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

了解赞比亚卢萨卡感染艾滋病毒的囚犯的纵向临床结果和释放后保留护理

• 批准号: 9028902
• 负责人: Michael Emmanuel Herce
• 金额: $ 13.6万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-23 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9028902
• 关键词: Address; Affect; Africa South of the Sahara; Alcohol consumption; Alcohol or Other Drugs use; American; Anti-Retroviral Agents; Area; Attention; Attitude; Automobile Driving; Award; Behavior Therapy; Behavioral Model; Behavioral Research; Biometry; CD4 Lymphocyte Count; Caring; Cells; Cessation of life; Classification; Clinical; Clinical Research; Communicable Diseases; Communities; Connecticut; Continuity of Patient Care; Data; Databases; Disease Progression; Drug usage; Elements; Enabling Factors; Enrollment; Epidemiologic Methods; Epidemiology; Ethical Issues; Faculty; Focus Groups; Foundations; Funding; Future; Goals; HIV; HIV Infections; HIV risk; HIV-1; Health; Health Benefit; Health behavior; High Prevalence; Human Subject Research; Imprisonment; Individual; Infectious Diseases Research; Inferior; International; Intervention; Interview; Knowledge; Lead; Learning; Life; Medicine; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Modeling; Morbidity - disease rate; North America; North Carolina; Outcome; Participant; Persons; Physicians; Play; Population; Prevalence; Prevention; Prisoner; Prisons; Psychology; Psychometrics; Psychosocial Influences; Public Health; Publishing; Qualifying; Qualitative Evaluations; Questionnaires; Reporting; Research; Research Activity; Research Personnel; Research Project Grants; Resources; Risk; Risk Behaviors; Role; Sampling; Services; Severities; South Africa; Staging; Substance Use Disorder; System; Training; Training Activity; Tuberculosis; Universities; Viral Load result; Viremia; Vulnerable Populations; Zambia; alcohol use disorder; antiretroviral therapy; base; career; career development; cohort; design; experience; follow-up; global health; high risk; instrument; international center; mortality; patient oriented research; preference; prevent; professor; programs; psychosocial; scale up; skills; theories; therapy design; transmission process

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.

抽象的 这是Fogarty International Center国际研究科学家发展的申请 迈克尔·赫斯（Michael Herce）博士奖，这是一种传染病的身体和经验丰富的全球健康计划 北卡罗来纳大学教堂山（UNC）的实施者。赫斯博士处于他的形成阶段 研究职业，旨在将自己确立为独立的全球健康调查员 撒哈拉以南非洲（SSA）的应用健康行为理论和与HIV相关的纠正研究。这个奖项 将为赫斯博士提供实现以下职业发展目标所需的支持：（1） 推进他对人类受试者研究负责任行为的培训，特别关注道德 与涉及囚犯的研究有关的问题； （2）学会应用健康行为理论和定性 评估面向患者的研究和行为干预设计中的健康行为； （3）获得 评估和解决酒精使用障碍（AUD）和其他社会心理问题的正式培训 在SSA的HIV感染监狱人群中； （4）获得流行病学的高级分析技能 生物统计学； （5）在设计，实施和监督方面发展专业知识 SSA的纪律研究项目。为了实现这些目标，赫斯博士已经组装了一个非常成就的 并经验丰富 医学教授和涉及艾滋病毒感染囚犯的临床研究的公认领导者；他的赞比亚 主要导师斯图尔特·里德（Stewart Reid）博士，UNC医学副教授，中心高级顾问 赞比亚（Cidrz）的传染病研究，以及艾滋病毒和结核病研究专家 赞比亚监狱人口的服务交付；以及UNC医学副教授Carol Golin博士 健康行为，以及艾滋病毒行为研究和预防工作的专家涉及监禁 人们。支持赫斯博士和他的核心导师是两个坚定的资源导师：威廉·米勒博士，一个 高级流行病学方法和心理年轻的全球健康调查员的专家 独立和康涅狄格大学心理学教授塞思·卡利希曼（Seth Kalichman）博士，也是 AUDS专家与SSA中患有艾滋病毒的人有关HIV风险行为。 在全球范围内，目前有1000万人被监禁，其中包括SSA的100万囚犯。 SSA监狱 集中大量患有艾滋病毒感染的人。我们和其他人扩大了 抗逆转录病毒疗法的区域规模扩大，包括SSA监狱，并表明SSA囚犯可以开始 离开时，艺术在监狱中取得了出色的临床结果。但是，个人和公众 释放后，囚犯经常因囚犯而丢失，因为贫困 保留艾滋病毒护理。在SSA中驱动此问题的因素是出乎意料的，但据认为AUDS播放 由于其在该人群中的高度流行，重要的作用。告知未来过渡艾滋病毒的设计 护理干预措施，赫尔斯博士的提案指导了研究，以预先评估HIV-的临床结果 释放后感染的囚犯（AIM 1）；探索与健康行为理论有关的因素 释放后保留率在护理中，特别关注酒精使用障碍（AIMS 2和2A）；和行为 形成性研究以确定释放和利益相关者知识，吸引和偏好 过渡护理干预措施（目标3）。为了进行他的拟议研究，赫斯博士将利用国家 唯一的标识符系统和HIV临床数据库以及正在进行的大门基金会资助的Cidrz研究。 了解AUDS和其他因素如何影响感染HIV的囚犯的护理连续性 释放后对于制定未来的计划至关重要 发病率和死亡率，并防止囚犯返回的社区的艾滋病毒传播。这 此处概述的研究和培训活动将生成当前无法使用的数据，以告知设计 这样的过渡护理计划，并将构成将在结束前完成的R01申请的基础 在SSA中评估HIV感染的释放中这种干预措施的奖励期。