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.

Public Health Relevance

The proposed research is likely to improve the accuracy of adherence monitoring for adolescents and to lead to advancements in adolescent adherence support, particularly for resource-limited settings. This will help to improve adolescent HIV treatment outcomes and limit the spread of resistant virus.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23MH095669-02
Application #
8542894
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Kamath, Susannah M Allison
Project Start
2012-09-10
Project End
2017-05-31
Budget Start
2013-06-01
Budget End
2014-05-31
Support Year
2
Fiscal Year
2013
Total Cost
$174,802
Indirect Cost
$10,412
Name
Children's Hospital of Philadelphia
Department
Type
DUNS #
073757627
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Yang, Elizabeth; Mphele, Seipone; Moshashane, Neo et al. (2018) Distinctive barriers to antiretroviral therapy adherence among non-adherent adolescents living with HIV in Botswana. AIDS Care 30:224-231
Genn, Leah; Chapman, Jennifer; Okatch, Harriet et al. (2018) Pharmacy Refill Data are Poor Predictors of Virologic Treatment Outcomes in Adolescents with HIV in Botswana. AIDS Behav :
Ioannides, Kimon L H; Chapman, Jennifer; Marukutira, Tafireyi et al. (2017) Patterns of HIV Treatment Adherence do not Differ Between Male and Female Adolescents in Botswana. AIDS Behav 21:410-414
Coppock, Dagan; Zambo, Dikai; Moyo, Dumisani et al. (2017) Development and Usability of a Smartphone Application for Tracking Antiretroviral Medication Refill Data for Human Immunodeficiency Virus. Methods Inf Med 56:351-359
Wood, Sarah M; Lowenthal, Elizabeth; Lee, Susan et al. (2017) Longitudinal Viral Suppression Among a Cohort of Adolescents and Young Adults with Behaviorally Acquired Human Immunodeficiency Virus. AIDS Patient Care STDS 31:377-383
Haberer, Jessica E; Sabin, Lora; Amico, K Rivet et al. (2017) Improving antiretroviral therapy adherence in resource-limited settings at scale: a discussion of interventions and recommendations. J Int AIDS Soc 20:21371
Okatch, Harriet; Beiter, Kaylin; Eby, Jessica et al. (2016) Brief Report: Apparent Antiretroviral Overadherence by Pill Count is Associated With HIV Treatment Failure in Adolescents. J Acquir Immune Defic Syndr 72:542-545
Lowenthal, Elizabeth; Fiks, Alexander G (2016) Protecting Children Through Research. Pediatrics 138:
Bearden, David; Steenhoff, Andrew P; Dlugos, Dennis J et al. (2015) Early antiretroviral therapy is protective against epilepsy in children with human immunodeficiency virus infection in botswana. J Acquir Immune Defic Syndr 69:193-9
Lowenthal, Elizabeth D; Marukutira, Tafireyi; Tshume, Ontibile et al. (2015) Prediction of HIV Virologic Failure Among Adolescents Using the Pediatric Symptom Checklist. AIDS Behav 19:2044-8

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