There is a critical need to develop a diverse pool of highly trained clinician scholars to foster the development of biomedical, behavioral and clinical research related to drug abuse, addiction, and HIV prevention and treatment in general medical settings. Patients who abuse substances are more likely to be seen in general medical settings such as emergency departments (ED), general medical primary care clinics and inpatient wards, HIV and adolescent health clinics, and women's health centers. These patients often present with a complex array of acute consequences and complications (e.g. intoxication, overdose, withdrawal, trauma and infectious diseases) of substance use as well as chronic conditions such as HIV disease, hepatitis, pulmonary and cardiovascular disease. Objectives: The Yale-Drug Abuse, Addiction, and HIV Research Scholars (DAHRS) program provides a comprehensive three year post-doctorate, interdisciplinary, Mentored Career Development Program to improve drug abuse, addiction, and HIV medical outcomes integrating prevention and treatment in general medical settings including ED, primary care, HIV, adolescent, and women's health clinics. Specifically, Yale-DAHRS will: [Aim 1] Develop clinician scientists with the knowledge, skills, and ability to become independent investigators, generating findings of practical value with significant impact to improve health outcomes of patients with and at risk for drug abuse, addiction, and HIV;[Aim 2] Develop future leaders by providing Scholars with leadership tools and skills and creating individualized programs to ensure success in leading multidisciplinary research teams in studying drug abuse, addiction and HIV, and implementation and integration of research findings into general medical settings;and [Aim 3] Enhance the diversity of drug abuse, addiction, and HIV researchers. Addressing women and minority faculty under representation will enhance the diversity of investigators and research topics, broaden perspectives in setting research priorities, increase clinical trial participation, and expand knowledge. Working synergistically with Yale's established training programs in drug abuse, HIV and clinical investigation, Yale- DAHRS will capitalize on existing academic infrastructure and expertise to ensure success. Unique, features include: (1) An interdisciplinary, diverse faculty of independent researchers in illicit and prescription drug abuse and addiction, tobacco, alcohol, HIV, and medical complexities such as pain and hepatitis C;(2) Synergy with well established, high quality post-doctoral training programs at Yale;(3) The use of clinical informatics for data collection, data management, diagnostic tool development, and information dissemination;and (4) The integration of such diverse fields as public health, informatics, clinical epidemiology, systems engineering and demography with the traditional clinical sciences of internal medicine, emergency medicine, HIV medicine, pediatrics, obstetrics and gynecology, psychiatry, and psychology;(5) Established clinical research laboratories, including the Yale-New Haven Hospital, a tertiary care center for southern New England and a community hospital for the Greater New Haven Area, serving an ethnically, racially, culturally, and economically diverse population, a Veterans Affairs Medical Center and community treatment centers such as the APT Foundation and Federally Qualified Health Centers;(6) Synergies with established research centers and institutes such as the Center for Interdisciplinary Research on AIDS and the Veterans Aging Cohort on HIV. Career Development Plan: Yale-DAHRS is a three year research training program that will prepare a total of six clinician investigators for careers focusing on drug abuse, addiction, and HIV in general medical settings during its first funding cycle. Scholars will earn the Master in Health Sciences degree, combining rigorous training in research methodology, statistics and design with seminars in topics related to drug abuse, addiction, and HIV content, leadership, grant writing and responsible conduct of research. Candidates will complete published mentored research project(s) and prepare an application for the next career step;i.e. NIH R21, R03, R15, R34 mechanism. The collaboration of the multidisciplinary faculty and the combined robust strengths of two principal investigators from Emergency and Internal Medicine, both with extensive experience mentoring and as independent funded investigators will drive the Yale-DAHRS program. Potential Research Projects: Multiple research projects are "shovel ready" for Scholar training and can be completed within our allotted time frame, such as secondary data analysis using national large datasets e.g. VA Aging Cohort (HIV);risk factors, prevention and treatment of prescription drug abuse, office-based treatment of opioid dependence with buprenorphine, systematic reviews and meta-analyses, creation of cost effective evaluation models for patients with drug abuse, addiction and HIV including prescription drug abuse;investigation of gender and racial/ethnic disparities in identification and treatment interventions and outcomes;evaluation of screening, and treatment initiation in special populations (i.e. adolescent-elderly, veterans, incarcerated, HIV);comparison of models of screening, brief intervention and referral to treatment (SBIRT) delivery by providers and other innovative technologies;effectiveness and implementation of SBIRT science in general medicine practice with acute and chronic medical complexities.
Drug abuse, addiction, and HIV are significant public health issues, as they affect the health and well-being of a large portion of the population;have substantial negative health outcomes on individuals;and are extremely costly to the health care system. An investment in research to improve substance abuse and medical health outcomes is greatly needed. The proposed Yale-Drug Abuse, Addiction, and HIV Research Scholars (DAHRS) program focusing on general medical settings with patients throughout the life cycle will provide a three year post-doctoral, interdisciplinary, Mentored Career Development Program training six clinician-scientists for independent research careers in the field of drug abuse, addiction, and HIV through integration of prevention and treatment in general medical settings.
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