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: 8424265
• 负责人: DIANE S MORSE
• 金额: $ 17.22万
• 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/8424265
• 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.

国家药物滥用研究所（NIDA）的指导K23临床科学家发展奖将培训我作为一名独立的研究者，对患有药物使用障碍（SUD），HIV和/或丙型肝炎（HCV）和创伤史的共病，周期相关条件的女性进行基于理论的激励方法。我带来了一个独特的视角，作为一个内科医生照顾服务不足的妇女结合我的研究在理论为基础的动机应用于HCV服务的利用和亲密伴侣暴力（IPV）安全行为。我感兴趣的是从临床和公共卫生的角度来看，影响妇女在刑事司法环境中利用卫生服务的潜在动机。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）是指导我的研究的经验性动机模型。这项研究将需要在卫生服务、研究设计、定量评估和分析、特殊和差别待遇以及影响女被告的共病周期方面增加专门知识。我的方法结合了经验策略，刑事司法设置，以及对所需医疗服务的性别和创伤知情方法。我将调整我基于SDT的动机干预，以创建一个我称之为妇女健康支持倡议（WISH）的项目。在刑事司法环境中，艾滋病毒和丙型肝炎病毒的治疗不足是一个重大的公共卫生问题。1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。2，3 NIDA，CDC和美国公共卫生协会呼吁将艾滋病毒和丙型肝炎病毒治疗的有效和普遍方法作为刑事司法人群的研究重点。研究所的建议支持在虐待儿童或IPV历史高发的背景下解决妇女面临的综合风险。此外，他们建议调整服务以满足个人需求。我提出的研究项目的目标与这些国家的优先事项是一致的。1，4-7证据表明，女性SUD，而在长期监禁，可以坚持治疗艾滋病毒和丙型肝炎病毒。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。药物治疗法庭采用奖励和制裁模式，在吸引参与者的同时减少药物使用和累犯方面一直很有效。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治人群有效。12 -16它们支持在不同种族、社会经济和边缘化人群中消除目标行为的污名。17 -19这是刑事司法环境的关键。然而，动机背后的理论模型 方法并没有被广泛理解。特殊和差别待遇是一个以证据为基础的理论模型，它确立了自主动机作为改善人群健康行为的媒介，包括那些患有SUD或艾滋病毒的人。例如，对刑事司法环境中的妇女的医学研究不足。艾滋病毒和丙型肝炎病毒的流行率是未知的药物治疗法院的人口。在我提议的K23项目中，我将开始我的长期职业计划，研究WISH在治疗不足的女性药物治疗法庭被告中的可行性和效果。我将调查的作用，SDT在预测的治疗动机的变化影响艾滋病毒和HCV相关的服务。探索最近的动机结果确保了我的建议的相关性，不管WISH的效果如何。在K23指导期间，我将通过指导和指导课程获得研究培训和知识。我将利用我的知识和经验，使用行为治疗的阶段模型。21我将通过研究促进适当的服务利用，确立自己作为一个独立的调查员。K23指导临床科学家奖将使我能够实现以下目标：1。在刑事司法环境中改编和描述WISH。2.获得研究方法的培训：a）与患有并发症SUD，HIV，HCV或刑事司法参与（伦理，CBPR，卫生服务）的人的独特需求相关; B）先进的定量方法3。成为SDT关于方法，措施和结果的专家。4.提供背景资料，以告知R 01奖申请将在项目的第4年编写。与部门导师和研究资源在药物滥用，艾滋病毒，基于SDT的健康行为改变，刑事司法合作，妇女的健康，服务利用和临床研究方法，我非常适合从这个K23奖受益。我的背景为我提供了理解的深度和理想的时机来进行这个职业发展研究计划有效地解决复杂的服务需求的妇女与SUD，艾滋病毒，丙型肝炎病毒和IPV的风险，和创伤史。这些女被告迫切的公共卫生需求要求采取一种创造性的、基础广泛的方法。