Technology-based adaptive treatment strategies for antiretroviral adherence

描述（由申请人提供）：成功治疗艾滋病毒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承认技术对坚持接受抗逆转录病毒药物治疗的支持作用，这凸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，一些研究检查了电子提醒装置对抗逆转录病毒药物依从性的功效。然而，这些研究大多没有显示依从性的临床显著改善；这可能是因为他们主要研究的是单一方法的作用，而不考虑患者不遵守的具体原因。因此，大多数研究不是使用基于技术的量身定制的方法来解决明显的不遵守原因，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不依从性原因的定制干预措施。在K23职业发展奖的保护时间，培训和指导下，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，我的训练为我提供了坚实而基础的研究基础，并坚定了我成为临床研究者的决定。然而，我需要进一步的培训，使用技术和信息学来提高抗逆转录病毒药物的依从性，进行焦点小组和定性研究方面的高级培训，设计和实施行为干预，生物统计学方面的高级培训，以及为适应性治疗策略创建和测试规则。我已经确定马洛里·约翰逊医生为我的主要导师，他是坚持治疗领域的专家在指导方面有着出色的记录。Drs。尼古拉斯·谢恩、艾达·西姆、迈克尔·西尔弗伯格和埃里克·维廷霍夫将担任联合导师。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药物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)精通使用混合方法（定性和定量）研究行为干预的设计和评估；4)通过研究以证据为基础的艾滋病毒临床药剂师主导的促进艾滋病毒护理的举措，推动临床药学领域向前发展。我的研究的首要目标是确定和开发个性化的基于技术的方法，这些方法有可能克服艾滋病毒+青年不坚持治疗的具体原因。我将在K23奖期间接受的高级培训将填补我知识上的空白，使我能够成功地竞争R34拨款，开展一项基于技术的适应性干预措施的试点研究，以提高年轻艾滋病毒阳性男性和女性的依从性；这将导致R01来评估这种干预的有效性。

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.