This proposed renewal of Dr. Wilson's K24 builds on the strong record of success achieved during the first 6 years of this award. Since the start of his K24 in 2003 he has mentored 52 individuals, including 19 whom he is currently mentoring. During this time his mentees have produced 26 first author published manuscripts and 19 first author abstracts. Eight mentees have gone on to be awarded K23's, and 3 to receive R-series awards. The research environment at Tufts Medical Center and Tufts University is highly conducive Dr. Wilson's patient-oriented research and provides several different sources for mentees, and as of 2008 includes a Clinical Translational Science Award (CTSA). Dr. Wilson is Co-PI of the Tufts CTSA and a Director of the Tufts Clinical and Translational Research Portal, which means that the scope of his mentoring is now University wide. The patient oriented research of Dr. Wilson and his mentees focuses on problems with medication adherence in persons with HIV. Despite the availability of one pill once daily treatment for HIV, poor adherence with HIV antiretroviral therapy (ART) clearly continues to be a problem for HIV care providers worldwide. It is also clear that non-infectious comorbidity such as diabetes and cardiovascular disease is increasingly common in persons with HIV, and that medications required for these other conditions further complicate patients'adherence efforts. Progress on this important global problem requires that we be able to quickly and inexpensively identify patients with adherence problems, and that we have interventions to implement in response that target patients'individual needs. That is, we need to both better diagnosis and better treatment. The long term goal of this research is to link the accurate and timely diagnosis of medication adherence problems with customized treatments that are patient and medication specific. The overall research objective of this K24 is to complete a series of 5 significant and novel Aims, all of which focus on improving the quality of diagnosis and treatment of medication adherence problems in persons with HIV. The overall mentoring objective of this K24 is to develop researchers who not only have the skills to develop, implement, and publish hypothesis driven, patient-oriented research, but who understand the importance of bringing a multi-method, multi-disciplinary approach to clinical and translational research problems. In his mentoring Dr. Wilson emphasizes the importance of tailoring research methods to the nature of the problem of interest, even if that means learning new methods or developing collaborations with others from other disciplines familiar with those methods. The proposed research is relevant to the NIH's mission because it attempts to improve the quality of care for patients with a prevalent and serious, but highly treatable, chronic condition, and because the lessons learned from this HIV-related work are directly applicable to the care patients with other chronic conditions.

Public Health Relevance

Improving the health outcomes of persons with chronic conditions generally requires lifelong adherence with effective medications, which most patients find difficult. The patient-oriented research proposed in this K24 focuses broadly on improving both the diagnosis and treatment of medication adherence problems in persons with HIV. In addition, the mentoring plan that Dr. Wilson will implement will contribute to the training of the next generation of researchers to continue this important multidisciplinary work. While this K24 focuses on HIV, the lessons learned from this work are directly applicable to the care patients with other chronic conditions.

National Institute of Health (NIH)
Midcareer Investigator Award in Patient-Oriented Research (K24)
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Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
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Stirratt, Michael J
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Brown University
Public Health & Prev Medicine
Schools of Public Health
United States
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Genberg, Becky L; Lee, Yoojin; Rogers, William H et al. (2015) Four types of barriers to adherence of antiretroviral therapy are associated with decreased adherence over time. AIDS Behav 19:85-92
Wilson, Ira B; Fowler Jr, Floyd J; Cosenza, Carol A et al. (2014) Cognitive and field testing of a new set of medication adherence self-report items for HIV care. AIDS Behav 18:2349-58
Wallace, Byron C; Laws, M Barton; Small, Kevin et al. (2014) Automatically annotating topics in transcripts of patient-provider interactions via machine learning. Med Decis Making 34:503-12
Laws, M Barton; Lee, Yoojin; Rogers, William H et al. (2014) Provider-patient communication about adherence to anti-retroviral regimens differs by patient race and ethnicity. AIDS Behav 18:1279-87
Mayfield, Elijah; Laws, M Barton; Wilson, Ira B et al. (2014) Automating annotation of information-giving for analysis of clinical conversation. J Am Med Inform Assoc 21:e122-8
Galarraga, Omar; Genberg, Becky L; Martin, Rosemarie A et al. (2013) Conditional economic incentives to improve HIV treatment adherence: literature review and theoretical considerations. AIDS Behav 17:2283-92
Laws, M Barton; Taubin, Tatiana; Bezreh, Tanya et al. (2013) Problems and processes in medical encounters: the cases method of dialogue analysis. Patient Educ Couns 91:192-9
Liu, Honghu; Wilson, Ira B; Goggin, Kathy et al. (2013) MACH14: a multi-site collaboration on ART adherence among 14 institutions. AIDS Behav 17:127-41
Laws, M Barton; Beach, Mary Catherine; Lee, Yoojin et al. (2013) Provider-patient adherence dialogue in HIV care: results of a multisite study. AIDS Behav 17:148-59
Flickinger, Tabor E; Rose, Gary; Wilson, Ira B et al. (2013) Motivational interviewing by HIV care providers is associated with patient intentions to reduce unsafe sexual behavior. Patient Educ Couns 93:122-9

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