Understanding Longitudinal Clinical Outcomes and Post-release Retention in Care among HIV-infected Prisoners in Lusaka, Zambia

了解赞比亚卢萨卡感染艾滋病毒的囚犯的纵向临床结果和释放后保留护理

• 批准号: 9028902
• 负责人: Michael Emmanuel Herce
• 金额: $ 13.6万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-23 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9028902
• 关键词: Address; Affect; Africa South of the Sahara; Alcohol consumption; Alcohol or Other Drugs use; American; Anti-Retroviral Agents; Area; Attention; Attitude; Automobile Driving; Award; Behavior Therapy; Behavioral Model; Behavioral Research; Biometry; CD4 Lymphocyte Count; Caring; Cells; Cessation of life; Classification; Clinical; Clinical Research; Communicable Diseases; Communities; Connecticut; Continuity of Patient Care; Data; Databases; Disease Progression; Drug usage; Elements; Enabling Factors; Enrollment; Epidemiologic Methods; Epidemiology; Ethical Issues; Faculty; Focus Groups; Foundations; Funding; Future; Goals; HIV; HIV Infections; HIV risk; HIV-1; Health; Health Benefit; Health behavior; High Prevalence; Human Subject Research; Imprisonment; Individual; Infectious Diseases Research; Inferior; International; Intervention; Interview; Knowledge; Lead; Learning; Life; Medicine; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Modeling; Morbidity - disease rate; North America; North Carolina; Outcome; Participant; Persons; Physicians; Play; Population; Prevalence; Prevention; Prisoner; Prisons; Psychology; Psychometrics; Psychosocial Influences; Public Health; Publishing; Qualifying; Qualitative Evaluations; Questionnaires; Reporting; Research; Research Activity; Research Personnel; Research Project Grants; Resources; Risk; Risk Behaviors; Role; Sampling; Services; Severities; South Africa; Staging; Substance Use Disorder; System; Training; Training Activity; Tuberculosis; Universities; Viral Load result; Viremia; Vulnerable Populations; Zambia; alcohol use disorder; antiretroviral therapy; base; career; career development; cohort; design; experience; follow-up; global health; high risk; instrument; international center; mortality; patient oriented research; preference; prevent; professor; programs; psychosocial; scale up; skills; theories; therapy design; transmission process

ABSTRACT This is an application for a Fogarty International Center International Research Scientist Development Award for Dr. Michael Herce, an infectious disease physician and experienced global health program implementer at the University of North Carolina at Chapel Hill (UNC). Dr. Herce is in the formative stage of his research career and aims to establish himself as an independent global health investigator in the areas of applied health behavior theory and HIV-related corrections research in sub-Saharan Africa (SSA). This award will provide Dr. Herce with the support necessary to achieve the following career development goals: (1) to advance his training in the responsible conduct of human subjects research, with a special focus on the ethical issues related to research involving prisoners; (2) to learn to apply health behavior theory and the qualitative evaluation of health behaviors in patient-oriented research and behavioral intervention design; (3) to obtain formal training in assessing and addressing alcohol use disorders (AUDs) and other psychosocial issues among HIV-infected prison populations in SSA; (4) to acquire advanced analytical skills in epidemiology and biostatistics; and (5) to develop expertise in the design, implementation, and oversight of large multi- disciplinary research projects in SSA. To realize these goals, Dr. Herce has assembled a highly accomplished and experienced core mentorship team comprised of: his U.S. primary mentor, Dr. David Wohl, UNC Associate Professor of Medicine and a recognized leader in clinical research involving HIV-infected prisoners; his Zambia primary mentor, Dr. Stewart Reid, UNC Associate Professor of Medicine, Senior Faculty Advisor to the Centre for Infectious Disease Research in Zambia (CIDRZ), and an expert in HIV and tuberculosis research and service delivery in Zambian prison populations; and Dr. Carol Golin, UNC Associate Professor of Medicine and Health Behavior, and an expert in HIV behavioral research and prevention efforts involving incarcerated people. Supporting Dr. Herce and his core mentors are two committed resource mentors: Dr. William Miller, an expert in advanced epidemiological methods and mentoring young global health investigators to career independence, and Dr. Seth Kalichman, a Professor of Psychology at the University of Connecticut and an expert in AUDs as they relate to HIV-risk behaviors for persons living with HIV in SSA. Globally, 10 million people are currently incarcerated, including 1 million prisoners in SSA. SSA prisons concentrate large numbers of people with, and at risk for, HIV infection. We and others have extended the regional scale-up of anti-retroviral therapy to include SSA prisons, and have shown that SSA inmates can start ART while detained and achieve excellent clinical outcomes in prison. However, the individual and public health benefits afforded by ART in prisons are often lost for prisoners after release (“releasees”) due to poor retention in HIV care. The factors driving this problem in SSA are unexplored, but AUDs are thought to play an important role due to their high prevalence in this population. To inform the design of a future transitional HIV care intervention, Dr. Herce proposes mentored research to prospectively assess clinical outcomes for HIV- infected prisoners after release (Aim 1); explore factors from health behavior theory that are associated with post-release retention in care, with a special focus on alcohol use disorders (Aims 2 & 2a); and conduct formative research to determine releasee and stakeholder knowledge, attitudes, and preferences surrounding transitional care interventions (Aim 3). To conduct his proposed research, Dr. Herce will leverage a national unique identifier system and HIV clinical database and an ongoing Gates Foundation-funded CIDRZ study. Understanding how AUDs and other factors influence the care continuum for HIV-infected prisoners after release is critical to developing future programs to keep this population retained in care, reduce prisoner morbidity and mortality, and prevent onward HIV transmission in communities to which prisoners return. The research and training activities outlined here will generate currently unavailable data to inform the design of such a transitional care program, and will form the basis of a R01 application to be completed before the end of the award period to evaluate this intervention among HIV-infected releasees in SSA.

摘要 这是福格蒂国际中心国际研究科学家发展的申请 Michael Herce博士，传染病医生和经验丰富的全球卫生计划 在查佩尔山的北卡罗来纳州大学的实施者。赫塞博士正处于他的 研究生涯，旨在建立自己作为一个独立的全球健康调查员在以下领域 在撒哈拉以南非洲（SSA）应用健康行为理论和艾滋病毒相关的矫正研究。这个奖项 将为Herce博士提供必要的支持，以实现以下职业发展目标：（1） 推进他在负责任地进行人类受试者研究方面的培训，特别注重道德 （2）学习运用健康行为理论和质的研究方法， 以病人为中心的研究和行为干预设计中的健康行为评价;（3）获得 在评估和解决酒精使用障碍（AUD）和其他社会心理问题方面进行正式培训 （4）获得流行病学方面的高级分析技能， 生物统计学;和（5）发展设计，实施和监督大型多学科的专业知识， 在SSA的学科研究项目。为了实现这些目标，Herce博士组建了一个非常有成就的团队， 经验丰富的核心导师团队包括：他的美国主要导师，大卫沃尔博士，副教授 医学教授和涉及艾滋病毒感染囚犯的临床研究的公认领导者;他的赞比亚 主要导师，Stewart Reid博士，医学副教授，该中心的高级教师顾问 赞比亚传染病研究中心（CIDRZ），艾滋病毒和结核病研究专家， 在赞比亚监狱人口中提供服务;和医学和心理学副教授Carol Golin博士 健康行为，以及艾滋病毒行为研究和预防工作的专家，涉及监禁 人支持Herce博士和他的核心导师是两个致力于资源导师：威廉米勒博士， 高级流行病学方法专家，指导年轻的全球卫生调查人员， 塞思·卡利奇曼博士是康涅狄格大学的心理学教授， AUDs的专家，因为他们涉及到艾滋病毒感染者在SSA的艾滋病毒风险行为。 目前，全球有1000万人被监禁，其中包括100万名撒南非洲囚犯。SSA监狱 集中了大量艾滋病毒感染者和有感染风险的人。我们和其他人已经扩大了 * 在区域一级扩大抗逆转录病毒疗法的规模，将撒南监狱也包括在内，并表明撒南监狱的囚犯可以开始 在监狱中获得良好的临床结果。然而，个人和公众 监狱中抗逆转录病毒疗法所提供的健康福利往往在囚犯获释后（“被释放者”）由于贫困而丧失。 艾滋病毒护理的保留。在SSA中驱动这一问题的因素尚未探索，但AUDs被认为是 由于其在这一人群中的高流行率而发挥重要作用。为未来过渡性艾滋病毒的设计提供信息 护理干预，Herce博士建议指导研究，以前瞻性地评估艾滋病毒的临床结果， 释放后感染的囚犯（目标1）;从健康行为理论中探索与 释放后继续接受护理，特别关注酒精使用障碍（目标2和2a）;以及行为 形成性研究，以确定被释放者和利益相关者的知识，态度和偏好， 过渡性护理干预措施（目标3）。为了进行他提议的研究，Herce博士将利用一个全国性的 唯一标识符系统和艾滋病毒临床数据库以及正在进行的盖茨基金会资助的CIDRZ研究。 了解AUD和其他因素如何影响对艾滋病毒感染囚犯的连续护理 释放后是至关重要的发展未来的计划，以保持这一人口在照顾，减少囚犯 预防艾滋病毒在囚犯返回的社区的进一步传播。的 这里概述的研究和培训活动将产生目前无法获得的数据， 这样一个过渡性的护理计划，并将形成一个R 01应用程序的基础上完成年底前， 奖励期间，以评估这种干预艾滋病毒感染的释放在SSA。