This application proposes a training program to develop P. Todd Korthuis, MD, MPH into an independent clinician-scientist in investigations of drug abuse and HIV. Dr. Korthuis is a General Internist who specializes in caring for HIV-infected patients. The mentored career development plan consists of a three-tiered approach: formal coursework to augment his previously acquired skills, a broad-based experiential learning program, and a mentored clinical research experience. The primary goal of this program will be for Dr. Korthuis to achieve independence as a clinical investigator in all respects. His educational goals for this award are to advance his understanding of drug abuse theory and treatment and obtain advanced expertise in qualitative and quantitative research design and analysis methods while maintaining his expertise in HIV treatment and prevention issues pertinent to patients with drug abuse. He will conduct mentored clinical research under the direction of his primary mentor, Dr. Dennis McCarty, Director of the Center for Substance Abuse Research and Policy, and co-mentors Dr. David Hickam, Professor of Medicine and health services researcher at OHSU, Dr. Carla Green, an experienced qualitative methods researcher, and Dr. Steven Asch, Associate Professor of Medicine at UCLA and director of the Veteran's Administration HIV Quality Enhancement Research Initiative. Dr. Richard Moore, principal investigator of the national HIV Research Network, and Dr. Ruth Finkelstein, principal investigator of the HRSA Special Projects of National Significance Integrated Buprenorphine and HIV Care Evaluation and Support Center will assure data access and continued support for the proposed aims. The proposed research focuses on identifying quality outcomes for patients with co-occurring drug abuse and HIV infection. Though effective treatments exist for both drug abuse and HIV infection, their impact on improving quality of care outcomes like HIV viral suppression remains unclear. I theorize that patients with co-occurring drug abuse and HIV infection achieve quality outcomes through a combination of healthcare structural and patient characteristics. My central hypothesis is that among persons with a history of drug abuse, better HIV quality of care summary scores are associated with access to drug abuse treatment, high levels of indicated care, and centrally integrated drug abuse treatment care. To test this hypothesis, I aim to conduct three studies to (1) determine the effect of access to drug abuse treatment on HIV quality of care, (2) determine the effect of indicated care on HIV outcomes, and (3) determine the effect of integrated drug abuse and HIV care on HIV quality of care among persons with varying degrees of drug use over time.
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