Technology-based adaptive treatment strategies for antiretroviral adherence

基于技术的抗逆转录病毒依从性适应性治疗策略

• 批准号: 8841412
• 负责人: Parya Saberi
• 金额: $ 17.83万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-06-15 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8841412
• 关键词: AIDS clinical trial group; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; African American; Age; Age-Years; Anti-Retroviral Agents; Area; Behavior Therapy; Biometry; British; Caring; Cessation of life; Characteristics; Clinical; Clinical Investigator; Clinical Pharmacists; Data; Development; Devices; Diagnosis; Disease Progression; Effectiveness; Effectiveness of Interventions; Electronics; Epidemiology; Evaluation; Female; Focus Groups; Foundations; Goals; Grant; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health behavior; Incidence; Individual; Informatics; Intervention; Interview; K-Series Research Career Programs; Knowledge; Latino; Lead; Learning; Medical Informatics; Memory; Mental Depression; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Minority Groups; Participant; Patients; Persons; Pharmacy facility; Pilot Projects; Population; Public Health; Qualitative Methods; Qualitative Research; Questionnaires; Research; Research Design; Research Personnel; Research Project Grants; Resources; Risk; Risk Factors; Role; Series; Social support; Source; Technology; Testing; Time; Training; Treatment Efficacy; Treatment Failure; United States Dept. of Health and Human Services; Update; Woman; Work; World Health Organization; Youth; antiretroviral therapy; base; career; clinically significant; demographics; drug resistant virus; empowered; evidence base; forgetting; improved; lifetime risk; male; men; prototype; response; sex; skills; social stigma; therapy development; transmission process; treatment adherence; treatment strategy; young man; young woman

DESCRIPTION (provided by applicant): The Achilles heel of successful HIV treatment is adherence to antiretroviral (ARV) therapy, as non-adherence remains one of the strongest predictors of progression to AIDS and death. The recognition of the supportive role of technology for ARV adherence by the U.S. Department of Health and Human Services underscores the importance of the need for stronger evidence of the effectiveness of these interventions. As a result, several studies have examined the efficacy of electronic reminder devices on ARV adherence. However, most of these studies have not revealed clinically significant improvements in adherence; which may be because they have primarily investigated the role of a single method, irrespective of patient-specific reasons for non-adherence. Thus, instead of using tailored technology-based methods to address distinct non-adherence reasons, most studies compel the participant to "fit" the technology. Therefore, to most effectively use technology to improve adherence, customized interventions that focus on the patients' specific non-adherence reasons need to be considered. With protected time, training, and mentoring during this K23 career development award, I propose to acquire the skills needed to address these issues and to achieve my long-term career goal of becoming an independent clinical researcher. My training to date has provided me with a strong and basic foundation of research and affirmed my decision of becoming a clinical investigator. However, I require further training in the use of technology and informatics to improve ARV adherence, conducting focus groups and advanced training in qualitative research, designing and implementing behavioral interventions, advanced training in biostatistics, and creating and testing rules for adaptive treatment strategies. I have identified Dr. Mallory Johnson as my primary mentor, who is an expert in the area of treatment adherence and has an outstanding record of mentorship. Drs. Nicolas Sheon, Ida Sim, Michael Silverberg, and Eric Vittinghoff will serve as co-mentors. Through mentorship and training, I plan to pursue four interconnected career goals: 1) become an expert in technology-based methods of improving ARV adherence; 2) acquire expertise in adaptive treatment strategies; 3) become proficient in the use of mixed methods (qualitative and quantitative) research for the design and evaluation of behavioral interventions; and 4) move the field of clinical pharmacy forward by researching evidence-based HIV clinical pharmacist-led initiatives in advancing HIV care. The overarching objective of my research is to identify and develop individually-tailored technology-based approaches that have the potential to overcome specific reasons for non-adherence in HIV+ youth. The advanced training I will receive during this K23 award will fill the gaps in my knowledge and enable me to successfully compete for an R34 grant to conduct a pilot study of technology-based adaptive interventions to improve adherence in young HIV+ men and women; which will lead to an R01 to evaluate the efficacy of this intervention.

描述(申请人提供)：成功的艾滋病毒治疗的致命弱点是坚持抗逆转录病毒(ARV)治疗，因为不坚持治疗仍然是进展为艾滋病和死亡的最强预测因素之一。美国卫生与公众服务部认识到技术对遵守抗逆转录病毒药物的支持作用，这突显了需要更有力的证据来证明这些干预措施的有效性的重要性。因此，几项研究检查了电子提醒设备对抗逆转录病毒治疗依从性的效果。然而，这些研究中的大多数并没有显示出依从性在临床上的显著改善；这可能是因为他们主要研究了单一方法的作用，而不考虑患者不依从性的具体原因。因此，大多数研究不是使用量身定做的基于技术的方法来解决不同的不遵守原因，而是强迫参与者“适应”技术。因此，为了最有效地利用技术来提高依从性，需要考虑针对患者特定的不依从性原因的定制干预。在K23职业发展奖期间，有了受保护的时间、培训和指导，我建议获得解决这些问题所需的技能，并实现我成为一名独立临床研究人员的长期职业目标。到目前为止，我的培训为我提供了坚实的基础研究基础，并确认了我成为一名临床研究员的决定。然而，我需要在使用技术和信息学方面进行进一步培训，以提高抗逆转录病毒治疗的依从性，开展重点小组和定性研究方面的高级培训，设计和实施行为干预措施，生物统计学方面的高级培训，以及创建和测试适应性治疗策略的规则。我已经确定马洛里·约翰逊博士为我的主要导师，他是治疗依从性领域的专家，在指导方面有着出色的记录。Nicolas Sheon博士、Ida Sim博士、Michael Silverberg博士和Eric Vittinghoff博士将担任共同导师。通过指导和培训，我计划追求四个相互关联的职业目标：1)成为提高抗逆转录病毒治疗依从性的技术方法方面的专家；2)获得适应性治疗策略方面的专业知识；3)熟练使用混合方法(定性和定量)研究来设计和评估行为干预措施；以及4)通过研究以证据为基础的艾滋病毒临床药剂师领导的推进艾滋病毒护理的倡议，推动临床药学领域的发展。我的研究的首要目标是确定和开发有潜力克服艾滋病毒+青年不遵守的具体原因的个性化的基于技术的方法。我将在这个K23奖项期间接受的高级培训将填补我的知识空白，并使我能够成功竞争R34拨款，以开展一项基于技术的适应性干预措施的试点研究，以提高年轻HIV+男性和女性的依从性；这将导致R01，以评估这种干预措施的效果。