中包括2,800多名接受抗逆转录病毒治疗的儿童。我计划通过以下三个具体目标来实现本申请的研究目标：目标1：制定一份可靠、有效的综合儿科ART依从性测量问卷（CAMP - comprehensive ART Measure for Pediatrics）；目标2：开发一种可靠、有效、简短的儿童ART依从性测量工具（SF-CAMP），用于繁忙的临床护理环境中作为依从性筛查措施；目的5：评估肯尼亚西部AMPATH HIV临床护理系统中CAMP和SF-CAMP的现场准备情况、实施可行性和临床效用。我还建议开设一门培训、学习和指导课程，内容涉及国际环境下健康行为测量工具的设计和测试，使用心理测量分析来开发和验证临床工具，以及评估儿科艾滋病毒护理。研究工作与我的职业发展计划相结合，将使我成为一名独立的临床科学家，可以改善儿科HIV护理服务。公共卫生相关性：本研究的贡献有望成为在资源有限的情况下衡量儿童抗逆转录病毒治疗依从性的可靠、有效的工具。拟议的研究意义重大，因为我们必须准确地衡量依从性，以便为感染艾滋病毒的儿童提供长期临床管理，并找到有效的干预措施，防止病毒耐药性和不良后果。

DESCRIPTION (provided by applicant): Sustaining adherence to antiretroviral therapy (ART) is central to HIV management. For children in resource- limited settings, no well-validated measures of adherence exist. A reliable, valid measurement tool would provide more efficient, effective HIV care for this vulnerable population. My long-term goal is to work as a clinician-scientist who develops instruments to improve pediatric HIV care systems In resource-limited settings. In the near term, I want to focus on a reliable, valid, cost-effective way to measure children's ART adherence because this is central to the challenge of providing long-term HIV management. The objective of this application is to develop and test a reliable, valid instrument to measure pediatric ART adherence for children ages 0 to 14 years in western Kenya. The rationale for developing a validated adherence measure is to gain the ability to measure adherence accurately, test interventions to improve adherence, and assess if therapies optimize clinical outcomes. This work will be done within a long-standing US-Kenya partnership, the Academic Model for Providing Access to Healthcare (AMPATH). AMPATH cares for over 80,000 adult and pediatric HIV-infected patients in western Kenya, including over 2,800 children on ART. I plan to accomplish the research objective of this application by pursuing the following three specific aims: Aim 1: Develop a reliable, valid comprehensive pediatric ART adherence measurement questionnaire (CAMP - Comprehensive ART Measure for Pediatrics); Aim 2: Develop a reliable, valid, short-form version of the pediatric ART adherence measurement tool (SF-CAMP) for use as an adherence screening measure in busy clinical care environments; Aim S: Evaluate the field-readiness, implementation feasibility, and clinical utility of CAMP and SF-CAMP within the AMPATH HIV clinical care system in western Kenya. I also propose a course of training, study, and mentorship in the design and testing of health behavior measurement tools for International settings, the use of psychometric analyses to develop and validate clinical tools, and evaluation of pediatric HIV care. The combination of research work and my career development plan will enable me to become an independent clinician-scientist who can improve pediatric HIV care provision. PUBLIC HEALTH RELEVANCE: The contribution of this study is expected to be a reliable, valid instrument to measure pediatric ART adherence within a resource-limited setting. The proposed research is significant because we must measure adherence accurately to provide long-term clinical management for HIV-infected children and to find effective interventions to prevent viral resistance and poor outcomes.