Supporting Health in Drug Treatment Court for Women with HIV or Hepatitis C

支持艾滋病毒或丙型肝炎妇女在戒毒治疗法庭的健康

• 批准号: 8263472
• 负责人: DIANE S MORSE
• 金额: $ 17.21万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-02-15 至 2017-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8263472
• 关键词: Address; Alcohol or Other Drugs use; American Public Health Association; Award; Behavior; Behavior Therapy; Behavioral Model; Caring; Centers for Disease Control and Prevention (U.S.); Child Abuse; Clinic; Clinical; Clinical Research; Collaborations; Competence; Complex; County; Criminal Justice; Data; Development; Drug Courts; Drug usage; Effectiveness; Ethics; Feedback; Female; Focus Groups; Foundations; Gender; General Population; Goals; HIV; HIV Infections; Health; Health Services; Health Services Research; Health behavior; Health behavior change; Healthcare; Hepatitis C; Hepatitis C Prevalence; Hepatitis C virus; High Prevalence; Human; Imprisonment; Individual; Institutes; Internist; Intervention; Intervention Studies; Justice; Knowledge; Manuals; Measures; Mediator of activation protein; Medical; Mentored Clinical Scientist Award; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Modeling; Morbidity - disease rate; Motivation; National Institute of Drug Abuse; New York; Nicotine Dependence; Outcome; Outcome Measure; Participant; Patients; Persons; Pharmaceutical Preparations; Phase; Population; Prevalence; Procedures; Process; Public Health; Recommendation; Recording of previous events; Research; Research Design; Research Methodology; Research Personnel; Research Priority; Research Project Grants; Research Training; Resources; Rewards; Risk; Risk Behaviors; Role; Safety; Scientist; Self Determination; Services; Staging; Substance Use Disorder; Substance abuse problem; System; Testing; Theoretical model; Therapeutic; Time; TimeLine; Training; Trauma; Virus Diseases; Woman; Women' s Health Services; Writing; base; career; career development; cost; court; effective intervention; evidence base; experience; health care service utilization; health training; improved; interest; intimate partner violence; meetings; mortality; motivational intervention; partner violence; pilot trial; programs; research and development; response; service utilization; sexual assault; socioeconomics; theories; therapy development; uptake

DESCRIPTION (provided by applicant): The Mentored K23 Clinical Scientist Development Award from the National Institute on Drug Abuse (NIDA) will train me as an independent investigator of theory-based motivational approaches to women with the co-morbid, cyclically-related conditions of Substance Use Disorder (SUD), HIV and/or Hepatitis C (HCV), and trauma histories. I bring a unique perspective as an internist caring for underserved women in combination with my research in theory-based motivation applied to HCV services utilization and intimate partner violence (IPV) safety behaviors. I am interested in the underlying motivation impacting health services utilization of women in criminal justice settings from both the clinical and public health perspectives. I will be examining this motivation in the Drug Treatment Court setting. Self Determination Theory (SDT) is the empiric motivational model informing my research. This research will require increased expertise in health services, research design, quantitative assessment and analysis, SDT, and the cycle of co-morbid conditions impacting women defendants. My approach combines an empiric strategy, the criminal justice setting, and a gender and trauma-informed approach to needed healthcare services. I will adapt my SDT-based motivational intervention to create a program I call the Women's Initiative Supporting Health (WISH). Under-treatment of HIV and HCV among individuals in criminal justice settings is a major public health issue.1 While treatments differ, similar risks exist for HIV and HCV infection and under-treatment.2,3 The NIDA, CDC, and American Public Health Association are calling for effective and generalizable approaches for HIV and HCV treatment as a research priority in the criminal justice population. The institutes' recommendations support addressing combined risks in women, in the context of a high prevalence of child abuse or IPV histories. Furthermore, they recommend adapting services to meet individual needs. The goals of my proposed research project are consistent with these national priorities.1, 4-7 Evidence shows that women with SUD, while in long-term incarceration, can adhere to treatment of HIV and HCV. However, an unmet challenge is their post-release health services utilization. Additionally, to break the cycle of substance abuse, HIV, HCV, medical under-treatment, incarceration, and trauma, concurrent interventions are needed.8 Effective strategies are needed to engage this complex population in treatment. Drug Treatment Courts have been effective with a reward and sanction model in engaging participants while decreasing substance use and recidivism.9-11 Yet they usually do not address healthcare utilization. Motivational interventions have proven effective in difficult-to-treat populations suffering from SUD, nicotine addiction, HIV, and diabetes.12-16 They support destigmatization of targeted behaviors across varied ethnic, socio-economic, and marginalized populations.17-19 This is key in the criminal justice setting. However, the theoretical model underlying motivational approaches is not widely understood. SDT is an evidence-based theoretical model which establishes autonomous motivation as a mediator for improved health behavior in populations, including those with SUD or HIV.14, 20 Health conditions of subsets of the criminal justice populations are poorly understood. For example, women in criminal justice settings are medically under-studied. The prevalence of HIV and HCV is unknown in the Drug Treatment Court population. In my proposed K23 project I will begin my long-term career plan by examining the feasibility and effects of WISH in under-treated women Drug Treatment Court defendants. I will investigate the role of SDT in predicting changes in motivation for treatment influencing HIV and HCV-related services. Exploring proximal motivation outcomes insures the relevance of my proposal regardless of the effect of WISH. During the K23 mentored period, I will obtain research training and knowledge through mentoring and directed coursework. I will build upon my knowledge and experience using the Stage Model of Behavioral Therapies.21 I will establish myself as an independent investigator by studying promotion of appropriate service utilization. The K23 Mentored Clinical Scientist Award will allow me to accomplish the following goals: 1. Adapt and describe WISH in the criminal justice setting. 2. Obtain training in research methods: a) relevant to the unique needs of persons with co-morbid SUD, HIV, HCV or criminal justice involvement (ethics, CBPR, health services); b) advanced quantitative approaches 3. Become expert in SDT regarding approach, measures, and outcomes. 4. Provide background data to inform an R01 award application to be written during year 4 of the project. With departmental mentor and research resources in substance abuse, HIV, SDT-based health behavior change, criminal justice collaborations, women's health, services utilization, and clinical research methods, I am ideally suited to benefit from this K23 award. My background provides me the depth of understanding and the ideal timing to undertake this career development research plan effectively addressing complex service needs of women with SUD, HIV, HCV, and IPV risk, and trauma histories. The compelling public health needs of these women defendants mandate a creative, broad based approach. PUBLIC HEALTH RELEVANCE: This K23 mentored project builds the foundation for Dr. Morse's research career by addressing theory-based motivation mechanisms for drug-using women in criminal justice settings to engage in HIV and HCV-related services. Women's Initiative Supporting Health has the potential to improve autonomous motivation, needed service utilization, and clinical outcomes in a complex, under-treated population caught in a criminal justice, SUD, and trauma cycle by reaching them outside clinic walls. Increased service utilization could reduce overall costs associated with HIV and HCV, and improve individual and public health.

描述（由申请人提供）：由美国国家药物滥用研究所（NIDA）颁发的指导K23临床科学家发展奖将培训我成为一名独立的研究者，以理论为基础的动机方法，研究患有药物使用障碍（SUD）、艾滋病毒和/或丙型肝炎（HCV）和创伤史的女性共病、周期性相关疾病。作为一名照顾得不到充分服务的妇女的内科医生，结合我在HCV服务利用和亲密伴侣暴力（IPV）安全行为的理论动机方面的研究，我带来了独特的视角。从临床和公共卫生的角度来看，我对影响妇女在刑事司法环境中利用卫生服务的潜在动机很感兴趣。我将在药物治疗法庭的背景下研究这一动机。自我决定理论（SDT）是我研究的经验激励模型。这项研究将需要在保健服务、研究设计、定量评估和分析、SDT以及影响女性被告的合并症周期方面增加专门知识。我的方法结合了经验战略，刑事司法设置，以及性别和创伤知情的方法，需要的医疗保健服务。我将调整我基于sdt的动机干预来创建一个项目，我称之为妇女支持健康倡议（WISH）。刑事司法环境中个人对艾滋病毒和丙型肝炎病毒治疗不足是一个主要的公共卫生问题虽然治疗方法不同，但艾滋病毒和丙型肝炎病毒感染和治疗不足存在类似的风险NIDA、CDC和美国公共卫生协会呼吁将有效和可推广的HIV和HCV治疗方法作为刑事司法人群的研究重点。这些研究所的建议支持在儿童虐待或IPV病史高发的背景下解决妇女的综合风险。此外，他们建议调整服务以满足个人需要。我提出的研究项目的目标与这些国家优先事项是一致的。1,4 -7有证据表明，患有SUD的妇女在长期监禁期间可以坚持治疗HIV和HCV。然而，一个尚未解决的挑战是他们释放后对保健服务的利用。此外，为了打破药物滥用、艾滋病毒、丙型肝炎病毒、医疗不足、监禁和创伤的循环，需要同时采取干预措施需要有效的策略使这一复杂人群参与治疗。药物治疗法庭通过奖励和制裁的模式有效地吸引了参与者，同时减少了药物的使用和再犯。9-11然而，它们通常不涉及医疗保健利用。动机干预已被证明对患有SUD、尼古丁成瘾、艾滋病毒和糖尿病的难以治疗的人群有效。12-16他们支持在不同种族、社会经济和边缘化人群中对目标行为进行去污名化。17-19这是刑事司法环境中的关键。然而，理论模型背后的动机