The proposed K23 application will strongly support Dr. Raeanne Moore's long-term career goal of becoming an independent clinical scientist investigating and promoting optimal functioning among older HIV+ adults, with applied expertise in using innovative mobile health technologies. The proposal has considerable
because 1) the older HIV+ population is growing, 2) daily functioning difficulties are common among older persons living with HIV, and 3) disability costs associated with these impairments place a significant burden on society. Available assessment methods do not capture the combination of risk and protective factors impacting daily functioning, [nor do they assess day-to-day variability in daily functioning], at the intersection of HIV and aging. Ecological Momentary Assessment (EMA) via smartphones is a cost-effective, ambulatory data collection technique that allows for real-time, in vivo assessment of relationships between daily life experiences, thoughts, feelings, and behaviors. Preliminary work by the candidate demonstrated the feasibility and acceptability of smartphone-based EMA methods in older HIV+ adults. [The targeted research project aims to use EMA to: 1) accurately identify the kinds of daily activities older HIV+ adults engage in and how they appraise their success in these activities, 2) identify which patients are at the greatest risk for poor functioning (e.g., those wth poorest cognition), which will help us identify patients with the greatest need for clinical servics, and 3) test psychological mechanisms (e.g., depressed mood) that might be driving daily fluctuations in functioning. Results of this project will enrich our knowledge of the challenges faced by older adults with HIV and set the stage for Dr. Moore to develop mobile treatments that anticipate individual downward trajectories of daily functioning. This project is directly relevantto NIMH Strategic Objective #4 of using mobile technology to strengthen the public health impact of NIMH-supported research.] Mentored research will be supplemented with structured career development activities. These activities will fill a critical gap in Dr. Moore's past training by enabling her to achieve the following career goals: 1) acquire key neuroAIDS knowledge [(i.e., neurocognitive, neuromedical, and psychiatric aspects of aging with HIV)]; 2) acquire expertise in EMA methodology and data analysis; 3) gain research skills in [personalized mobile intervention trial design and analysis;] and 4) enhance her professional development skills to design and conduct high-impact studies on the integration of topics in goals 1-3. To facilitate the successful completion of her training objectives and career goals, Dr. Moore has assembled an accomplished, multidisciplinary mentoring team with specific project-relevant expertise, including: assessment and intervention studies with HIV+ persons using mobile technology (Primary Mentor, David J. Moore); EMA and mobile interventions among older adults (Co-Mentor, Colin A. Depp); [advanced longitudinal biostatistics (Co-Mentor, Florin Vaida)]; neuromedical aspects of aging with HIV and clinical outcomes (Co-Mentor, Scott L. Letendre); [mobile health (mHealth) ethics (Consultant, Camille Nebeker)]; cutting-edge advances in mobile health technology (Consultant, Kevin Patrick); neuropsychology and functional outcomes in HIV (Consultant, Robert K. Heaton); and psychosocial clinical trials and real-time mobile interventions (Consultant, Eric Granholm). This proposal will capitalize on the University of California, San Diego infrastructure, including the HIV Neurobehavioral Research Program (HRNP), Stein Institute for Research on Aging, Center for Wireless and Population Health Systems, and Clinical and Translational Research Institute. The proposed hands-on research training, strong mentorship team, robust infrastructure, coursework, didactics, and scholarly activities, along with her past research and clinical experiences, will place Dr. Moore in a unique position to conduct high impact research to serve the [functional rehabilitation] needs of a growing, underserved and vulnerable population of older persons living with HIV. PUBLIC HEALTH RELEVANCE: Daily functioning difficulties are common among older persons living with HIV, and disability costs associated with these impairments place a significant burden on society. Available assessment methods do not capture the combination of risk and protective factors impacting daily functioning at the intersection of HIV and aging, and the proposed study will use Ecological Momentary Assessment (EMA) as a low cost, efficient, objective measure of functioning among older persons with HIV. Understanding the primary factors leading to functional impairments at an individual level will inform the development of new interventions aimed at reducing disability and improving overall quality of life among older persons living with HIV.
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