Training in Nursing Interventions for HIV and Addiction in Criminal Justice Settings

在这项提议的四年时间里，卡尔伯特博士将实现他的职业目标--建立一条独立的职业道路 通过三个培训目标制定、测试和传播艾滋病毒和成瘾干预措施：(1 发展研究方法方面的专业知识，以开发、测试和评估艾滋病毒和艾滋病的循证干预措施 上瘾，重点是低收入和中等收入国家的艾滋病毒+囚犯；(2获得提供和 通过精心设计的临床试验，测试针对个人行为改变的复杂干预措施；3)增加 精通临床试验分析的统计方法和评估过程的技术 实施。在这个阶段，一个有指导的职业发展奖是必不可少的，以便为候选人提供 培训和经验，以开发和测试复杂的囚犯干预措施。尽管候选人收到了 出色的博士后指导，他之前没有开发、测试或评估循证证据的经验 干预，这是他的职业目标。卡尔伯特博士在以下领域组建了一支杰出的导师团队 艾滋病毒、干预开发和临床试验。在他们的指导下，他将完成正式的课程和 进行研究以实现他的职业目标，并在完成K奖后提交极具竞争力的R01/R34。 印度尼西亚的艾滋病毒流行正在扩大，并与吸毒和监禁密切相关。很少 艾滋病毒携带者(8%)接受抗逆转录病毒疗法(ART)治疗，艾滋病毒相关死亡率 2005-13年间增长了427%，尽管全球范围内有所减少。印尼艾滋病毒流行的核心是注射疫苗的人 毒品，以及对坚持抗逆转录病毒治疗有问题的囚犯，特别是在获释后。有效地使用艺术在 被释放的囚犯可以改善健康状况，限制艾滋病毒的传播。设置在...的上下文中 印度尼西亚巨大的治疗差距，拟议的指导性研究项目具有很高的创新性，因为它们是 美国以外的第一项研究开发和测试了对获释囚犯的服药依从性干预， 在全球范围内，抗逆转录病毒治疗不遵守和死亡的风险显著增加。这些目标直接针对NIDA (2016财年)艾滋病研究的优先领域包括：1)吸引和留住接受护理的药物使用者；以及2) 为具有挑战性的真实世界环境开发基于证据的干预措施。在项目1中，我们将开发一种艺术 使用雅典娜对印度尼西亚获释囚犯的坚持干预(通过家庭教育坚持 和护理评估)，这是一种循证干预，作为我们的概念框架。在项目2中，我们将 进行试点随机对照试验，以检查文化可接受性和组织可行性 干预。这不是一项重复研究。相反，我们使用一种连贯的方法(Adapt-ITT)来进行文化适应 雅典娜解决了从监狱过渡的问题--导致了新的以证据为基础的干预。卡尔伯特博士是 独一无二地准备从事这项工作，因为他在护理方面有很强的背景，他的印尼语技能，以及 以前在印度尼西亚监狱的研究经验。然而，应聘者需要经过大量的培训才能 在国际环境中开发、测试和评估针对囚犯的复杂干预措施。

Over the four years of this proposal, Dr. Culbert will achieve his career goal of establishing an independent career path developing, testing, and disseminating interventions for HIV and addiction through three training objectives: (1 Develop expertise in research methods to develop, test, and evaluate evidence-based interventions for HIV and addiction with a focus on HIV+ prisoners in low and middle-income countries; (2 Gain experience delivering and testing complex interventions for behavior change with individuals through well-designed clinical trials; 3) Increase proficiency in statistical methods for analyzing clinical trials and techniques for evaluating processes of implementation. A mentored career development award is essential at this stage to provide the candidate with training and experience to develop and test complex interventions with prisoners. Although the candidate received excellent postdoctoral mentoring, he has no prior experience developing, testing, or evaluating evidence-based interventions, which are his career aims. Dr. Culbert has assembled an outstanding team of mentors in the fields of HIV, intervention development, and clinical trials. Under their guidance, he will complete formal coursework and conduct research to achieve his career goals and submit a highly competitive R01/R34 upon completion of the K award. The HIV epidemic in Indonesia is expanding and closely intertwined with substance use and incarceration. Very few people living with HIV (<8%) receive treatment with antiretroviral therapy (ART), and HIV-related mortality has increased 427% from 2005-13, despite global reductions. At the core of Indonesia's HIV epidemic are people who inject drugs, and prisoners for whom ART adherence is problematic, especially after prison release. Effective use of ART in prisoners at the point of release could improve health outcomes and limit the spread of HIV. Set in the context of Indonesia's large treatment gap, the proposed mentored research projects are highly innovative because they are the first studies outside the U.S. to develop and test a medication adherence intervention for released prisoners, who globally are at markedly increased risk of ART non-adherence and mortality. These aims directly address NIDA (FY2016) priority areas for AIDS research including: 1) engaging and retaining substance users in care; and 2) developing evidence-based interventions for challenging, real-world settings. In Project 1, we will develop an ART adherence intervention for released prisoners in Indonesia, using ATHENA (Adherence Through Home Education and Nursing Assessment), an evidence-based intervention, as our conceptual framework. In Project 2, we will conduct a pilot randomized controlled trial to examine cultural acceptability and organizational feasibility of the intervention. This is not a replication study. Rather, we use a coherent methodology (ADAPT-ITT) to culturally adapt ATHENA to address the transition from prison – resulting in a new evidence-based intervention. Dr. Culbert is uniquely poised to conduct this work because of his strong background in nursing, his Indonesian language skills, and previous research experience in Indonesian prisons. The candidate requires substantial training, however, to be able to develop, test, and evaluate complex interventions with prisoners in international settings.