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.

Public Health Relevance

The research proposed in this K23 award is relevant because: 1) it will identify and evaluate interventions that may improve ARV adherence and thereby decrease the risk of treatment failure, disease progression, and the emergence and transmission of drug resistant virus;2) it has the potential to identify technologies that may empower HIV-positive individuals and be used across settings and populations;3) it has a secondary focus on a population that is disproportionately affected by HIV/AIDS and is in line with national HIV research objectives.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Stirratt, Michael J
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Olea Jr, Antonio; Grochowski, Janet; Luetkemeyer, Anne F et al. (2018) Role of a clinical pharmacist as part of a multidisciplinary care team in the treatment of HCV in patients living with HIV/HCV coinfection. Integr Pharm Res Pract 7:105-111
Saberi, Parya; Ming, Kristin; Legnitto, Dominique et al. (2018) Novel methods to estimate antiretroviral adherence: protocol for a longitudinal study. Patient Prefer Adherence 12:1033-1042
Koss, Catherine A; Hosek, Sybil G; Bacchetti, Peter et al. (2018) Comparison of Measures of Adherence to Human Immunodeficiency Virus Preexposure Prophylaxis Among Adolescent and Young Men Who Have Sex With Men in the United States. Clin Infect Dis 66:213-219
Sauceda, John A; Neilands, Torsten B; Johnson, Mallory O et al. (2018) An update on the Barriers to Adherence and a Definition of Self-Report Non-adherence Given Advancements in Antiretroviral Therapy (ART). AIDS Behav 22:939-947
Saberi, Parya; Ming, Kristin; Dawson-Rose, Carol (2018) What does it mean to be youth-friendly? Results from qualitative interviews with health care providers and clinic staff serving youth and young adults living with HIV. Adolesc Health Med Ther 9:65-75
Saberi, Parya; Neilands, Torsten B; Ming, Kristin et al. (2017) Strong Correlation Between Concentrations of Antiretrovirals in Home-Collected and Study-Collected Hair Samples: Implications for Adherence Monitoring. J Acquir Immune Defic Syndr 76:e101-e103
van den Berg, Jacob J; Neilands, Torsten B; Johnson, Mallory O et al. (2016) Using Path Analysis to Evaluate the Healthcare Empowerment Model Among Persons Living with HIV for Antiretroviral Therapy Adherence. AIDS Patient Care STDS 30:497-505
Saberi, Parya; Siedle-Khan, Robert; Sheon, Nicolas et al. (2016) The Use of Mobile Health Applications Among Youth and Young Adults Living with HIV: Focus Group Findings. AIDS Patient Care STDS 30:254-60
Sauceda, John A; Johnson, Mallory O; Saberi, Parya (2016) Nonadherence as 4-day Antiretroviral Therapy Interruptions: Do Depression and Race/Ethnicity Matter as Much in the Modern Antiretroviral Therapy Era? AIDS Behav 20:2624-2628
Lippman, Sheri A; Shade, Starley B; Sumitani, Jeri et al. (2016) Evaluation of short message service and peer navigation to improve engagement in HIV care in South Africa: study protocol for a three-arm cluster randomized controlled trial. Trials 17:68

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