Supporting Health in Drug Treatment Court for Women with HIV or Hepatitis C

支持艾滋病毒或丙型肝炎妇女在戒毒治疗法庭的健康

• 批准号: 8792203
• 负责人: DIANE S MORSE
• 金额: $ 17.23万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-02-15 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8792203
• 关键词: Address; Alcohol or Other Drugs use; American Public Health Association; Award; Behavior; Behavior Therapy; Behavioral Model; Caring; Centers for Disease Control and Prevention (U.S.); Child Abuse; Clinic; Clinical; Clinical Research; Collaborations; Competence; Complex; County; Criminal Justice; Data; Development; Drug Courts; Drug usage; Effectiveness; Ethics; Feedback; Female; Focus Groups; Foundations; Gender; General Population; Goals; HIV; HIV Infections; Health; Health Services; Health Services Research; Health behavior; Health behavior change; Healthcare; Hepatitis C; Hepatitis C Prevalence; Hepatitis C virus; High Prevalence; Human; Imprisonment; Individual; Institutes; Internist; Intervention; Intervention Studies; Justice; Knowledge; Manuals; Measures; Mediator of activation protein; Medical; Mentored Clinical Scientist Award; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Modeling; Morbidity - disease rate; Motivation; National Institute of Drug Abuse; New York; Nicotine Dependence; Outcome; Outcome Measure; Participant; Patients; Persons; Pharmaceutical Preparations; Phase; Population; Prevalence; Procedures; Process; Public Health; Recommendation; Recording of previous events; Research; Research Design; Research Methodology; Research Personnel; Research Priority; Research Project Grants; Research Training; Resources; Rewards; Risk; Risk Behaviors; Role; Safety; Scientist; Self Determination; Services; Staging; Substance Use Disorder; Substance abuse problem; System; Testing; Theoretical model; Therapeutic; Time; TimeLine; Training; Trauma; Virus Diseases; Woman; Women' s Health Services; Writing; base; career; career development; cost; court; effective intervention; evidence base; experience; health care service utilization; health training; improved; interest; intimate partner violence; meetings; mortality; motivational intervention; partner violence; pilot trial; programs; research and development; response; service utilization; sexual assault; socioeconomics; theories; therapy development; uptake

DESCRIPTION (provided by applicant): The Mentored K23 Clinical Scientist Development Award from the National Institute on Drug Abuse (NIDA) will train me as an independent investigator of theory-based motivational approaches to women with the co-morbid, cyclically-related conditions of Substance Use Disorder (SUD), HIV and/or Hepatitis C (HCV), and trauma histories. I bring a unique perspective as an internist caring for underserved women in combination with my research in theory-based motivation applied to HCV services utilization and intimate partner violence (IPV) safety behaviors. I am interested in the underlying motivation impacting health services utilization of women in criminal justice settings from both the clinical and public health perspectives. I will be examining this motivation in the Drug Treatment Court setting. Self Determination Theory (SDT) is the empiric motivational model informing my research. This research will require increased expertise in health services, research design, quantitative assessment and analysis, SDT, and the cycle of co-morbid conditions impacting women defendants. My approach combines an empiric strategy, the criminal justice setting, and a gender and trauma-informed approach to needed healthcare services. I will adapt my SDT-based motivational intervention to create a program I call the Women's Initiative Supporting Health (WISH). Under-treatment of HIV and HCV among individuals in criminal justice settings is a major public health issue.1 While treatments differ, similar risks exist for HIV and HCV infection and under-treatment.2,3 The NIDA, CDC, and American Public Health Association are calling for effective and generalizable approaches for HIV and HCV treatment as a research priority in the criminal justice population. The institutes' recommendations support addressing combined risks in women, in the context of a high prevalence of child abuse or IPV histories. Furthermore, they recommend adapting services to meet individual needs. The goals of my proposed research project are consistent with these national priorities.1, 4-7 Evidence shows that women with SUD, while in long-term incarceration, can adhere to treatment of HIV and HCV. However, an unmet challenge is their post-release health services utilization. Additionally, to break the cycle of substance abuse, HIV, HCV, medical under-treatment, incarceration, and trauma, concurrent interventions are needed.8 Effective strategies are needed to engage this complex population in treatment. Drug Treatment Courts have been effective with a reward and sanction model in engaging participants while decreasing substance use and recidivism.9-11 Yet they usually do not address healthcare utilization. Motivational interventions have proven effective in difficult-to-treat populations suffering from SUD, nicotine addiction, HIV, and diabetes.12-16 They support destigmatization of targeted behaviors across varied ethnic, socio-economic, and marginalized populations.17-19 This is key in the criminal justice setting. However, the theoretical model underlying motivational approaches is not widely understood. SDT is an evidence-based theoretical model which establishes autonomous motivation as a mediator for improved health behavior in populations, including those with SUD or HIV.14, 20 Health conditions of subsets of the criminal justice populations are poorly understood. For example, women in criminal justice settings are medically under-studied. The prevalence of HIV and HCV is unknown in the Drug Treatment Court population. In my proposed K23 project I will begin my long-term career plan by examining the feasibility and effects of WISH in under-treated women Drug Treatment Court defendants. I will investigate the role of SDT in predicting changes in motivation for treatment influencing HIV and HCV-related services. Exploring proximal motivation outcomes insures the relevance of my proposal regardless of the effect of WISH. During the K23 mentored period, I will obtain research training and knowledge through mentoring and directed coursework. I will build upon my knowledge and experience using the Stage Model of Behavioral Therapies.21 I will establish myself as an independent investigator by studying promotion of appropriate service utilization. The K23 Mentored Clinical Scientist Award will allow me to accomplish the following goals: 1. Adapt and describe WISH in the criminal justice setting. 2. Obtain training in research methods: a) relevant to the unique needs of persons with co-morbid SUD, HIV, HCV or criminal justice involvement (ethics, CBPR, health services); b) advanced quantitative approaches 3. Become expert in SDT regarding approach, measures, and outcomes. 4. Provide background data to inform an R01 award application to be written during year 4 of the project. With departmental mentor and research resources in substance abuse, HIV, SDT-based health behavior change, criminal justice collaborations, women's health, services utilization, and clinical research methods, I am ideally suited to benefit from this K23 award. My background provides me the depth of understanding and the ideal timing to undertake this career development research plan effectively addressing complex service needs of women with SUD, HIV, HCV, and IPV risk, and trauma histories. The compelling public health needs of these women defendants mandate a creative, broad based approach.

描述（由申请人提供）：美国国家药物滥用研究所（NIDA）的指导K23临床科学家发展奖将作为对妇女的基于理论的动机方法的独立研究者训练，该方法是针对具有循环，周期性使用疾病的妇女（SUD），HIV和/HIV和/或肝炎（HCV）和Trauma Castorione的妇女。我带来了一个独特的观点，作为一名国际照顾服务不足的女性，以及我在HCV服务利用和亲密伴侣暴力（IPV）安全行为的基于理论动机方面的研究。我对从临床和公共卫生的角度从刑事司法环境中影响妇女的卫生服务利用的潜在动机感兴趣。我将在药物治疗法院的环境中检查这种动机。自我确定理论（SDT）是通知我的研究的经验动机模型。这项研究将需要提高卫生服务，研究设计，定量评估和分析，SDT以及影响女性被告的合并状况周期的专业知识。我的方法结合了经验战略，刑事司法机构，以及针对需要医疗服务的性别和创伤的方法。我将调整基于SDT的动机干预措施，以创建一个我称之为支持健康的女性倡议（WISH）的计划。在刑事司法环境中，艾滋病毒和HCV的治疗不足是一个主要的公共卫生问题。1虽然治疗方法有所不同，但艾滋病毒和HCV感染和治疗不足的治疗风险相似。2,3NIDA，CDC和美国公共卫生协会呼吁有效且普遍的HIV和HCV治疗方法作为刑事司法司法司法司法官方的优先研究。该机构的建议支持在虐待儿童或IPV历史的高度流行的情况下，支持妇女的总风险。此外，他们建议适应服务以满足个人需求。我提出的研究项目的目标与这些国家的优先事项是一致的。1，4-7证据表明，在长期监禁中，SUD的妇女可以遵守艾滋病毒和HCV的治疗。但是，未满足的挑战是他们的释放后健康服务利用。此外，为了打破滥用药物，艾滋病毒，HCV，医疗治疗，监禁和创伤的周期，需要并发干预措施。8需要有效的策略来使这种复杂的人群参与治疗。药物治疗法院在参与者的同时，在减少药物使用和累犯的同时，有奖励和制裁模式有效。9-11但是它们通常不解决医疗保健利用。事实证明，动机干预对患有SUD，尼古丁成瘾，艾滋病毒和糖尿病的难以治疗的人群有效。12-16他们支持各种种族，社会经济和边缘化人群的目标行为的命运。17-19这在刑事司法环境中至关重要。但是，励志的理论模型 方法并未被广泛理解。 SDT是一种基于证据的理论模型，它确立了自主动机，作为改善人群健康行为的调解人，包括患有SUD或HIV的人。14，对刑事司法人口的种群的20种健康状况，对刑事司法人口的20种健康状况知之甚少。例如，刑事司法环境中的妇女在医学上被研究不足。艾滋病毒和HCV的患病率在药物治疗法院人群中未知。在我提出的K23项目中，我将通过检查愿望对未经治疗的妇女治疗法院被告的可行性和影响来开始我的长期职业计划。我将研究SDT在预测影响HIV和HCV相关服务的治疗动机变化中的作用。探索近端动机结果可确保我的提议的相关性，而不管愿望的影响如何。在K23指导期间，我将通过指导和定向课程获得研究培训和知识。我将使用行为疗法的舞台模型来基于自己的知识和经验。21我将通过研究促进适当的服务利用来确立自己为独立研究者。 K23指导的临床科学家奖将使我能够实现以下目标：1。在刑事司法环境中适应和描述愿望。 2。获得研究方法培训：a）与Comorbid SUD，HIV，HCV或刑事司法参与的人的独特需求有关（Elthics，CBPR，Health Services）； b）先进的定量方法3。就方法，措施和结果成为SDT的专家。 4.提供背景数据，以告知R01奖励申请，该申请将在项目的第4年内编写。借助毒品滥用，艾滋病毒，基于SDT的健康行为改变，刑事司法合作，妇女健康，服务利用和临床研究方法的部门导师和研究资源，我非常适合从这一K23奖中受益。我的背景为我提供了了解这项职业发展研究计划的理解深度和理想的时机，从而有效解决了SUD，HIV，HCV和IPV风险以及创伤历史的妇女的复杂服务需求。这些女性被告的强大公共卫生需求要求一种创造性的基于广泛的方法。