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.

项目概要 这是北大学神经学家 Monica M. Diaz 博士的 K23 奖学金申请 卡罗莱纳州在教堂山医学院。迪亚兹博士正在将自己定位为以患者为中心的研究人员 拉丁美洲脑健康和艾滋病毒交叉点的临床研究。迪亚兹博士至少有一半驻扎在 自 2019 年以来，她在秘鲁开展了一项指导性试点研究，评估与艾滋病毒相关的神经认知功能 秘鲁老年人艾滋病毒感染者的疾病（HAND）。 K23 奖项将为 Diaz 博士提供必要的 支持发展 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 国际环境中的验证，3) 神经心理学评估，4) 高级生物统计技能，5) 实施科学框架和方法。 Diaz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 [国际神经认知障碍评估专家] HAND 的评估] 和 Clare Barrington 博士 [拉丁美洲的混合方法/定性研究专业知识] 她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 导师是三位合作者：Maria Marquine 博士（具有拉丁裔 HAND 专业知识的神经心理学家）、Dr. Michael Hudgens（具有艾滋病毒观察数据专业知识的生物统计学家）和 Patricia Garcia 博士 （秘鲁艾滋病毒实施科学专家）。这个多学科的指导团队嵌入在 高度协作的培训环境对于迪亚兹博士发展成为一名独立研究者至关重要 目标是优化拉丁美洲艾滋病毒感染者大脑健康的诊断和治疗。 在中低收入国家，随着抗逆转录病毒药物的获得越来越多，HAND 是一个紧迫的问题 治疗，强调迫切需要优化 HAND 的诊断和预测以进行早期干预。博士。 Diaz 在本申请中概述的研究计划利用了试点数据，该数据表明近 30% 的人 利马的艾滋病毒感染者曾有过 HAND，但由于缺乏区域性的支持，HAND 的诊断在拉丁美洲非常有限。 神经心理学测试的规范数据和专家。拟议的研究包括一个前瞻性队列 来自利马两个社会经济状况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。研究 寻求调整和验证基于平板电脑的认知筛查工具，目前针对早期阿尔茨海默病进行了优化 在秘鲁进行 HAND 筛查（目标 1）。已知的可改变的认知障碍危险因素，包括 健康的社会决定因素，将用于为秘鲁的 HAND 建立一个预测统计模型，该模型可以识别 可干预因素（目标 2）。这两个工具将通过迭代来实施、评估和优化 与艾滋病毒护理人员进行多轮访谈（目标 3）。该 K23 奖项将为 Diaz 博士提供指导 成为独立调查员所需的专业知识，以改善服务不足的人的大脑健康 拉丁美洲的艾滋病毒感染者。该提案是朝着开发大前景迈出的关键一步 研究确定拉丁美洲 HAND 的频率和风险因素，作为未来的 R01 拨款。