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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23MH097649-02
Application #
8490444
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Stirratt, Michael J
Project Start
2012-06-15
Project End
2017-04-30
Budget Start
2013-05-01
Budget End
2014-04-30
Support Year
2
Fiscal Year
2013
Total Cost
$177,783
Indirect Cost
$11,683
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
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
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
Saberi, Parya; Catz, Sheryl L; Leyden, Wendy A et al. (2015) Antiretroviral Therapy Adherence and Use of an Electronic Shared Medical Record Among People Living with HIV. AIDS Behav 19 Suppl 2:177-85
Gilvydis, Jennifer M; Steward, Wayne T; Saberi, Parya et al. (2015) Need for improvements in clinical practice to retain patients in pre-antiretroviral therapy care: Data from rural clinics in North West Province, South Africa. AIDS Care 27:1275-8
Saberi, Parya; Neilands, Torsten B; Vittinghoff, Eric et al. (2015) Barriers to antiretroviral therapy adherence and plasma HIV RNA suppression among AIDS clinical trials group study participants. AIDS Patient Care STDS 29:111-6
Saberi, Parya; Johnson, Mallory O (2015) Moving toward a novel and comprehensive behavioral composite of engagement in HIV care. AIDS Care 27:660-4
Saberi, Parya; Johnson, Mallory O (2015) Correlation of Internet Use for Health Care Engagement Purposes and HIV Clinical Outcomes Among HIV-Positive Individuals Using Online Social Media. J Health Commun 20:1026-32
Saberi, Parya; Mayer, Kenneth; Vittinghoff, Eric et al. (2015) Correlation between use of antiretroviral adherence devices by HIV-infected youth and plasma HIV RNA and self-reported adherence. AIDS Behav 19:93-103
Cocohoba, Jennifer; Dong, Betty J; Johnson, Mallory O et al. (2014) Reporting of critical information in studies of pharmacists in HIV care. Int J Pharm Pract 22:375-85
Saberi, Parya; Neilands, Torsten B; Johnson, Mallory O (2014) Association between dog guardianship and HIV clinical outcomes. J Int Assoc Provid AIDS Care 13:300-4

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