Understanding Longitudinal Clinical Outcomes and Post-release Retention in Care among HIV-infected Prisoners in Lusaka, Zambia

摘要 这是一份申请福格蒂国际中心国际研究科学家发展项目的申请表 迈克尔·赫斯博士获奖，他是一位传染病内科医生，也是一位经验丰富的全球卫生项目 北卡罗来纳大学教堂山分校(UNC)实施者。赫斯博士正处于他的成长阶段 研究生涯，目标是在以下领域确立自己作为独立全球卫生调查员的地位 撒哈拉以南非洲(SSA)应用健康行为理论和艾滋病毒相关矫正研究。本奖项 将为Herce博士提供必要的支持，以实现以下职业发展目标：(1) 促进他在负责任的人类受试者研究行为方面的培训，特别关注道德问题 与服刑人员研究有关的问题；(2)学会应用健康行为理论和定性 以病人为中心的研究和行为干预设计中的健康行为评估；(3)获得 在评估和解决酒精使用障碍及其他心理社会问题方面的正规培训 在SSA感染艾滋病毒的监狱人群中进行培训；(4)学习流行病学和 生物统计学；以及(5)发展设计、实施和监督大型多学科的专门知识 SSA的学科研究项目。为了实现这些目标，赫斯博士组装了一个非常有成就的 经验丰富的核心导师团队包括：他的美国主要导师，北卡罗来纳大学合伙人David Wohl博士 医学教授，在涉及感染艾滋病毒的囚犯的临床研究方面公认的领导者；他的赞比亚 主要导师，斯图尔特·里德博士，北卡罗来纳大学医学副教授，该中心高级学院顾问 赞比亚传染病研究中心(CIDRZ)，以及艾滋病毒和结核病研究和 赞比亚监狱人口中的服务提供情况；以及北卡罗来纳大学医学和医学副教授Carol Golin博士 健康行为，以及涉及监禁的艾滋病毒行为研究和预防工作的专家 人民。支持Herce博士和他的核心导师的是两位坚定的资源导师：William Miller博士，一位 高级流行病学方法专家，并指导年轻的全球卫生研究人员的职业生涯 以及康涅狄格大学心理学教授塞思·卡里奇曼博士和 在与SSA中艾滋病毒携带者的艾滋病毒危险行为有关的AUDS方面的专家。 在全球范围内，目前有1000万人被监禁，其中包括被关押在苏丹解放军的100万名囚犯。SSA监狱 集中大量艾滋病毒感染者和有感染艾滋病毒风险的人。我们和其他人已经延长了 区域扩大抗逆转录病毒治疗，将SSA监狱包括在内，并表明SSA囚犯可以开始 在被拘留期间进行抗逆转录病毒治疗，并在监狱中取得出色的临床结果。然而，个人和公众 监狱中的囚犯(“被释放人”)在获释后往往因为贫穷而失去了抗逆转录病毒治疗所提供的健康福利。 保留在艾滋病毒护理中。在SSA中驱动这一问题的因素尚不清楚，但AUD被认为起到了 由于其在这一人群中的高流行率，它将发挥重要作用。为未来过渡性艾滋病毒的设计提供信息 护理干预，Herce博士建议进行有指导的研究，以前瞻性地评估HIV的临床结果- 释放后被感染的囚犯(目标1)；从健康行为理论探索与以下因素相关的因素 释放后继续接受照料，特别关注酒精使用障碍(目标2和2a)； 形成性研究，以确定被发布者和利益相关者周围的知识、态度和偏好 过渡期护理干预措施(目标3)。为了进行他提议的研究，Herce博士将利用一个全国性的 唯一识别系统和艾滋病毒临床数据库，以及正在进行的盖茨基金会资助的CIDRZ研究。 了解AUDS和其他因素如何影响对感染艾滋病毒的囚犯的连续护理 释放后，对于制定未来的计划，将这些人留在看守所，减少囚犯，至关重要 减少发病率和死亡率，并防止艾滋病毒在囚犯返回的社区中进一步传播。这个 此处概述的研究和培训活动将生成当前无法获得的数据，以供设计 这样的过渡性护理计划，并将形成在#年结束前完成的R01申请的基础 在SSA的HIV感染获释对象中评估这项干预措施的奖励期限。

ABSTRACT This is an application for a Fogarty International Center International Research Scientist Development Award for Dr. Michael Herce, an infectious disease physician and experienced global health program implementer at the University of North Carolina at Chapel Hill (UNC). Dr. Herce is in the formative stage of his research career and aims to establish himself as an independent global health investigator in the areas of applied health behavior theory and HIV-related corrections research in sub-Saharan Africa (SSA). This award will provide Dr. Herce with the support necessary to achieve the following career development goals: (1) to advance his training in the responsible conduct of human subjects research, with a special focus on the ethical issues related to research involving prisoners; (2) to learn to apply health behavior theory and the qualitative evaluation of health behaviors in patient-oriented research and behavioral intervention design; (3) to obtain formal training in assessing and addressing alcohol use disorders (AUDs) and other psychosocial issues among HIV-infected prison populations in SSA; (4) to acquire advanced analytical skills in epidemiology and biostatistics; and (5) to develop expertise in the design, implementation, and oversight of large multi- disciplinary research projects in SSA. To realize these goals, Dr. Herce has assembled a highly accomplished and experienced core mentorship team comprised of: his U.S. primary mentor, Dr. David Wohl, UNC Associate Professor of Medicine and a recognized leader in clinical research involving HIV-infected prisoners; his Zambia primary mentor, Dr. Stewart Reid, UNC Associate Professor of Medicine, Senior Faculty Advisor to the Centre for Infectious Disease Research in Zambia (CIDRZ), and an expert in HIV and tuberculosis research and service delivery in Zambian prison populations; and Dr. Carol Golin, UNC Associate Professor of Medicine and Health Behavior, and an expert in HIV behavioral research and prevention efforts involving incarcerated people. Supporting Dr. Herce and his core mentors are two committed resource mentors: Dr. William Miller, an expert in advanced epidemiological methods and mentoring young global health investigators to career independence, and Dr. Seth Kalichman, a Professor of Psychology at the University of Connecticut and an expert in AUDs as they relate to HIV-risk behaviors for persons living with HIV in SSA. Globally, 10 million people are currently incarcerated, including 1 million prisoners in SSA. SSA prisons concentrate large numbers of people with, and at risk for, HIV infection. We and others have extended the regional scale-up of anti-retroviral therapy to include SSA prisons, and have shown that SSA inmates can start ART while detained and achieve excellent clinical outcomes in prison. However, the individual and public health benefits afforded by ART in prisons are often lost for prisoners after release (“releasees”) due to poor retention in HIV care. The factors driving this problem in SSA are unexplored, but AUDs are thought to play an important role due to their high prevalence in this population. To inform the design of a future transitional HIV care intervention, Dr. Herce proposes mentored research to prospectively assess clinical outcomes for HIV- infected prisoners after release (Aim 1); explore factors from health behavior theory that are associated with post-release retention in care, with a special focus on alcohol use disorders (Aims 2 & 2a); and conduct formative research to determine releasee and stakeholder knowledge, attitudes, and preferences surrounding transitional care interventions (Aim 3). To conduct his proposed research, Dr. Herce will leverage a national unique identifier system and HIV clinical database and an ongoing Gates Foundation-funded CIDRZ study. Understanding how AUDs and other factors influence the care continuum for HIV-infected prisoners after release is critical to developing future programs to keep this population retained in care, reduce prisoner morbidity and mortality, and prevent onward HIV transmission in communities to which prisoners return. The research and training activities outlined here will generate currently unavailable data to inform the design of such a transitional care program, and will form the basis of a R01 application to be completed before the end of the award period to evaluate this intervention among HIV-infected releasees in SSA.