This proposal outlines an integrated training and research program for a NIDA K23 Mentored Research Scientist Development Award. Dr, Himelhoch's long-term goal is to become an academic health services researcher studying access, provision and outcomes of HIV related medical care for HIV+ individuals with co-occurring psychiatric and substance disorders. A crucial challenge is to find effective ways to help individuals with co-occurring psychiatric and substance disorders successfully access and coordinate HIV related health care. To address this challenge, key HIV stakeholders in the City of Baltimore have proposed the development of a case-management intervention that may help these individuals better access and coordinate their HIV related health care. My immediate career goal then is to partner with these stakeholders using a community based participatory framework to help develop and then study the feasibility of using this case-management intervention. The training plan includes didactic coursework in advanced biostatistics, design of clinical trials, qualitative methods, and tutorials in community based participatory research, feasibility and effectiveness trials and case management interventions. This training plan will be integrated with three mentored research projects. First, a longitudinal study using data from the HIV Research Network Database will be used to study patterns of HIV related health care utilization to help identify potential factors that may be targeted in the community-based intervention. Second, a qualitative study will be employed to investigate the patient's perspective as it relates to obstacles to receiving HIV related medical care. This study will help ensure that relevant patient centered information is not excluded from the design process. Third, a pilot feasibility study using the final case management approach will be studied. If the results of these studies suggest the case management intervention is feasible it will inform the subsequent development of an extramural grant proposal aimed at studying the effectiveness of this intervention.
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