Novel Measures and Theory of Pediatric Antiretroviral Therapy Adherence in Uganda

乌干达儿童抗逆转录病毒治疗依从性的新措施和理论

• 批准号: 8496118
• 负责人: Jessica Elizabeth Haberer
• 金额: $ 18.31万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8496118
• 关键词: 5 year old; AIDS/HIV problem; Address; Adherence; Adult; Affect; African; Age; Area; Award; Behavior; Behavior Therapy; Behavioral Sciences; Caregivers; Caring; Cellular Phone; Child; Child Development; Child Mental Health; Childhood; China; Clinical; Data; Data Collection; Devices; Dose; Drug resistance; Electronics; Ethnography; Face; Failure; Foundations; Funding; Future; General Hospitals; Genotype; Goals; Grant; HIV; Health; Health Services Research; Home environment; Hour; Individual; Instruction; International; Intervention; Interview; Intuition; K-Series Research Career Programs; Life; Liquid substance; Massachusetts; Master' s Degree; Measurement; Measures; Mental Health; Mentors; Mentorship; Methods; Modeling; Monitor; Nigeria; Outcome; Patient Self-Report; Patients; Performance; Pharmaceutical Preparations; Pharmacy facility; Population; Population Research; Prevention; Principal Investigator; Questionnaires; RNA; Records; Regimen; Reporting; Research; Research Personnel; Resources; Risk; School-Age Population; Social Responsibility; System; Tanzania; Testing; Theoretical model; Time; Training; Transportation; Treatment Failure; Treatment outcome; Uganda; Viral; Viral Load result; Voice; Weight; Weights and Measures; Wireless Technology; Work; antiretroviral therapy; base; career; cohort; experience; high risk; improved; liquid formulation; monitoring device; novel; physical conditioning; pill; prevent; response; skills; social capital; success; theories; therapy adherence

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 same 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 interventions 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.

项目摘要（请参阅说明）： 在资源有限的设置中，感染HIV的儿童并不能可靠地实现高水平的依从性 在相同情况下在成年人中看到的抗逆转录病毒疗法（ART），因此代表了优先人群 进行研究。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 可行的客观措施。此外，现有的依从性措施无法检测到依从性的失误 并提供机会在病毒衰竭之前提高依从性。新颖的依从性监测策略 需要在资源有限的设置中更好地理解和干预儿科艺术依从性。在 这项为期五年的K23职业发展奖申请申请，我建议获取解决问题所需的技能 这些问题并实现我的长期职业目标，以改善儿科艺术的依从性和治疗 资源有限设置中的结果。我对小儿艾滋病毒/艾滋病治疗有很好的了解 通过我在中国克林顿基金会的先前工作来照顾。我还拥有健康硕士学位 服务研究和AS是一项正在进行的R21多种艺术测量的R21研究的主要研究者 乌干达儿童的遵守。但是，我需要更好地了解定量分析的 遵守措施，新颖的依从性测量，儿童发展和心理健康以及混合 方法分析以开发和测试新的行为干预措施以改善小儿艺术依从性。我 已经确定戴维·班斯伯格博士为我的主要导师。他是依从性的国际专家 研究并具有出色的指导记录。 Julius Kiwanuka博士和Steve Safren博士将 在小儿艾滋病毒/艾滋病治疗和护理和行为科学领域担任联合官员， 分别。使用这些技能，我建议1）检查新型依从性措施的表现 基于乌干达5岁以下艾滋病毒感染儿童的护理人员的无线技术； 2） 对这些新型依从性措施的可行性和可接受性进行混合方法评估； 3）建立一种基于社会资本的艺术依从性行为的理论模型 资源有限的设置。该模型可能适合幼儿，因为他们的依从性很大 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 并成为成功的独立研究人员所必需的经验。奖项结束时 时期，我将提交ROI申请，以测试基于无线技术和 理论模型可以改善乌干达儿童的HIV感染儿童的依从性和病毒抑制。

项目成果

High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya.

• DOI: 10.1007/s10461-012-0317-8
• 发表时间: 2013-07
• 期刊: AIDS AND BEHAVIOR
• 影响因子: 4.4
• 作者: Van der Elst, Elisabeth Maria;Mbogua, Judie;Operario, Don;Mutua, Gaudensia;Kuo, Caroline;Mugo, Peter;Kanungi, Jennifer;Singh, Sagri;Haberer, Jessica;Priddy, Frances;Sanders, Eduard Joachim
• 通讯作者: Sanders, Eduard Joachim

Antiretroviral prophylaxis for HIV prevention in heterosexual men and women.

• DOI: 10.1056/nejmoa1108524
• 发表时间: 2012-08-02
• 期刊: The New England journal of medicine
• 作者: Baeten JM;Donnell D;Ndase P;Mugo NR;Campbell JD;Wangisi J;Tappero JW;Bukusi EA;Cohen CR;Katabira E;Ronald A;Tumwesigye E;Were E;Fife KH;Kiarie J;Farquhar C;John-Stewart G;Kakia A;Odoyo J;Mucunguzi A;Nakku-Joloba E;Twesigye R;Ngure K;Apaka C;Tamooh H;Gabona F;Mujugira A;Panteleeff D;Thomas KK;Kidoguchi L;Krows M;Revall J;Morrison S;Haugen H;Emmanuel-Ogier M;Ondrejcek L;Coombs RW;Frenkel L;Hendrix C;Bumpus NN;Bangsberg D;Haberer JE;Stevens WS;Lingappa JR;Celum C;Partners PrEP Study Team
• 通讯作者: Partners PrEP Study Team

Caregiver perceptions and motivation for disclosing or concealing the diagnosis of HIV infection to children receiving HIV care in Mbarara, Uganda: a qualitative study.

• DOI: 10.1371/journal.pone.0093276
• 发表时间: 2014
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Kiwanuka J;Mulogo E;Haberer JE
• 通讯作者: Haberer JE

Excellent adherence to antiretrovirals in HIV+ Zambian children is compromised by disrupted routine, HIV nondisclosure, and paradoxical income effects.

• DOI: 10.1371/journal.pone.0018505
• 发表时间: 2011-04-21
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Haberer JE;Cook A;Walker AS;Ngambi M;Ferrier A;Mulenga V;Kityo C;Thomason M;Kabamba D;Chintu C;Gibb DM;Bangsberg DR
• 通讯作者: Bangsberg DR

Explaining antiretroviral therapy adherence success among HIV-infected children in rural Uganda: a qualitative study.

• DOI: 10.1007/s10461-014-0924-7
• 发表时间: 2015-04
• 期刊: AIDS AND BEHAVIOR
• 影响因子: 4.4
• 作者: Olds, Peter K.;Kiwanuka, Julius P.;Ware, Norma C.;Tsai, Alexander C.;Haberer, Jessica E.
• 通讯作者: Haberer, Jessica E.