Chronic hepatitis C virus (HCV) is a significant public health problem and leading cause of liver failure and death for HIV(+) populations in the U.S. Many HIV(+) individuals have not benefited from HCV treatment advances due to opioid abuse despite the prevalence of this comorbidity. Buprenorphine (BPN), recently approved for office-based treatment of opioid addiction, provides opportunity to integrate HIV, HCV and addiction care in a single office-based setting. This Mentored Patient-Oriented Research Career Development Award will prepare Dr. Lynn Taylor to design and implement studies to improve health services delivery for HIV/HCV coinfected drug users and develop treatment and secondary prevention interventions to stem these epidemics and limit the morbidity and mortality of those at high risk for HCV disease progression. Dr. Taylor, an Assistant Professor of Medicine at Brown Medical School, has assembled an experienced mentorship team in the robust environment of Miriam Hospital and Brown University. With mentor Dr. Peter Friedmann and co-mentors Drs. Timothy Flanigan, Jack Wands, Joseph Hogan, Kathleen Morrow and Diana Sylvestre, Dr. Taylor will undertake advanced training in health services, substance abuse and viral hepatitis research;and qualitative, statistical and clinical trials methodologies for intervention development. Through the proposed project, an intervention will be developed to investigate BPN as a means to extend HCV therapy and optimize HCV, HIV and addiction outcomes among HIV/HCV coinfected opioid users. Phase I will evaluate barriers to the intervention using qualitative techniques. In Phase II, the intervention will be developed based on existing models utilizing BPN to stabilize HIV(-) street heroin injectors for HCV care, observed therapy and secondary prevention programs. In Phase III, a pilot feasibility study of the combined BPN/HCV treatment and secondary prevention intervention will be implemented and evaluated among 45 coinfected opioid users at an HIV primary care site to explore whether integrated care improves medical outcomes and decreases transmission behaviors. Results of this research may have implications not only for reducing the burden of HCV among HIV(+) drug users but also in developing reproducible models for integrating addiction and HCV treatment with HIV primary care. The information obtained will lead to the development of a future R01 submission.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Mentored Patient-Oriented Research Career Development Award (K23)
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Human Development Research Subcommittee (NIDA)
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Khalsa, Jagjitsingh H
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Miriam Hospital
United States
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Taylor, Lynn E; Foont, Julie A; DeLong, Allison K et al. (2014) The spectrum of undiagnosed hepatitis C virus infection in a US HIV clinic. AIDS Patient Care STDS 28:4-9
Taylor, Lynn E; Swan, Tracy; Matthews, Gail V (2013) Management of hepatitis C virus/HIV coinfection among people who use drugs in the era of direct-acting antiviral-based therapy. Clin Infect Dis 57 Suppl 2:S118-24
Grebely, Jason; Oser, Megan; Taylor, Lynn E et al. (2013) Breaking down the barriers to hepatitis C virus (HCV) treatment among individuals with HCV/HIV coinfection: action required at the system, provider, and patient levels. J Infect Dis 207 Suppl 1:S19-25
Garg, Shikha; Taylor, Lynn E; Grasso, Chris et al. (2013) Prevalent and incident hepatitis C virus infection among HIV-infected men who have sex with men engaged in primary care in a Boston community health center. Clin Infect Dis 56:1480-7
MacNamara, Marina M C; Moren, Kathleen; Taylor, Lynn E et al. (2012) State-wide support for physician-mothers who are breastfeeding. Med Health R I 95:9-13
Blackard, Jason T; Welge, Jeffrey A; Taylor, Lynn E et al. (2011) HIV mono-infection is associated with FIB-4 - A noninvasive index of liver fibrosis - in women. Clin Infect Dis 52:674-80
Taylor, Lynn E; Holubar, Marisa; Wu, Kunling et al. (2011) Incident hepatitis C virus infection among US HIV-infected men enrolled in clinical trials. Clin Infect Dis 52:812-8
Taylor, Lynn E; Bowman, Sarah E; Chapman, Stacey et al. (2011) Treatment for hepatitis C virus genotype 1 infection in HIV-infected individuals on methadone maintenance therapy. Drug Alcohol Depend 116:233-7
Taylor, L E; DeLong, A K; Maynard, M A et al. (2011) Acute hepatitis C virus in an HIV clinic: a screening strategy, risk factors, and perception of risk. AIDS Patient Care STDS 25:571-7
Rich, Josiah D; Taylor, Lynn E (2010) The beginning of a new era in understanding hepatitis C virus prevention. J Infect Dis 202:981-3