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

描述(由申请人提供)：艾滋病毒/艾滋病患者在获释后不久不参与或停止护理，通常是在相互竞争的需要的情况下。尽管刑事司法环境中妇女的艾滋病毒流行率比男子高几倍，但她们的艾滋病毒治疗结果没有经过实证检查，也没有成为二级预防干预的目标。在社区监督(如缓刑、假释)下感染艾滋病毒的妇女存在一个特别的差距，她们面临的竞争压力往往包括持续的人际暴力、管理家庭责任以及驾驭复杂的护理和监督制度。为了弥补这些重大差距，第一个项目是对1250名已获释的艾滋病毒在押人员(250人为女性)的纵向数据进行二次分析，这些囚犯参加了人权事务管理局资助的具有国家意义的特别项目--加强与监狱环境中艾滋病毒初级护理和服务的联系。分析集中在这一队列中的性别差异，探索核心假设，特别是对于艾滋病毒携带者离开监狱的女性，持续的艾滋病毒护理、抗逆转录病毒坚持和病毒抑制的主要障碍是抑郁、活性物质使用和亲密伴侣暴力。在这些发现的基础上，第二个项目使用混合方法来调整和试点测试整体健康恢复计划(HHRP)，这是一种疾控中心基于证据的干预措施，将作为一个框架，在社区矫正监督下优化妇女的艾滋病毒治疗结果。这位候选人是Jaimie Meyer博士，由于她作为一名医学人类学家和艾滋病毒内科医生的背景，以及她与监狱中艾滋病毒携带者女性的长期接触，她独特地准备好执行这项工作。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职业目标是：1)发展必要的研究方法方面的专业知识，以设计、执行和评估与CJS女性艾滋病毒治疗结果相关的临床试验；2)在干预措施的开发、适应、测试、实施和传播方面获得经验，解决针对性别的障碍，以优化艾滋病毒治疗结果；以及3)在以患者为导向的研究中发展一条独立的职业道路，重点关注艾滋病毒、妇女健康和药物滥用之间的联系。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，她组建了一支出色的跨学科指导团队，拥有艾滋病毒、妇女健康、药物滥用、CJS、流行病学和干预开发方面的专业知识。在他们的指导下，她将完成相关的教学课程，最终获得硕士学位，并接受统计学和流行病学方面的高级培训。她作为艾滋病毒、CJS女性健康和药物滥用领域的独立临床研究员的成功职业轨迹，进一步得到了耶鲁大学丰富的资源环境的支持。

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.