DOT-HARRT for HIV-Infected South African Adults

联合抗逆转录病毒治疗(Art)时代的早期几年带来了显著的减少。 在工业化国家与艾滋病毒感染有关的发病率和死亡率，最近， 国际和地方倡议使发展中国家能够获得HAART。初步数据来自 我之前的工作和其他工作表明，良好的遵从性在资源有限的环境中是可行的，但它确实是 不清楚这些结果在规模化抗逆转录病毒治疗项目中是否可重现，以及可能采取的干预措施 在这样的环境中，要有效地最大限度地遵守。同伴倡导者已经被用来提高 在各种环境下坚持接受药物治疗。为了调查Peer的潜在效用- 我建议进行一项随机试验，300名患者将被分配到 无论是对等DOT-HAART还是每日两次的斯塔夫定、拉米夫定和 法韦伦兹24个月。本研究的具体目的是：1)评估Peer-DOT HAART的影响 关于控制病毒载量和以病毒载量和CD4T细胞计数衡量的免疫恢复；2) 评价DOT-HAART对治疗依从性的影响；3)确定 同龄人DOT与自身给药的HAART臂中的HAART抵抗；4)比较 同龄人DOT与自我给药HAART中新发或复发的机会性感染的发生率。我的 假设是同龄人DOT-HAART组的患者将具有高水平的治疗依从性和 从而更有效地控制病毒负荷，从而限制病毒学失败的可能性，药物 抵抗力和疾病进展。这项研究将产生关于另一个社区的关键数据- 基于提供HAART的方法，这可能成为整个撒哈拉以南非洲的标准护理 和发展中国家。我的职业发展计划是以研究生培训计划为基础的， 包括约翰·霍普金斯大学和开普敦大学的综合课程， 有组织的指导，以及论文委员会的指导。我的职业规划和研究建议是 与我成为一名有效的独立调查员的长期目标一致，并优化 撒哈拉以南非洲艾滋病毒感染者的治疗结果。

The early years of the combination antiretroviral therapy (ART) era have brought about dramatic reductions in the morbidity and mortality associatedwith HIV infection in industrialized countries and recently, international and local initiative have allow access to HAART in the developing world. Preliminary data from my prior work and other have shown that good adherence is feasible in resource-limited settings, but it is unclear whether these results are reproducible in scaled ART programs and what interventions would likely be effective at maximizing adherence in such settings. Peer advocates have been used to improve adherence with medical therapies in a variety of settings. In order to investigate the potential utility of peer- advocates in South Africa, I propose to conduct a randomized trial in which 300 patients will be assigned to either peer-DOT-HAART or self-administration of a twice daily combination of Stavudine, Lamivudine and Efavirenz for 24 months. The specific aims of this study are: 1) to evaluate the impact of peer-DOT HAART on control of viral burden and immune restoration as measured by viral load and CD4 T cell counts; 2) to evaluate the impact of DOT-HAART on treatment adherence; 3) the determination the proportion of genotypic HAART resistance in the peer-DOT vs. self-administered HAART arms; 4) to compare the incidence of new or recurrent opportunistic infection in the peer-DOT vs. self-administered HAART. My hypothesis is that the patients in the peer-DOT-HAART arm will have high levels of treatment adherence and hence more effective in controlling viral burden, thereby limiting the likelihood of virologic failure, drug resistance, and disease progression. This study will generate critical data on an alternative community- based approach of delivering HAART which may become a standard of care throughout sub-Saharan Africa and the developing world. My career development plan is based on a post-graduate training program, which includes comprehensive coursework at the Johns Hopkins University and University of Cape Town, structured mentoring, and guidance from a thesis committee. My career plan and research proposal are consistent with my long-term goals of becoming an effective independent investigator, and optimizing treatment outcomes in HIV-infected in sub-Saharan Africa.