Targeted Monitoring and Determinants of Adherence in Adolescents with HIV

描述(由申请者提供)：K23职业发展奖候选人的目标是成为一名独立调查员，其工作将导致成功的干预措施，以促进艾滋病毒感染(HIV+)青少年的遵守，特别是在资源有限的环境中。与成年人和年幼的儿童相比，艾滋病毒+青少年对抗逆转录病毒治疗的依从性较差。这在撒哈拉以南非洲至关重要，那里大约90%的艾滋病毒感染青年生活在那里，那里的治疗选择有限。对于HIV+青少年来说，依从性差通常是他们长期治疗成功的最大障碍。此外，低成本的监测策略，如患者自我报告，在青少年中往往不太可靠。拟议的研究将确定是否可以使用简单评估的青少年特征来针对个别青少年选择低成本的依从性监测策略。它还将阐明关键的潜在可改变的危险因素对青少年治疗依从性的影响，展示未来干预研究的目标，以支持资源有限的青少年的依从性。该奖项的候选人在资源有限的环境下的儿科和青少年治疗方面有很强的背景，曾在博茨瓦纳全职工作4年，担任博茨瓦纳-贝勒儿童临床卓越中心(COE)的副主任。COE已经为2000多名艾滋病毒阳性的儿童和青少年提供了护理和治疗，也是K23研究的研究地点。除了在资源有限的环境下提供儿科和青少年艾滋病毒护理方面的丰富经验外，该奖项的候选人还接受过临床流行病学培训，并是CDC公共卫生有效性补助金的PI，评估资源有限环境下青少年遵守的其他方面。候选人的主要导师是罗伯特·格罗斯博士。格罗斯博士是艾滋病毒依从性研究的国际专家，在指导方面有着出色的记录。Steven Feierman博士、Karen Glanz博士、黄伟霆博士和Seipone Mphele博士将分别担任医学人类学、健康行为学、生物统计学和临床心理学领域的联合导师。拟议的培训和指导将为候选人提供必要的技能和经验，以支持她发展成为一名成功的独立研究人员。K23的研究和培训计划将把她的专业知识扩展到行为理论、测试构建和验证、定性和纵向分析以及国际研究伦理等领域。

DESCRIPTION (provided by applicant): The candidate for this K23 Career Development Award aims to become an independent investigator whose work will lead to successful interventions to promote adherence among HIV-infected (HIV+) adolescents, particularly in resource-limited settings. HIV+ adolescents have poor adherence to antiretroviral therapy relative to both adults and younger children. This is of paramount importance in sub-Saharan Africa where about 90% of HIV-infected youth live and where treatment options are limited. For HIV+ adolescents, poor adherence is commonly their greatest barrier to long-term treatment success. In addition, low-cost monitoring strategies such as patient self-report are often less reliable in adolescents. The proposed research will determine whether simply assessed adolescent characteristics can be used to target the choice of low-cost adherence monitoring strategies for individual adolescents. It will also clarify the impact of key potentially modifiabl risk factors on treatment adherence in adolescents, demonstrating targets for future interventional studies to support adherence among adolescents in resource-limited settings. The candidate for this award has a strong background in pediatric and adolescent treatment in resource-limited settings, having worked full-time in Botswana for 4 years as the Associate Director of the Botswana-Baylor Children's Clinical Centre of Excellence (COE). The COE has provided care and treatment to over 2000 HIV+ children and adolescents and is the study site for the K23 research. In addition to her extensive experience in pediatric and adolescent HIV care in resource-limited settings, the candidate for this award has undergone training in clinical epidemiology and is the PI for a CDC Public Health Effectiveness Grant evaluating other aspects of adherence among adolescents in a resource-limited setting. The candidate's primary mentor is Dr. Robert Gross. Dr. Gross is an international expert in HIV adherence research and has an outstanding track record of mentorship. Drs. Steven Feierman, Karen Glanz, Wei-Ting Hwang and Seipone Mphele will serve as co-mentors in the areas of medical anthropology, health behavior, biostatistics, and clinical psychology, respectively. The proposed training and mentorship will provide the candidate with the skills and experience necessary to support her development as a successful independent researcher. The K23 research and training plan will expand her expertise into the areas of behavioral theory, test construction and validation, qualitative and longitudinal analyses, and international research ethics.