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

刑事司法环境中艾滋病毒和成瘾护理干预培训

• 批准号: 9767752
• 负责人: Gabriel John Culbert
• 金额: $ 20.68万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9767752
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Aftercare; Alcohol or Other Drugs use; Area; Attitude; Behavior Therapy; Belief; Capital; Career Choice; Caring; Cessation of life; Cities; Clinical Trials; Clinical Trials Design; Communities; Comorbidity; Complex; Continuity of Patient Care; Country; Criminal Justice; Data; Diagnosis; Discipline of Nursing; Discrimination; Drops; Drug usage; Education; Epidemic; Evidence based intervention; Funding; Future; Goals; HIV; Health; Heroin; Home environment; Imprisonment; Incidence; Income; Individual; Indonesia; Infection; Injecting drug user; Injections; International; Intervention; K-Series Research Career Programs; Knowledge; Language; Laws; Mentors; Mentorship; Methadone; Methodology; Narcotics; National Institute of Drug Abuse; Needle Sharing; Nursing Assessment; Outcome; Patients; Persons; Pharmaceutical Preparations; Prevalence; Prevention; Prisoner; Prisons; Process; Publishing; Randomized Controlled Trials; Recording of previous events; Reporting; Research; Research Methodology; Research Personnel; Research Project Grants; Resources; Risk; Risk Behaviors; Sex Behavior; Sexual Partners; Social support; Southeastern Asia; Statistical Methods; Stigmatization; Substance Use Disorder; Techniques; Testing; Therapeutic; Training; Viral; Work; addiction; antiretroviral therapy; base; behavior change; career; comparative effectiveness; effective intervention; effectiveness trial; evidence base; experience; high risk; implementation science; improved; innovation; low and middle-income countries; medication compliance; mortality; novel; nursing intervention; prevent; public health relevance; skills; social stigma; systematic review; therapy adherence; therapy development; transmission process

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.

在这四年的建议，博士卡尔伯特将实现他的职业目标，建立一个独立的职业道路 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门知识，以开发、测试和评估基于证据的艾滋病毒干预措施， 成瘾，重点是低收入和中等收入国家的艾滋病毒阳性囚犯;（2）获得提供和 通过精心设计的临床试验，测试复杂的干预措施，以改变个人的行为; 3）增加 熟练掌握分析临床试验的统计方法和评估临床试验过程的技术。 实施.在此阶段，辅导式职业发展奖至关重要，可为候选人提供 培训和经验，以制定和测试对囚犯的复杂干预措施。虽然候选人收到 优秀的博士后指导，他没有以前的经验，开发，测试，或评估循证医学 干预，这是他的职业目标。Culbert博士组建了一个杰出的导师团队， 艾滋病毒，干预发展和临床试验。在他们的指导下，他将完成正式的课程， 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R 01/R34。 印度尼西亚的艾滋病毒流行病正在扩大，并与药物使用和监禁密切相关。很少 艾滋病毒感染者（<8%）接受抗逆转录病毒疗法（ART）治疗，艾滋病毒相关死亡率 从2005年到2013年增长了427%，尽管全球都在减少。印度尼西亚艾滋病毒流行的核心是那些注射艾滋病毒的人。 吸毒者和坚持抗逆转录病毒疗法有问题的囚犯，特别是在获释后。有效利用抗逆转录病毒疗法 囚犯在释放时的健康状况可以改善，并限制艾滋病毒的传播。中确定的 印度尼西亚的巨大治疗差距，拟议的指导研究项目具有高度创新性，因为它们是 美国以外的第一项研究，为获释囚犯开发和测试药物依从性干预， 在全球范围内，ART不依从性和死亡率的风险显著增加。这些目标直接针对NIDA （2016财政年度）艾滋病研究的优先领域包括：1）让药物使用者参与并保持护理;以及2） 为具有挑战性的现实世界环境制定循证干预措施。在项目1中，我们将开发一种ART 在印度尼西亚，使用ATHENA（通过家庭教育的依从性）对获释囚犯进行依从性干预 和护理评估），以证据为基础的干预，作为我们的概念框架。在项目2中，我们 进行一项试验性随机对照试验，以检查文化的可接受性和组织的可行性， 干预这不是一项复制研究。相反，我们使用一种连贯的方法（ADAPT-ITT）来适应文化 ATHENA解决从监狱的过渡-导致新的循证干预。卡伯特博士是 由于他在护理方面的深厚背景，他的印度尼西亚语技能， 以前在印度尼西亚监狱的研究经验。候选人需要大量的培训，但是， 开发、测试和评估在国际环境中对囚犯的复杂干预措施。