David Alain Wohl, MD, an Associate Professor in the Division of Infectious Diseases at the University of North Carolina (UNC), submits this application for a K24 Mid-Career award. The purpose of the K24 is to enable recipients to: a) Devote more time to augment their capabilities in Patient-Oriented Research (POR);and b) Provide mentoring to new clinical investigators in the conduct of POR. Dr. Wohl is a nationally recognized thought-leader in HIV clinical research - particularly that exploring the nexus between incarceration and HIV. In this application he proposes to develop skills that will serve his future work in this significant area of research including qualitative data collection and analysis methodology, higher-level analytical techniques, and strategies for effective leadership. He will expand an established record of mentorship to develop greater capacity and research opportunities in order to foster the research careers of early investigators. Candidate: Dr. Wohl has been a highly productive HIV clinical researcher and has established UNC as a major center for HIV-related corrections research. Since 2003, he has been continuously NIH-funded to conduct research aiming to optimize HIV detection and care for people involved in the criminal justice system, a population with prevalent substance abuse and mental health disorders, and has directly translated the findings of three R01-supported investigations into modification of practice in the NC prison system. Based on his investigations, the NC prison system has adopted antiretroviral self-medication instead of universal directly observed therapy, shifted to voluntary opt-out HIV testing on intake, and developed new transitional care models for HIV-infected releasees. Further, Dr. Wohl has a strong record of teaching and mentorship of new investigators, supporting procurement of awards and first-authored publications by mentees, as well as independence of these talented investigators. Mentoring Plan/Environment: This application will leverage the extensive training resources at UNC including the Center for AIDS Research (CFAR), the School of Public Health-based K30 training program, the School of Medicine MD/PhD program, and the UNC Infectious Diseases research fellowship - each of which Dr. Wohl is deeply involved with. As a founder and Co-Director of the UNC CFAR Prison Working Group, Site Leader of the UNC AIDS Clinical Trials Unit, and Director of the NC AIDS Training and Education Center (ATEC), Dr. Wohl is well-positioned to access and mentor students, fellows and junior faculty within and beyond UNC. As requests for mentoring have increased, Dr. Wohl proposes to receive formal and informal guidance to develop further as a mentor. Further, to better serve those he supervises and enhance his own productively, he seeks this award to strengthen and enhance his data collection and analytical skills including qualitative and quantitative data collection and analysis. Research Plan: The established research infrastructure Dr. Wohl and his collaborators have built, including the establishment of cohorts of HIV-infected and -uninfected prison releasees, and his collaborative relationships with the prison system, public health entities, and other research groups, serve as a platform to provide ample opportunities for mentee research. There remain a number of highly significant questions to be answered across the cascade of HIV care, including: What are the best methods to conduct HIV screening and linkage to care in prison in a manner respects individual autonomy? To what extent are HIV-infected prisoners engaged in care while incarcerated? Can intransigent individual (e.g., substance abuse, mental health disorders, low motivation) and structural (e.g., poverty, discrimination, stigma) obstacles to linkage to HIV care and services after release be surmounted, and if so, how? The K24 support will permit Dr. Wohl the time to pursue work that are natural extensions of his research, and provide rich opportunities for mentee research while protecting time to support his devotion to mentorship.
HIV continues to be concentrated among incarcerated men and women in the US. As such, incarceration remains a critical opportunity to diagnose and treat those unaware they are infected and reengage into care those who have fallen from the HIV care continuum. Such interventions improve individual well-being and reduce the potential for HIV transmission. Practical, affordable, and scalable models for seek, test, treat and retain for persons with HIV moving through the correctional system and back to the community have yet to be established and are countered by prevalent substance abuse, poverty, stigma, and discrimination. The proposed mentor award will support the mentoring of new investigators to continue to conduct patient-oriented research to recognize these barriers and develop pragmatic approaches to improve the care of HIV-infected prisoners and reduce the risk of their transmitting their virus to others following release.