Opiate Dependence, HIV and Adherence Interventions

描述（由申请人提供）： 本申请是一个指导的以患者为导向的研究职业发展奖（K23）的请求，以准备博士桑德拉斯普林格成为一名独立的研究者。她将通过指导课程，完成研究人员的指导，参与三个重点研究项目和提交学术手稿来实现这一目标。具体而言，她将接受设计和实施干预措施的培训，以坚持抗逆转录病毒治疗和药物治疗阿片类药物成瘾的艾滋病毒+个人从惩教环境中释放。她的研究表明，阿片类药物依赖的艾滋病毒阳性囚犯在监禁期间改善了他们的CD4计数和病毒载量。然而，随着这些人重新吸毒，未能坚持抗逆转录病毒治疗，导致健康状况不佳，这种好处就失去了。施普林格博士还协助制定了针对艾滋病毒阳性吸毒者的社区依从性干预措施。在她的职业发展过程中，她将获得培训和经验，将被释放的艾滋病毒阳性囚犯与有效的干预措施联系起来。斯普林格博士将在她的职业发展奖期间依次进行三个项目。第一部分包括在一项直接给予抗逆转录病毒治疗（DAART）的随机对照试验中，对影响HIV+药物使用者坚持抗逆转录病毒治疗的因素进行的次要数据分析。第二个项目将评估将艾滋病毒+吸毒者与美沙酮维持计划联系起来并在该环境中提供DAART的可行性。第三个项目将首先将艾滋病毒阳性囚犯从监狱释放后与丁丙诺啡治疗联系起来，然后进行第二项可行性研究，将他们与丁丙诺啡加DAART联系起来。职业发展计划是一个精心设计的阶段性方法，旨在为Springer博士提供必要的技能和数据，以发展R01并在奖励结束时成为独立调查员。她的工作将大大有助于艾滋病毒和药物滥用治疗之间的接口，其中需要严格评估干预措施。

DESCRIPTION (provided by applicant): This application is a request for a Mentored Patient-Oriented Research Career Development Award (K23) to prepare Dr. Sandra Springer to become an independent investigator. She will accomplish this goal through directed coursework, mentoring from accomplished researchers, involvement with three focused research projects and submission of scholarly manuscripts. Specifically, she will receive training in the design and implementation of interventions for adherence to antiretroviral therapy and drug treatment for opiate-addicted HIV+ individuals being released from the correctional setting. Her research has demonstrated that HIV+ prisoners with opiate dependence improve their CD4 count and viral load while incarcerated. This benefit, however, is lost as these individuals relapse to drug use, fail to adhere to antiretroviral therapy and result in poor health outcomes. Dr. Springer has also assisted with development of community-based adherence interventions for HIV+ drug users. During her career development, she will gain training and experience to connect released HIV+ prisoners to effective interventions. Dr. Springer will sequentially conduct three projects during her career development award. The first include secondary data analyses of factors that effect adherence to antiretroviral therapy among HIV+ drug users in a randomized controlled trial of directly administered antiretroviral therapy (DAART). The second project will evaluate the feasibility of linking HIV+ drug users to a methadone maintenance program and providing DAART within that setting. The third project will first link HIV+ prisoners to buprenorphine treatment upon release from prison, followed by a second feasibility study of linking them to buprenorphine plus DAART. The career development plan is a carefully staged approach to provide Dr. Springer with the skills and data necessary to develop an R01 and become an independent investigator by the end of the award. Her work will contribute greatly to the interface between HIV and substance abuse treatment where rigorously evaluated interventions are needed.