DOT and Prevention for HIV(+) Persons Leaving Prison

描述(由申请人提供)： 这项申请是为了获得以患者为导向的研究职业发展奖(K23)，为詹妮弗·米蒂博士设计和实施研究做好准备，以提高服药依从性，并为出院的艾滋病毒(+)患者提供二级预防。 米蒂博士是布朗医学院的医学助理教授。米里亚姆医院和布朗医学院的临床研究培训环境是K23的理想选择，因为他们在预防、直接观察艾滋病毒(+)患者的治疗方面具有丰富的经验，而且他们在 惩戒人员以及从监狱释放的以下个人。该奖项的主要导师是Timothy Flanigan医学博士，他在药物滥用、预防和观察疗法研究方面拥有丰富的经验，并参与了许多针对HIV(+)患者出狱的研究项目。Mitty博士还将得到一个强大的指导团队的全力支持，其中包括甲型H1V预防领域的领导者Kenneth Mayer博士、在行为预防和定性研究方面有专长的凯瑟琳·莫罗博士，以及在坚持用药、直接观察治疗、药物使用和监禁人口方面拥有专长的非现场导师Rick Altice博士。马卡利诺博士和霍根博士将参与研究设计、仪器开发和分析。 接受高效抗逆转录病毒治疗的艾滋病毒(+)患者离开监狱后，不遵守药物治疗的风险增加，血浆病毒载量增加。此外，我们的网站和其他网站记录了出狱后艾滋病毒危险行为的增加。通过这一项目，将为出狱的艾滋病毒(+)感染者开发一种改进的直接观察治疗和二级预防干预相结合的方法。这项研究的第一阶段将使用定量和定性技术来评估干预的促进者和障碍。在第二阶段，将仿照现有的DOT和二级预防计划，制定试点干预措施。在第三阶段，这项干预将在50名艾滋病毒(+)患者从罗德岛成人惩教所获释后过渡到社区进行试点。将评估干预的可接受性和可行性，以及在释放后前6个月内干预对血浆病毒载量抑制和自我报告的艾滋病毒危险行为的效果。

DESCRIPTION (provided by applicant): This application is a request for a Mentored Patient-Oriented Research Career Development Award (K23) to prepare Dr. Jennifer Mitty to design and implement studies to increase medication adherence and provide secondary prevention to HIV(+) individuals being released from the correctional setting. Dr. Mitty is an Assistant Professor of Medicine at Brown Medical School. The clinical research training environments at the Miriam Hospital and Brown Medical School are ideal for a K23 because of their extensive experience in prevention, directly observed therapy for HIV(+) patients and their work within corrections as well as following individuals being released from prison. The primary mentor for this award is Timothy Flanigan, MD, who has extensive experience in substance abuse, prevention and observed therapy research, and is involved in many research projects with HIV(+) individuals leaving prison. Dr Mitty will also have the full support of a strong mentorship team including Dr. Kenneth Mayer who is a leader in the field of H1V prevention, Dr. Kathleen Morrow whose expertise is in behavioral prevention and qualitative research, and Dr. Rick Altice who will serve as an off-site mentor and has an expertise in medication adherence, directly observed therapy, substance use and incarcerated populations. Drs Macalino and Hogan will be involved in study design, instrument development and analysis. HIV(+) persons leaving prison on highly active antiretroviral therapy are at increased risk of medication non-adherence and increased plasma viral load. In addition, our site and others have documented an increase in HIV risk behaviors after release from prison. Through this project a combined modified directly observed therapy and secondary prevention intervention will be developed for HIV(+) individuals leaving prison. Phase I of this study will use quantitative and qualitative techniques to evaluate facilitators and barriers to the intervention. During Phase II, a pilot intervention will be developed, modeled on existing DOT and secondary prevention programs. In phase III, this intervention will be piloted on 50 HIV(+) individuals transitioning to the community after release from the Adult Correctional Institution in Rhode Island. Acceptability and feasibility of the intervention will be evaluated, as well as efficacy of the intervention on plasma viral load suppression and self-reported HIV-risk behaviors during the first 6 months post release.