Evaluating and Improving HIV Outcomes in Community-Based Women who Interface with

描述（由申请人提供）：艾滋病毒/艾滋病（PLWHA）感染者在出狱后没有参与或很快停止护理，通常是在竞争性需求的背景下。尽管刑事司法环境中妇女的艾滋病毒流行率比男性高几倍，但她们的艾滋病毒治疗结果没有得到实证检验，也没有成为二级预防干预的目标。在社区监督下（例如缓刑、假释）感染艾滋病毒的妇女尤其存在差距，她们的竞争压力往往包括持续的人际暴力、管理家庭责任以及应对复杂的护理和监督系统。为了解决这些关键差距，第一个项目是对1250名艾滋病毒释放的监狱被拘留者（250名女性）的纵向数据进行二次分析，这些被拘留者参加了“加强与监狱环境中艾滋病毒初级保健和服务的联系”倡议，这是一个由人权服务局资助的具有国家意义的特别项目。该分析侧重于这一队列中的性别差异，探讨了一个中心假设，即对于即将离开监狱的艾滋病毒感染者来说，持续的艾滋病毒护理、抗逆转录病毒依从性和病毒抑制的主要障碍是抑郁、积极使用药物和亲密伴侣暴力。在这些发现的基础上，第二个项目采用混合方法调整和试点测试了全面健康康复方案（HHRP），这是一项以疾病预防控制中心为基础的干预措施，将作为一个框架，优化社区惩教监督下妇女的艾滋病毒治疗结果。候选人杰米·迈耶（Jaimie Meyer）博士是完成这项工作的独特人选，因为她是医学人类学家和艾滋病毒医生的背景，以及她长期与监狱中感染艾滋病毒的妇女接触。她最近完成了传染病临床研究，目前是耶鲁大学艾滋病跨学科研究中心的博士后研究员。她的长期职业目标和专业目标是：1)开发必要的研究方法的专业知识，以设计，执行和评估与CJS中妇女艾滋病毒治疗结果相关的临床试验；2)获得干预措施开发、适应、测试、实施和传播方面的经验，以解决影响优化艾滋病毒治疗结果的性别障碍；3)在以患者为导向的研究领域开辟一条独立的职业道路，重点研究艾滋病毒、妇女健康和药物滥用之间的关系。为了实现这些目标，并成功地从临床医生转变为独立资助的医师学者，她组建了一支优秀的跨学科指导团队，在艾滋病毒、妇女健康、药物滥用、CJS、流行病学和干预发展方面具有专业知识。在他们的指导下，她将完成相关的教学课程，最终获得硕士学位，并接受统计和流行病学方面的高级培训。她成功的职业生涯轨迹是在艾滋病、CJS妇女健康和药物滥用方面的独立临床研究员，耶鲁大学丰富的资源环境进一步促进了她的发展。

DESCRIPTION (provided by applicant): People living with HIV/AIDS (PLWHA) do not engage in or discontinue care soon after prison-release, often in the context of competing needs. Despite HIV prevalence among women in criminal justice settings (CJS) being several-fold higher than among men, their HIV treatment outcomes have not been empirically examined nor have they been targeted for secondary prevention interventions. A particular gap exists for HIV-infected women under community supervision (e.g. probation, parole) whose competing stresses often include ongoing interpersonal violence, managing family responsibilities and navigating complex systems of care and supervision. To address these critical gaps, the first project is a secondary analysis of longitudinal data from 1250 released jail detainees with HIV (250 are women) enrolled in the Enhancing Linkages to HIV Primary Care and Services in Jail Settings Initiative, a HRSA-funded Special Project of National Significance. The analysis focuses on gender differences in this cohort, exploring the central hypothesis that, particularly for women with HIV leaving jail, the major barriers to persistent HIV care, antiretroviral adherence, and viral suppression are depression, active substance use, and intimate partner violence. Building on these findings, the second project employs mixed methods to adapt and pilot test the Holistic Health Recovery Program (HHRP), a CDC evidence-based intervention that will serve as a framework to optimize HIV treatment outcomes for women under community correctional supervision. The candidate, Dr. Jaimie Meyer, is uniquely poised to perform this work because of her background as a medical anthropologist and HIV physician and her prolonged engagement with women with HIV in prison. She recently completed her clinical fellowship in Infectious Diseases and is currently a post-doctoral research fellow at the Center for Interdisciplinary Research on AIDS at Yale. Her long-term career goals and professional objectives are to: 1) Develop expertise in research methods necessary to design, perform, and evaluate clinical trials relating to HIV treatment outcomes among women in the CJS; 2) Gain experience in intervention development, adaptation, testing, implementation, and dissemination that will address gender-specific barriers to optimized HIV treatment outcomes; and 3) Develop an independent career path in patient-oriented research focused on the interface between HIV, women's health, and substance abuse. To achieve these goals and successfully transition from clinician to an independently funded physician-scholar, she has assembled a stellar interdisciplinary mentoring team with expertise in HIV, women's health, substance abuse, CJS, epidemiology and intervention development. Under their guidance, she will complete relevant didactic coursework, culminating in a Master degree with advanced training in statistics and epidemiology. Her successful career trajectory as independent clinical researcher in HIV, women's health in the CJS, and substance abuse is further fostered by the resource-rich environment available to her at Yale University.