Funder: National Institute on Drug Abuse
Project period: 07/01/2012 - 06/30/2017
Grant Type: Research
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. PUBLIC HEALTH RELEVANCE: Despite HIV prevalence among women in criminal justice settings 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 women with HIV under community supervision (e.g., probation, parole) whose competing stresses often include intimate partner violence, mental illness, substance abuse, and navigating complex systems of care and supervision. The goal of this research is to inform, adapt and test an intervention that will improve HIV treatment outcomes for community-based women who interface with the criminal justice system, either after release from jail or during community supervision.