HAART Adherence Interventions in Africa: an RCT

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DESCRIPTION (provided by applicant): Candidate: Dr. Michael H. Chung is a Senior Fellow in the Division of Allergy and Infectious Diseases at the University of Washington. A graduate of the University of Chicago Pritzker School of Medicine and the Harvard School of Public Health, he has been conducting HIV-1 randomized clinical trials in Nairobi, Kenya since 2002. His immediate goal is to complete several international HIV-1 field studies and to strengthen his knowledge of epidemiology and biostatistics. His long-term career goal is to become an expert in antiretroviral adherence in resource-poor settings and spatial epidemiology. Environment: Ranking third among U.S. universities in HIV/AIDS research funding, the University of Washington counts the Center for AIDS Research, the AIDS Clinical Trials Unit, and the International AIDS Research and Training Program among its many HIV/AIDS resources. In Nairobi, the University of Washington has been involved in collaborative HIV-1 research since 1985 and has been conducting randomized clinical trials continuously since 1992. In this ideal research environment, Dr. Chung will develop his research career by receiving expert mentorship, taking courses in relevant fields, and leading the implementation of HIV-1 studies in Kenya. Research: With the advent of large-scale free HAART treatment programs in Africa, good adherence to antiretrovirals will be essential to preserve health and prevent the spread of resistant HIV-1 variants. Adherence knowledge in this resource-poor setting is limited and not supported by any randomized clinical trials. Consequently, this study proposes a 4-armed factorial randomized clinical trial in Nairobi, Kenya to determine the effect of cognitive and behavioral interventions on HAART adherence. Within this trial, the study also proposes to examine attitudes towards adherence interventions and identify sociodemographic and spatial correlates of adherence. The study hypothesizes that educational counseling and medication alarm devices may significantly improve adherence, and that poor adherence may be associated with low socioeconomic standing, increased mobility, and distance from clinic.