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: 10654864
• 负责人: Monica Maria Diaz
• 金额: $ 19.66万
• 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/10654864
• 关键词: AIDS prevention; Abbreviations; 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 Diagnosis; Early Intervention; Early identification; Education; Elderly; Employment; Environment; Evaluation; Financial Hardship; Focus Groups; Frequencies; Future; 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; Population; Poverty; Predictive Factor; Prospective Studies; Prospective cohort; Protocols documentation; Qualitative Research; Reporting; Research; Research Methodology; Research Personnel; Resources; Risk; Risk Factors; Scientist; Screening procedure; Site; Specialist; Specificity; Statistical Models; Syphilis; Tablets; Testing; Time; Training; Tuberculosis; Underserved Population; United States National Institutes of Health; Universities; Validation; Work; antiretroviral therapy; bilingualism; brain health; care providers; career development; cognitive performance; cognitive testing; design; diagnostic accuracy; diagnostic tool; disorder risk; experience; flexibility; implementation framework; implementation science; improved; low and middle-income countries; low health literacy; medical schools; modifiable risk; multidisciplinary; multimodality; neurocognitive disorder; novel; patient oriented; predictive modeling; screening; sex; 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.

项目摘要 这是北大学神经科医生莫妮卡·迪亚兹（Monica M. Diaz）博士颁发的K23奖。 卡罗来纳州教堂山医学院的卡罗莱纳州。迪亚兹博士正在以患者为导向的调查员建立自己 拉丁美洲大脑健康与艾滋病毒相交的临床研究。迪亚兹博士至少基于一半 自2019年以来在秘鲁的时间，她开发了一项指导的试点研究，评估与HIV相关的神经认知 在秘鲁患艾滋病毒的老年人中的疾病（手）。 K23奖将为迪亚兹博士提供必要的 支持在5个关键领域发展专业知识的支持：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论。迪亚兹博士组建了一支核心导师团队（博士 Gwenn Garden [神经认知障碍评估专家]，Victor Valcour博士[国际专家 Hand]和Clare Barrington博士[拉丁美洲的混合方法/定性研究专业知识] 谁将指导迪亚兹博士实现她的培训目标和职业发展。支持迪亚兹博士及其核心 导师是三个合作者：Maria Marquine博士（神经心理学家在拉丁美洲人的专业知识），博士 迈克尔·哈金斯（Michael Hudgens）（具有艾滋病毒观察数据专业知识的生物统计学家）和帕特里夏·加西亚（Patricia Garcia）博士 （秘鲁的艾滋病毒实施科学专家）。这个多学科的心态团队嵌入了 高度协作的培训环境对于迪亚兹博士的发展至关重要 目的是优化拉丁美洲艾滋病毒患者的脑部健康诊断和治疗方法。 在低和中等收入国家中，手的迫切问题随着抗逆转录病毒的访问越来越多 治疗，强调迫切需要优化诊断和预测早期干预措施。博士 迪亚兹（Diaz 在利马生活艾滋病毒有手，但由于缺乏地区，拉丁美洲的诊断限制了。 正常数据和神经心理学测试的专家。拟议的研究包括一个前瞻性队列 来自利马的两家社会经济诊所的HIV和HIV阴性控制患者的患者。研究 旨在适应和验证基于平板电脑的认知筛查工具，目前已针对早期的阿尔茨海默氏症优化 筛选以检测秘鲁的手（AIM 1）。已知可改变的认知障碍风险因素，包括 健康的社会决定者将用于建立秘鲁的Hand的预测统计模型，可以识别 可间隔因素（目标2）。这两个工具将通过迭代实施，评估和优化 与艾滋病毒护理提供者进行面试的回合（AIM 3）。该K23奖将为Diaz博士提供Mentalship 成为成为独立研究者所必需的专业知识，以改善服务不足的大脑健康 在拉丁美洲患艾滋病毒的人群。该提议是发展庞大的前景的关键一步 研究将拉丁美洲的手的频率和风险因素确定为未来的R01赠款。

项目成果

A review of neurological health disparities in Peru.

• DOI: 10.3389/fpubh.2023.1210238
• 发表时间: 2023
• 期刊: FRONTIERS IN PUBLIC HEALTH
• 影响因子: 5.2
• 作者: Almubaslat, Faris;Sanchez-Boluarte, Sofia S.;Diaz, Monica M.
• 通讯作者: Diaz, Monica M.

Mental health impact of the COVID-19 pandemic on patients with neurodegenerative diseases and perceived family caregiver burden in Lima, Peru.

秘鲁利马，COVID-19 大流行对神经退行性疾病患者的心理健康影响以及家庭护理人员负担。

• DOI: 10.1002/brb3.3361
• 发表时间: 2024-01
• 期刊: BRAIN AND BEHAVIOR
• 影响因子: 3.1
• 作者: Diaz, Monica M.;Bailey, Maisie;Garcia, Bettsie;Aguilar, Ximena R.;Sanchez, Danilo Coronel
• 通讯作者: Sanchez, Danilo Coronel