Technology-based adaptive treatment strategies for antiretroviral adherence

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.