Novel Measures and Theory of Pediatric Antiretroviral Therapy Adherence in Uganda

项目总结（见说明）： 在资源有限的环境中，感染艾滋病毒的儿童不能可靠地达到高水平的坚持， 在桑内环境中的成人中观察到抗逆转录病毒治疗（ART），因此代表优先人群 用于研究儿童抗逆转录病毒治疗依从性评估因自我报告的局限性和缺乏 可行的客观措施。此外，现有的遵守措施不能检测遵守失误 并在病毒学失败之前提供改善依从性的机会。新型依从性监测策略 需要更好地了解和干预资源有限的情况下儿科ART依从性。在 这五年的K23职业发展奖的申请，我建议获得所需的技能，以解决 这些问题，并实现我的长期职业目标，提高儿科ART坚持和治疗 在资源有限的情况下取得成果。我对儿科艾滋病毒/艾滋病治疗有很好的了解， 通过我之前在克林顿基金会在中国的工作，我得到了很好的照顾。我还有一个健康硕士学位 服务研究，是正在进行的多项ART措施的R21研究的主要研究者 在乌干达儿童中。然而，我需要更好地理解定量分析， 坚持措施，新的坚持措施，儿童发展和心理健康，以及混合- 方法分析，以开发和测试新的行为干预，以提高儿科ART依从性。我 已经认定大卫·邦斯伯格博士是我的主要导师他是一个国际专家在坚持 研究，并有一个优秀的跟踪记录的导师。朱利叶斯·基瓦努卡博士和史蒂夫·萨夫伦博士 担任儿科艾滋病毒/艾滋病治疗和护理以及行为科学领域的共同导师， 分别使用这些技能，我建议1）检查新的坚持措施的性能 在乌干达五岁以下感染艾滋病毒儿童的照顾者中使用无线技术; 2） 对这些新的依从性指标的可行性和可接受性进行混合方法评估; （3）建立了基于社会资本的幼儿ART依从行为的理论模型。 资源有限的环境。这种模式可能适合幼儿，因为他们的坚持很大程度上 反映了照顾者的行为。拟议的培训和指导将为我提供技能， 成为一名成功的独立研究人员所需的经验。在颁奖的最后 在此期间，我将提交一份ROI申请，以测试基于无线技术的干预措施， 这一理论模型可能会提高艾滋病毒感染的乌干达儿童的依从性和病毒抑制。

PROJECT SUMMARY (See instructions): HIV-infected children in resource-limited settings do not reliably achieve the high levels of adherence to antiretroviral therapy (ART) seen in adults in the sanne setting and therefore represent a priority population for research. ART adherence assessment in children is complicated by limitations in self-report and absence of feasible objective measures. Moreover, existing adherence measures do not detect adherence lapses and offer opportunities to improve adherence before virologic failure. Novel adherence monitoring strategies are needed to better understand and intervene on pediatric ART adherence in resource-limited settings. In this five-year K23 career development award application, I propose to acquire the skills needed to address these issues and to achieve my long-term career goal of improving pediatric ART adherence and treatment outcomes in resource-limited settings. I have a good understanding of pediatric HIV/AIDS treatment and care through my prior work with the Clinton Foundation in China. I also have a master's degree in Health Services Research and am the principal investigator of an ongoing R21 study of multiple measures of ART adherence in Ugandan children. I, however, need a better understanding of quantitative analysis for adherence measures, novel adherence measurements, child development and mental health, and mixed- methods analysis to develop and test novel behavioral intervenfions to improve pediatric ART adherence. I have identified Dr. David Bangsberg as my primary mentor. He is an international expert in adherence research and has an outstanding track record of mentorship. Dr. Julius Kiwanuka and Dr. Steve Safren will serve as co-mentors in the areas of pediatric HIV/AIDS treatment and care and behavioral science, respectively. Using these skills, I propose to 1) examine the performance of novel adherence measures based on wireless technology among caregivers of HIV-infected children under age five in Uganda; 2) perform mixed method assessments of the feasibility and acceptability of these novel adherence measures; and 3) develop a theoretic model for ART adherence behavior based on social capital for young children in a resource-limited setting. This model may be appropriate for young children, because their adherence largely reflects the behavior of their caregivers. The proposed training and mentorship will provide me with the skills and experience necessary to become a successful independent researcher. Toward the end of the award period, I will submit an ROI application to test an intervention based on wireless technology and the theoretic model that may improve adherence and viral suppression among HIV-infected Ugandan children.