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: 8792203
• 负责人: DIANE S MORSE
• 金额: $ 17.23万
• 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 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8792203
• 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.

描述(由申请者提供)：国家药物滥用研究所(NIDA)颁发的指导K23临床科学家发展奖将培训我成为一名基于理论的激励方法的独立调查员，以研究患有药物使用障碍(SUD)、艾滋病毒和/或丙型肝炎(HCV)和创伤病史的女性的共同疾病和周期性相关疾病。作为一名照顾服务不足的女性的内科医生，我结合我对应用于丙型肝炎病毒服务利用和亲密伴侣暴力(IPV)安全行为的基于理论的动机的研究，带来了一个独特的视角。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保健服务的根本动机。我将在戒毒法庭的环境中研究这种动机。自我决定理论(SDT)是指导我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、SDT以及影响女性被告的合并症循环方面增加专门知识。我的方法结合了经验主义战略、刑事司法设置，以及对所需医疗服务的性别和创伤信息方法。我将调整我的基于SDT的动机干预，创建一个我称之为支持健康的妇女倡议(Wish)的项目。1虽然治疗方法不同，但艾滋病毒和丙型肝炎病毒感染和接受治疗的风险相似。2，3美国国家开发协会、美国疾病控制与预防中心和美国公共卫生协会呼吁对艾滋病毒和丙型肝炎病毒的治疗采取有效和普遍的方法，作为刑事司法人群的研究优先事项。这些研究所的建议支持在虐待儿童或艾滋病毒病史高发的背景下解决妇女的综合风险问题。此外，他们还建议调整服务以满足个人需求。我提议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，患有SUD的妇女在长期监禁期间，可以坚持治疗艾滋病毒和丙型肝炎。然而，一个尚未满足的挑战是他们出院后的卫生服务利用情况。此外，为了打破药物滥用、艾滋病毒、丙型肝炎、医疗不足、监禁和创伤的循环，需要同时采取干预措施。8需要采取有效的战略，使这一复杂的人群参与治疗。戒毒法庭一直采用奖惩模式有效地吸引参与者，同时减少药物使用和复发。9-11然而，它们通常不涉及医疗保健的利用。激励性干预措施已被证明对患有SUD、尼古丁成瘾、艾滋病毒和糖尿病的难以治疗的人群有效。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点。17-19这是刑事司法环境中的关键。然而，动机背后的理论模型 人们对这些方法的理解并不广泛。SDT是一个以证据为基础的理论模型，它确立了自主动机，作为改善包括SUD或HIV感染者在内的人群健康行为的中介。14、20刑事司法人群亚群的健康状况知之甚少。例如，刑事司法环境中的妇女在医学上研究不足。艾滋病毒和丙型肝炎病毒在戒毒所人群中的流行率尚不清楚。在我提议的K23项目中，我将通过审查WISH在未得到充分治疗的女性药物治疗法庭被告中的可行性和效果来开始我的长期职业计划。我将研究SDT在预测治疗动机变化影响艾滋病毒和丙型肝炎相关服务方面的作用。探索近期的动机结果确保了我的建议的相关性，而不管Wish的效果如何。在K23指导期间，我将通过指导和指导课程工作来获得研究培训和知识。我将以我的知识和经验为基础，使用行为治疗的阶段模式。21我将通过研究促进适当的服务利用，确立自己作为一名独立调查者的地位。K23指导临床科学家奖将使我实现以下目标：1.在刑事司法环境中改编和描述Wish。2.获得研究方法方面的培训：a)与同时患有艾滋病、艾滋病毒、丙型肝炎或参与刑事司法的人的独特需要有关(伦理、CBPR、卫生服务)；b)先进的量化方法3.成为有关方法、措施和结果的特殊需要方面的专家。4.提供背景数据，以便为将在项目第四年期间编写的R01奖励申请提供参考。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、妇女健康、服务利用和临床研究方法方面拥有部门导师和研究资源，我非常适合从这个K23奖项中受益。我的背景为我提供了深入的理解和理想的时机来实施这项职业发展研究计划，有效地满足有SUD、艾滋病毒、丙型肝炎和IPV风险以及创伤病史的女性的复杂服务需求。这些女性被告迫切的公共卫生需求要求采取创造性的、基础广泛的方法。