Opiate Dependence, HIV and Adherence Interventions

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DESCRIPTION (provided by applicant): This application is a request for a Mentored Patient-Oriented Research Career Development Award (K23) to prepare Dr. Sandra Springer to become an independent investigator. She will accomplish this goal through directed coursework, mentoring from accomplished researchers, involvement with three focused research projects and submission of scholarly manuscripts. Specifically, she will receive training in the design and implementation of interventions for adherence to antiretroviral therapy and drug treatment for opiate-addicted HIV+ individuals being released from the correctional setting. Her research has demonstrated that HIV+ prisoners with opiate dependence improve their CD4 count and viral load while incarcerated. This benefit, however, is lost as these individuals relapse to drug use, fail to adhere to antiretroviral therapy and result in poor health outcomes. Dr. Springer has also assisted with development of community-based adherence interventions for HIV+ drug users. During her career development, she will gain training and experience to connect released HIV+ prisoners to effective interventions. Dr. Springer will sequentially conduct three projects during her career development award. The first include secondary data analyses of factors that effect adherence to antiretroviral therapy among HIV+ drug users in a randomized controlled trial of directly administered antiretroviral therapy (DAART). The second project will evaluate the feasibility of linking HIV+ drug users to a methadone maintenance program and providing DAART within that setting. The third project will first link HIV+ prisoners to buprenorphine treatment upon release from prison, followed by a second feasibility study of linking them to buprenorphine plus DAART. The career development plan is a carefully staged approach to provide Dr. Springer with the skills and data necessary to develop an R01 and become an independent investigator by the end of the award. Her work will contribute greatly to the interface between HIV and substance abuse treatment where rigorously evaluated interventions are needed.