Connecting People, Places, and Barriers: The Effect of These Connections on Adhe

描述(由申请人提供)：作为一名训练有素的健康地理学家，在社会生态模型、社区影响和地理信息系统领域拥有专业知识，我更感兴趣的是从方法学和干预角度扩大我在药物滥用和艾滋病毒/艾滋病接口方面的研究重点。为此，在接下来的五年培训中，我将把我的时间集中在利用系统科学技术对感染吸毒者的依从性、滞留性和艾滋病毒治疗结果的多维相关性进行研究。最终目标是设计干预措施，以改善这一弱势群体的艾滋病毒治疗结果。为了实现这一目标，我将与一个国际公认的导师小组合作，接受药物使用障碍流行病学、艾滋病毒传播和治疗、社会网络分析和干预措施设计方面的培训。我实现这一职业目标的具体目标是：1.增强我的背景和对现有文献的理解，这些文献涉及在吸毒者中寻求、检测、治疗和保持对艾滋病毒感染的行为和临床干预。A.社会网络分析的理论、可视化和应用方面的高级专业知识，包括自我中心网络、整体网络和纵向网络。结合空间依赖，创新性地将社交网络指标提升为空间-社交网络指标。发展设计、实施和评估随机对照试验所需的研究方法方面的专业知识。3.在干预措施的制定、测试、实施和传播方面获得经验，这些干预措施将解决艾滋病毒阳性吸毒者遵守和保留护理方面的多方面障碍。4.在以行为干预为导向的研究中发展一条独立的职业道路，重点放在药物滥用和艾滋病毒之间的交集上，方法是成功地撰写和接受R01补助金。鉴于辅导在培训和职业发展过程中的至关重要，我组建了一个由导师和顾问组成的强大的跨学科小组，他们将在我五年的高级培训期间提供指导。弗雷德里克·阿尔蒂斯博士将担任我的主要导师(药物滥用、艾滋病毒、干预)，迈克尔·科彭哈弗博士(艾滋病毒、干预)和卡尔·拉特金博士(社交网络分析、社区影响、干预)将作为共同导师。我将进一步咨询奥弗·哈雷尔博士的生物统计学，莱西·斯奈德博士的健康传播，以及迈克尔·埃姆奇博士的健康研究的地理学理论。培训将为感染艾滋病毒的脆弱吸毒者提供开展两个研究项目的机会。研究1：通过检查药物使用HIV阳性人群中坚持抗逆转录病毒疗法、保留护理和HIV治疗结果的多维(个人-社会-生态)相关性，为干预措施的发展提供信息。[1、2、3年(部分)]这是使用随机对照试验(项目)的数据进行的二次分析 Stride，Altice，R01 DA030768)及其《社交网络和邻里关系》副刊。为此，我增加了以下目标：具体目标1：将社交网络度量(即，从网络结构派生)扩展到空间社会度量(基于网络结构和主体与其网络成员之间的空间接近度)。具体目标2：在地理信息科学界面中可视化和绘制受试者的“活动空间”模式，包括访问具有正面和负面影响的常规位置。这与受试者的居住地点有很大的不同。具体目标3：检查个人、社会关系、活动空间和邻里关系对坚持抗逆转录病毒治疗、保留和艾滋病毒治疗结果的综合影响，以健全的多维社会生态框架为模型。研究2：开发和试点空间网络驱动的短消息服务干预，以优化艾滋病毒阳性吸毒者对抗逆转录病毒治疗的依从性、护理保留和艾滋病毒治疗结果。[第3年(部分)、第4、第5阶段]第1阶段：选择对受试者(或自尊者)坚持抗逆转录病毒治疗、保留和艾滋病毒治疗结果具有更强影响的社会网络成员(或改变者)。研究一对自我的活动空间及其社会网络的组成和特征的形成性评估将决定选择方案。第二阶段：进行试点，以测试一种新的空间网络驱动的短信干预的可行性、可接受性和初步效果。该干预包括三个手臂：1)艾滋病护理中的自我，其中两个变化者的交互指数值最高，生活在自我接受短信的活动空间内；2)艾滋病护理中的自我，两个变化者的交互指数值最高，生活在接收短信的活动空间之外；以及3)艾滋病护理中的自我，没有干预(观察性手臂)。

DESCRIPTION (provided by applicant): As a trained health geographer with expertise in the areas of social-ecological models, neighborhood effects, and Geographic Information System, I am further interested in expanding my research foci in the interface of substance abuse and HIV/AIDS, both from methodological and intervention perspectives. To that end, in the upcoming five years of training, I will devote my time to focused research on multidimensional correlates to adherence, retention, and HIV treatment outcomes among infected drug users using system science techniques. The ultimate goal is to design interventions to improve HIV treatment outcomes among this vulnerable population. To achieve this goal, I will work with an internationally recognized group of mentors to obtain training in the epidemiology of substance use disorders, HIV transmission and treatment, social network analysis, and design of interventions. My specific objectives to achieve this career goal are: 1. Enhance my background and understanding of existing literature on behavioral and clinical interventions to seek, test, treat, and retain in care among drug users with HIV infection. 2. A. Advance expertise in theory, visualization, and application of social network analysis, including egocentric network, whole network, and longitudinal networks. Incorporate spatial dependency to innovatively advance social network metrics to spatial-social network metrics. B. Develop expertise in research methods necessary to design, perform, and evaluate randomized controlled trials. 3. Gain experience in intervention development, testing, implementation, and dissemination that will address multidimensional barriers to adherence and retention in care among HIV positive drug users. 4. Development of an independent career path in behavioral intervention-oriented research focused on the intersection between substance abuse and HIV by successfully writing and receipt of a R01 grant. Given the vital importance of mentoring in the process of training and career development, I have assembled a strong interdisciplinary panel of mentors and consultants who will provide guidance throughout my five years of advanced training. Dr. Frederick Altice will serve as my primary mentor (substance abuse, HIV, intervention), with Drs. Michael Copenhaver (HIV, intervention) and Carl Latkin (social network analysis, neighborhood effects, intervention) as co-mentors. I will further consult Drs. Ofer Harel for biostatistics, Lesie Snyder for health communication, and Michael Emch for geographical theories of health research. The training will provide opportunities to conduct two research projects for vulnerable drug users with HIV infection. Study 1: To inform the development of an intervention by examining multidimensional (individual- social-ecological) correlates of adherence to ART, retention in care, and HIV treatment outcomes among drug using HIV positive population. [Year 1, 2, 3 (Part)] This is a secondary analysis using data from a randomized controlled trial (Project STRIDE, Altice, R01 DA030768) and its 'Social Network and Neighborhood' Supplement. To this I add the following aims: Specific Aim 1: Extend social network metrics (i.e., derived from network structure) to spatial-social metrics (based on both network structure and spatial proximity between subjects and their network members). Specific Aim 2: Visualize and map the 'activity space' patterns of subjects in a Geographic Information Science interface, including visits to routine locations of positive and negative influence. This is significantly different tha the just the residential location of the subjects. Specific Aim 3: Examine the combined effect of individual, social relationships, activity space, and neighborhood correlates of adherence to ART, retention, and HIV treatment outcomes modeled on a robust multidimensional social-ecological framework. Study 2: To develop and pilot a spatial-network driven intervention with short message services (SMS) that will optimize adherence to ART, retention in care, and HIV treatment outcomes for HIV positive drug users. [Year 3(Part), 4, 5] Phase 1: Select social network members (or alters) who will have stronger effect on the subjects (or egos) adherence to ART, retention, and HIV treatment outcomes. Formative evaluations of ego's activity space and composition and features of their social networks from Study 1 will determine the selection protocol. Phase 2: Conduct a pilot to test the feasibility, acceptability, and preliminary efficacyof a novel spatial- network driven intervention with SMS. The intervention has three arms: 1) Ego in HIV care with two alters assigned highest Interaction Index value, living inside ego's activity space receiving SMS, 2) Egos in HIV care with two alters assigned highest Interaction Index values, living outside the activity space receiving SMS, and 3) Egos in HIV care with no intervention (observational arm).