Preclinical Cardiovascular Disease among Adolescents and Young Adults in Haiti

项目概要 Lindsey Reif 博士是一位全球健康流行病学家，其职业目标是利用流行病学研究来 对感染艾滋病毒的青少年和年轻人（AYALH）实施高影响力的健康干预措施。结束 在过去的十年中，她发表了 10 篇第一作者论文，重点关注评估健康结果和 对海地 AYALH 的干预。 AYALH 经历了数十年的艾滋病毒感染，现在面临着艾滋病毒相关问题 随着年龄的增长，他们会出现合并症，特别是心血管疾病（CVD）。她的 K01 目标是 扩大她的培训和研究，重点关注艾滋病毒相关的临床前心血管疾病——无症状心脏代谢 AYALH 中表明 CVD 发生的异常。她将采取基于证据的干预措施 预防早发 CVD，对 AYALH 的整个生命过程产生影响。 她的培训目标是建立以下方面的专业知识：1) AYALH 中的 CVD 流行病学，2) 混合方法， 3) 实施科学，以设计和实施预防心血管疾病发病率的干预措施 死亡率。她的职业发展计划包括来自团队的多学科指导，该团队带来了 在 AYALH、HIV 和 CVD 流行病学以及实施科学方面拥有数十年的研究经验 跨越全球卫生环境。该团队在全球健康方面拥有无可挑剔的指导记录 研究。 Reif 博士还将学习补充性高级课程来支持她的培训目标。她的 K01 拥有强大的研究和培训环境的支持，该环境充分利用了 40 年的合作 威尔康奈尔（纽约）和 GHESKIO（海地）之间。 Reif 博士的研究计划建立了 AYALH 中临床前 CVD 的流行病学，并采用了 预防临床前 CVD 发生及其进展的循证干预措施。她将进行一次 对 500 名 HIV 参与者和 500 名年龄在 18-30 岁的 HIV 参与者进行的前瞻性队列研究，随访 3 年 海地。在目标 1 中，她将评估临床前 CVD 的患病率、发病年龄和进展（pre- 高血压、微量白蛋白尿和血脂异常）。她将评估 3 种风险因素 领域：生活方式、艾滋病毒相关和社会心理。她假设由艾滋病毒驱动的一系列危险因素 相关因素和心理社会因素与 AYALH 中的临床前 CVD 相关。在目标 2 中，她将适应 基于证据的 WHO HEARTS 技术包针对低收入国家的 AYALH 使用混合方法和 实施科学。本 K01 解决了临床前 CVD 流行病学知识差距 AYALH 并告知调整基于证据的 CVD 干预措施以防止过早残疾和 该人群在成年后死亡。 Reif博士的培训和职业发展计划 补充和扩展她现有的技能，并最终提交 NIH R01，以帮助她 过渡为独立调查员。

PROJECT SUMMARY Dr. Lindsey Reif is a global health epidemiologist with a career goal to leverage epidemiologic research to implement high-impact health interventions for adolescents and young adults living with HIV (AYALH). Over the past decade, she has published 10 first-author papers focused on evaluating health outcomes and interventions among AYALH in Haiti. AYALH, who have survived decades of HIV, now face HIV-related comorbidities, specifically cardiovascular disease (CVD), as they age into adulthood. Her K01 objective is to expand her training and research to focus on HIV-related preclinical CVD— asymptomatic cardiometabolic abnormalities indicating the onset of CVD—among AYALH. She will adapt evidence-based interventions to prevent early onset CVD with impact for AYALH across the lifecourse. Her training objectives are to build expertise in: 1) CVD epidemiology among AYALH, 2) mixed-methods, and 3) implementation science in order to design and implement interventions to prevent CVD morbidity and mortality. Her career development plan includes multidisciplinary mentorship from a team that brings decades of experience in research among AYALH, HIV and CVD epidemiology, and implementation science across global health settings. The team has an impeccable track record of mentorship in global health research. Dr. Reif will also take complementary advanced coursework to support her training objectives. Her K01 is supported by a robust research and training environment that leverages a 40-year collaboration between Weill Cornell (New York) and GHESKIO (Haiti). Dr. Reif’s research plan establishes the epidemiology of preclinical CVD among AYALH and adapts an evidence-based intervention to prevent the onset of preclinical CVD and its progression. She will conduct a prospective cohort study among 500 HIV+ and 500 HIV- participants ages 18-30 years, followed for 3 years in Haiti. In Aim 1, she will evaluate the prevalence, age of onset and progression of preclinical CVD (pre- hypertension, microalbuminuria, and dyslipidemia) by HIV serostatus. She will evaluate risk factors in 3 domains: lifestyle, HIV-related, and psychosocial. She hypothesizes clusters of risk factors, driven by HIV- related and psychosocial factors, are associated with preclinical CVD among AYALH. In Aim 2, she will adapt the evidence-based WHO HEARTS technical package for AYALH in LICs using mixed methods and implementation science. This K01 addresses the knowledge gap of the epidemiology of preclinical CVD among AYALH and informs the adaptation of evidence-based CVD interventions to prevent premature disability and death among this population as they emerge into adulthood. Dr. Reif’s training and career development plan complement and expand her existing skillset and culminate in the submission of an NIH R01 facilitating her transition to independent investigator.