This application is for a Mid-Career Investigator Award in Patient-Oriented Research (K-24). My goals in this award are to: 1) Increase research productivity in a resource poor setting and 2) Directed mentorship of promising sub-Saharan African students, medical officers, fellows and junior faculty in designing, executing, and publishing outcomes research relevant to resource-poor settings. My research to date has focused on adherence and health outcomes in impoverished HIV+ drug users in San Francisco. This has included NIMH-funded research on the biology of incomplete adherence (NIMH 54907), Directly Observed Depression Treatment to improve depression and HIV treatment outcomes in depressed homeless individuals (NIMH 63011) and a comparison of Modified Directly Observed Therapy vs. Adherence Case Management (NIMH 64388). This domestic program has identified 9 junior investigators who have collectively published 7 first author publications. More recently, I have expanded my research program to Uganda. With pilot R-21 funding from the NIAAA, we are studying adherence, pharmacokinetics and resistance to generic antiretroviral therapy (NIAAA 014784). This expanding international research program has also identified 4 talented junior investigators (2 Ugandan and 2 US investigators) with 2 manuscripts accepted for publication and an additional two in review. The K-24 mechanism is ideally suited to create sufficient protected time to expand this international research program and to provide directed mentorship of these promising investigators. My established relationship with and support of Makerere University in Uganda likely will lead to several additional promising international investigators. Furthermore, this directed goal of expanding international HIV research and mentorship is a priority for my home institution; I have the supportive commitment from my home institution to reduce my clinical and administrative responsibilities to 20% in order to achieve this goal.
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