Evaluating and Improving HIV Outcomes in Community-Based Women who Interface with

描述（由申请人提供）：艾滋病毒/艾滋病感染者（PLWHA）在出狱后不久不会立即参与或停止护理，通常是在竞争需求的背景下。尽管刑事司法环境中妇女的艾滋病毒流行率比男子高出几倍，但她们的艾滋病毒治疗结果尚未得到实证检验，也没有成为二级预防干预措施的目标。受社区监督（如缓刑、假释）的感染艾滋病毒的妇女面临的压力尤其大，她们面临的压力往往包括持续的人际暴力、管理家庭责任和应对复杂的护理和监督系统。为了解决这些关键的差距，第一个项目是从1250释放监狱被拘留者的纵向数据进行二次分析艾滋病毒（250人是妇女）参加加强联系，艾滋病毒初级保健和服务在监狱设置的倡议，一个HRSA资助的国家意义的特别项目。分析的重点是在这个队列中的性别差异，探索的核心假设，特别是对妇女与艾滋病毒离开监狱，持续的艾滋病毒护理，抗逆转录病毒治疗依从性和病毒抑制的主要障碍是抑郁症，活性物质的使用，和亲密伴侣的暴力。在这些研究结果的基础上，第二个项目采用混合方法来适应和试点测试整体健康恢复计划（HHRP），这是一项CDC循证干预措施，将作为一个框架，优化社区矫正监督下妇女的艾滋病毒治疗结果。候选人Jaimie Meyer博士因其作为医学人类学家和艾滋病毒医生的背景以及她长期与监狱中的艾滋病毒感染妇女接触而独特地准备开展这项工作。她最近完成了传染病的临床研究，目前是耶鲁大学艾滋病跨学科研究中心的博士后研究员。她的长期职业目标和专业目标是：1）发展必要的研究方法的专业知识，以设计，执行和评估与CJS中女性艾滋病毒治疗结果相关的临床试验; 2）获得干预措施开发，适应，测试，实施和传播方面的经验，这将解决特定性别的障碍，以优化艾滋病毒治疗结果; 3）在以病人为导向的研究中发展独立的职业道路，重点是艾滋病毒、妇女健康和药物滥用之间的相互关系。为了实现这些目标，并成功地从临床医生过渡到独立资助的医生学者，她组建了一支优秀的跨学科指导团队，拥有艾滋病毒，妇女健康，药物滥用，CJS，流行病学和干预发展方面的专业知识。在他们的指导下，她将完成相关的教学课程，最终获得统计学和流行病学高级培训的硕士学位。她成功的职业生涯轨迹作为独立的临床研究人员在艾滋病毒，妇女的健康在CJS和药物滥用是进一步促进了她在耶鲁大学提供的资源丰富的环境。

DESCRIPTION (provided by applicant): People living with HIV/AIDS (PLWHA) do not engage in or discontinue care soon after prison-release, often in the context of competing needs. Despite HIV prevalence among women in criminal justice settings (CJS) being several-fold higher than among men, their HIV treatment outcomes have not been empirically examined nor have they been targeted for secondary prevention interventions. A particular gap exists for HIV-infected women under community supervision (e.g. probation, parole) whose competing stresses often include ongoing interpersonal violence, managing family responsibilities and navigating complex systems of care and supervision. To address these critical gaps, the first project is a secondary analysis of longitudinal data from 1250 released jail detainees with HIV (250 are women) enrolled in the Enhancing Linkages to HIV Primary Care and Services in Jail Settings Initiative, a HRSA-funded Special Project of National Significance. The analysis focuses on gender differences in this cohort, exploring the central hypothesis that, particularly for women with HIV leaving jail, the major barriers to persistent HIV care, antiretroviral adherence, and viral suppression are depression, active substance use, and intimate partner violence. Building on these findings, the second project employs mixed methods to adapt and pilot test the Holistic Health Recovery Program (HHRP), a CDC evidence-based intervention that will serve as a framework to optimize HIV treatment outcomes for women under community correctional supervision. The candidate, Dr. Jaimie Meyer, is uniquely poised to perform this work because of her background as a medical anthropologist and HIV physician and her prolonged engagement with women with HIV in prison. She recently completed her clinical fellowship in Infectious Diseases and is currently a post-doctoral research fellow at the Center for Interdisciplinary Research on AIDS at Yale. Her long-term career goals and professional objectives are to: 1) Develop expertise in research methods necessary to design, perform, and evaluate clinical trials relating to HIV treatment outcomes among women in the CJS; 2) Gain experience in intervention development, adaptation, testing, implementation, and dissemination that will address gender-specific barriers to optimized HIV treatment outcomes; and 3) Develop an independent career path in patient-oriented research focused on the interface between HIV, women's health, and substance abuse. To achieve these goals and successfully transition from clinician to an independently funded physician-scholar, she has assembled a stellar interdisciplinary mentoring team with expertise in HIV, women's health, substance abuse, CJS, epidemiology and intervention development. Under their guidance, she will complete relevant didactic coursework, culminating in a Master degree with advanced training in statistics and epidemiology. Her successful career trajectory as independent clinical researcher in HIV, women's health in the CJS, and substance abuse is further fostered by the resource-rich environment available to her at Yale University.