Improving identification of HIV-associated neurocognitive disorder (HAND) in Latin America: A multimodal approach to HAND in Peru

改善拉丁美洲 HIV 相关神经认知障碍 (HAND) 的识别：秘鲁针对 HAND 的多模式方法

• 批准号: 10548528
• 负责人: Monica Maria Diaz
• 金额: $ 19.86万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10548528
• 关键词: AIDS prevention; Affect; Age; Alzheimer disease screening; Alzheimer' s Disease; Anxiety; Area; Behavioral; Biometry; Chronic; Clinic; Clinical; Clinical Assessment Tool; Clinical Research; Cognition Disorders; Cognitive; Country; Data; Development; Diagnosis; Diagnostic; Early Intervention; Early identification; Elderly; Environment; Financial Hardship; Focus Groups; Frequencies; Future; Gardenal; Goals; Grant; HIV; HIV Seronegativity; HIV diagnosis; HIV-associated neurocognitive disorder; Hour; Impaired cognition; Individual; Infection; International; Interview; Latin America; Latino Population; Medical; Mental Depression; Mental Health; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methodology; Methods; Morbidity - disease rate; Neurologist; Neuropsychological Tests; Neuropsychology; North Carolina; Nurses; Outcome; Paper; Patients; Persons; Peru; Peruvian; Physicians; Pilot Projects; Play; Poverty; Predictive Factor; Prospective Studies; Prospective cohort; Protocols documentation; Qualitative Methods; Qualitative Research; Reporting; Research; Research Methodology; Research Personnel; Resources; Risk; Risk Factors; Role; Scientist; Screening procedure; Sex Education; Site; Specialist; Specificity; Statistical Models; Syphilis; Tablets; Testing; Time; Training; Tuberculosis; Underserved Population; United States National Institutes of Health; Universities; Validation; Work; antiretroviral therapy; base; bilingualism; brain health; care providers; career development; cognitive development; cognitive performance; cognitive testing; design; diagnostic accuracy; diagnostic tool; disorder risk; experience; flexibility; health literacy; implementation framework; implementation science; improved; low and middle-income countries; medical schools; modifiable risk; multidisciplinary; multimodality; neurocognitive disorder; novel; patient oriented; predictive modeling; screening; skills; social determinants; social health determinants; socioeconomic disparity; socioeconomics; systematic review; tool

PROJECT SUMMARY This is an application for a K23 award for Dr. Monica M. Diaz, a neurologist at the University of North Carolina at Chapel Hill School of Medicine. Dr. Diaz is establishing herself as an investigator in patient-oriented clinical research at the intersect of brain health and HIV in Latin America. Dr. Diaz has been based at least half- time in Peru since 2019 where she developed a mentored pilot study assessing HIV-associated neurocognitive disorder (HAND) in older people living with HIV in Peru. The K23 award will provide Dr. Diaz with the necessary support to develop expertise in 5 key areas: 1) Qualitative research methods and analysis, 2) clinical tool validation in international settings, 3) neuropsychological assessments, 4) advanced biostatistical skills, 5) implementation science frameworks and methodology. Dr. Diaz has assembled a team of core mentors (Dr. Gwenn Garden [expert in neurocognitive disorder assessments], Dr. Victor Valcour [expert in international assessments of HAND] and Dr. Clare Barrington [mixed-methods/qualitative research expertise in Latin America] who will guide Dr. Diaz in achieving her training goals and career development. Supporting Dr. Diaz and her core mentors are three collaborators: Dr. Maria Marquine (neuropsychologist with expertise in HAND in Latinos), Dr. Michael Hudgens (biostatistician with expertise in HIV observational data) and Dr. Patricia Garcia (implementation science expert on HIV in Peru). This multi-disciplinary mentorship team embedded within a highly collaborative training environment is crucial for Dr. Diaz’s development into an independent investigator with the goal of optimizing diagnostics and treatments for brain health in people with HIV in Latin America. HAND is a pressing issue in low-and-middle-income countries with increasing access to antiretroviral therapy, highlighting the urgent need to optimize diagnostics and prediction of HAND for early interventions. Dr. Diaz’s research plan outlined in this application leverages pilot data that demonstrated that nearly 30% of people living with HIV in Lima had HAND, yet diagnostics for HAND are limited in Latin America given a lack of regional normative data and experts in neuropsychological testing. The proposed research includes a prospective cohort of patients with HIV and HIV-negative controls from two socioeconomically-distinct HIV clinics in Lima. The study seeks to adapt and validate a tablet-based cognitive screening tool currently optimized for early Alzheimer’s screening to detect HAND in Peru (Aim 1). Known modifiable risk factors for cognitive impairment, including social determinants of health, will be used to build a predictive statistical model for HAND in Peru that can identify intervenable factors (Aim 2). These two tools will be implemented, evaluated and optimized through iterative rounds of interviewing with HIV care providers (Aim 3). This K23 award will provide Dr. Diaz with the mentorship and expertise necessary to become an independent investigator to improve brain health of underserved populations with HIV in Latin America. This proposal is a crucial step toward developing a large prospective study identifying frequency and risk factors for HAND in Latin America as a future R01 grant.

项目总结 这是诺斯大学神经学家莫妮卡·M·迪亚兹博士的K23奖项申请书 卡罗莱纳在教堂山医学院。迪亚兹医生正在确立自己作为一名以病人为本的研究人员的地位 拉丁美洲脑健康与艾滋病毒交叉点的临床研究。迪亚兹博士至少有一半是基于- 自2019年以来一直在秘鲁，在那里她开发了一项评估艾滋病毒相关神经认知的指导性试点研究 秘鲁艾滋病毒携带者中的老年障碍(手)。K23奖将为迪亚兹博士提供必要的 支持开发5个关键领域的专业知识：1)定性研究方法和分析，2)临床工具 国际环境下的验证，3)神经心理评估，4)高级生物统计技能，5) 实施科学框架和方法。迪亚兹博士组建了一支核心导师团队(Dr。 Gwenn Garden[神经认知障碍评估专家]，Victor Valcour博士[国际专家 手的评估]和Clare Barrington博士[拉丁美洲的混合方法/定性研究专长] 世卫组织将指导迪亚兹博士实现她的培训目标和职业发展。支持迪亚兹博士和她的核心 导师有三位合作者：Maria Marquine博士(对拉丁裔有专长的神经心理学家)、Dr Marquine博士。 迈克尔·哈金斯(在艾滋病毒观测数据方面有专长的生物统计学家)和帕特里夏·加西亚博士 (秘鲁艾滋病毒实施科学专家)。这一多学科指导团队嵌入了 高度协作的培训环境对迪亚兹博士成为独立调查员至关重要 目标是优化拉丁美洲艾滋病毒携带者大脑健康的诊断和治疗。 在低收入和中等收入国家，手是一个紧迫的问题，因为获得抗逆转录病毒的机会越来越多 强调迫切需要优化手部的诊断和预测，以便进行早期干预。Dr。 Diaz在本申请中概述的研究计划利用了试点数据，这些数据表明，近30%的人 生活在利马的艾滋病毒携带者有手，但由于缺乏地区性疾病，拉丁美洲对手的诊断有限 标准化数据和神经心理测试方面的专家。拟议的研究包括一项前瞻性队列研究。 来自利马两家社会经济不同的艾滋病毒诊所的艾滋病毒患者和艾滋病毒阴性对照患者。这项研究 寻求调整和验证一种基于平板电脑的认知筛查工具，目前针对早期阿尔茨海默氏症进行了优化 在秘鲁进行手部筛查(目标1)。认知障碍的已知可改变风险因素，包括 健康的社会决定因素，将被用于建立秘鲁手部的预测性统计模型，该模型可以识别 干预因素(目标2)。这两个工具将通过迭代进行实施、评估和优化 与艾滋病毒护理提供者进行了几轮面谈(目标3)。这项K23奖项将为迪亚兹博士提供指导 以及成为独立调查员所需的专业知识，以改善未得到充分服务的人的大脑健康 拉丁美洲的艾滋病毒携带者。这项提议是朝着发展大前景迈出的关键一步。 研究确定拉丁美洲手部疾病的频率和风险因素，作为未来的R01赠款。