Barriers to Effective HIV Care for Injection Drug Users After Release from Prison

注射吸毒者出狱后有效治疗艾滋病毒的障碍

• 批准号: 8410792
• 负责人: Ryan Patrick Westergaard
• 金额: $ 19.49万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-15 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8410792
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Aftercare; Anti-Retroviral Agents; Applied Research; Area; Award; Back; Behavior; Caring; Clinical Investigator; Cohort Studies; Collaborations; Communities; Competence; Complex; Continuity of Patient Care; Data; Data Sources; Databases; Development Plans; Drug user; Ensure; Environment; Ethical Issues; Faculty; Funding; Future; General Population; Goals; HIV; HIV Infections; Health; Health Services Accessibility; High Prevalence; Imprisonment; Individual; Injecting drug user; Interdisciplinary Study; Intervention; Interview; Intravenous; Left; Life; Link; Maryland; Medical Records; Medicine; Mental Health; Mentors; Methods; National Institute of Drug Abuse; Neighborhoods; Outcome; Participant; Patients; Perception; Pharmaceutical Preparations; Phase; Population; Primary Health Care; Prisons; Process; Provider; Public Health; Qualitative Methods; Qualitative Research; Questionnaires; Regimen; Research; Research Infrastructure; Research Methodology; Research Personnel; Research Project Grants; Risk; Sampling; Science; Services; Site; Structure; System; Testing; Time; Training; Training Activity; Universities; Viral Load result; Visit; Wisconsin; Work; abstracting; antiretroviral therapy; base; career; career development; clinical care; cohort; density; design; experience; follow-up; improved; innovation; member; novel; patient oriented; prevent; programs; social; substance abuse treatment; success; therapy development; transmission process

DESCRIPTION (provided by applicant): Candidate: My career goal is to improve the health of people living with HIV through interdisciplinary research aimed at reducing barriers to optimal HIV care for traditionally underserved patient groups. My short term goal is to establish myself as an independent investigator as a tenure-track junior faculty member at the University of Wisconsin-Madison, and to develop an innovative research program in collaboration with state and federal prison systems. Research Project: My proposed research uses an innovative, mixed-methods approach to comprehensively evaluate barriers to accessing continuous HIV care for people who become incarcerated. I propose three distinct aims which will address this question using different types and sources of data, in order to identify which factors causing suboptimal care are the most important and potentially amenable to intervention. Aim 1 will utilize longitudinal data from the AIDS Linked to the Intravenous Experience (ALIVE) study to examine individual and neighborhood-level factors associated with poor linkage to care following incarceration. Aim 2 will be an expanded analysis of HIV care outcomes that incorporates retrospectively-collected medical records data from correctional facilities for ALIVE participants who were incarcerated between 1998 and 2011. Aim 3 will confirm and inform the findings of quantitative phase of the study through semi-structured interviews with patients while they are receiving HIV care in prison, and follow-up interviews within several months after release to the community. Career Development Plan: My proposed training and mentoring activities will center around (1) attaining expertise in analysis of complex longitudinal data; (2) developing competence using qualitative research methods; (3) building partnerships with correctional agencies for HIV research; and (4) deeper understanding of ethical issues surrounding research in correctional settings. My applied research will be closely coordinated with my training activities, and will build toward an application for an R01-funded project in the fourth year of this award. Research Environment: I will be well-supported within the Department of Medicine at UW-Madison. In addition, I will benefit from the excellent research infrastructure of the ALIVE study at Johns Hopkins (Aims 1 & 2), and a large, NIDA-funded study of Seek, Test, and Treat Strategies for HIV in the WI Department of Corrections (Aim 3). PUBLIC HEALTH RELEVANCE: People in prison in the U.S. have a higher prevalence of HIV than the general population and may also be more likely to engage in behaviors that place others at risk for HIV when released back to the community. Developing strategies to ensure that incarcerated people continue to receive effective antiretroviral treatment after release may reduce the transmission of HIV in communities and decrease long-term complications of HIV infection.

描述（由申请人提供）：候选人：我的职业目标是通过跨学科研究改善艾滋病毒感染者的健康，旨在减少传统上服务不足的患者群体获得最佳艾滋病毒护理的障碍。我的短期目标是建立自己作为一个独立的调查员作为威斯康星大学麦迪逊分校的终身教职的初级教员，并制定与国家和联邦监狱系统合作的创新研究计划。研究项目：我提出的研究使用创新的混合方法来全面评估被监禁者获得持续艾滋病毒护理的障碍。我提出了三个不同的目标，这将解决这个问题，使用不同类型和来源的数据，以确定哪些因素导致次优护理是最重要的，并可能适合干预。目标1将利用艾滋病与静脉注射经验（ALIVE）研究的纵向数据，研究与监禁后护理联系不佳相关的个人和社区因素。目标2将扩大对艾滋病毒护理结果的分析，其中包括从1998年至2011年期间被监禁的ALIVE参与者的惩教设施中回顾性收集的医疗记录数据。目标3将通过对在监狱接受艾滋病毒护理的患者进行半结构化访谈，以及在释放到社区后几个月内进行后续访谈，确认并通报研究定量阶段的结果。职业发展计划：我建议的培训和指导活动将围绕（1）获得分析复杂纵向数据的专业知识;（2） 使用定性研究方法发展能力;（3）与惩教机构建立艾滋病毒研究的伙伴关系;（4）更深入地了解惩教环境中研究的伦理问题。我的应用研究将与我的培训活动密切协调，并将在该奖项的第四年申请R 01资助的项目。研究环境：我将在威斯康星大学麦迪逊分校医学系内得到很好的支持。此外，我将受益于约翰霍普金斯的ALIVE研究（目标1和2）的优秀研究基础设施，以及一项由美国国家免疫发展局资助的大型研究，即威斯康星州惩教部的艾滋病毒寻找，测试和治疗策略（目标3）。 公共卫生相关性：美国监狱中的人艾滋病毒的流行率高于一般人群，并且在释放回社区时也更有可能从事使其他人面临艾滋病毒风险的行为。制定战略，确保被监禁者在获释后继续获得有效的抗逆转录病毒治疗，可减少艾滋病毒在社区的传播，并减少艾滋病毒感染的长期并发症。