The purpose of this K24 application is to support the continuation and proposed expansions of Dr. Mallory Johnson's programs of mentoring and patient-oriented research (POR) in social and behavioral approaches to optimizing engagement in HIV care among drug-using populations. The candidate proposes new mentoring, new research, and additional training to build competency in drug abuse research, HCV and liver disease, and advanced research methodologies. The proposed plan for mentoring expands his current mentoring program in new directions, including an innovative grand mentoring program, new sources of mentees, development of online team-based mentoring tools, and scholarship in best practices of mentoring. These plans emphasize the importance of addressing challenges to successful transition to independence during periods of budgetary constraint through the leveraging and strategic use of data, infrastructure, and expertise available through existing NIH-funded research networks, training programs, and funding mechanisms.
Three aims for new research are proposed, which will provide data for future interventions to improve health care empowerment and clinical outcomes for populations at risk for suboptimal engagement in HIV care, including HIV-infected substance users (men, women, and transgender women) and HIV/HCV co-infected women. These POR activities will be conducted within the infrastructure of the Women's Interagency Health Study (WIHS), the CFAR Network of Integrated Clinical Systems (CNICS) and a cohort of transgender women led by one of the candidate's mentees. The overriding theme of the new POR is to investigate the challenges of engagement in care and uptake, persistence, and adherence, to antiretroviral therapy (ART) among populations at greatest risk for poor treatment outcomes. These POR activities will involve active participation by mentees and will complement their development plans and transitions to independence. All of the new aims will be framed in the Model of Health Care Empowerment and will provide preliminary data for subsequent observational and interventional studies of engagement in care. Through the efficient leveraging of existing resources, collaborations, data, and affiliations with NIH-funded networks, the overarching goal of this application is to support the development of early career investigators, new mentors, and to provide opportunities for my own training/competency-building, and to catalyze new projects in the area of engagement in HIV care among at- risk populations.

Public Health Relevance

Active engagement in clinical care and high levels of ART adherence allow people with HIV to live longer, healthier lives. However, marginalized populations such as substance users, sexual minorities, transgender persons, racial and ethnic minorities, those with mental illness, and those with unstable housing are more adversely impacted by the challenges of accessing and adhering to treatment and staying in care. The proposed funding will support the continued and expanded mentoring of early career investigators from diverse disciplines, and novel research on engagement in care among vulnerable populations.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Midcareer Investigator Award in Patient-Oriented Research (K24)
Project #
5K24DA037034-05
Application #
9518792
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Mandler, Raul N
Project Start
2014-07-01
Project End
2019-06-30
Budget Start
2018-07-01
Budget End
2019-06-30
Support Year
5
Fiscal Year
2018
Total Cost
Indirect Cost
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94118
Sauceda, John A; Lisha, Nadra E; Neilands, Torsten B et al. (2018) Cognitive-affective depressive symptoms and substance use among Latino and non-Latino White patients in HIV care: an analysis of the CFAR network of integrated clinical systems cohort. J Behav Med :
Merlin, Jessica S; Westfall, Andrew O; Long, Dustin et al. (2018) A Randomized Pilot Trial of a Novel Behavioral Intervention for Chronic Pain Tailored to Individuals with HIV. AIDS Behav 22:2733-2742
Woolf-King, Sarah E; Conroy, Amy A; Fritz, Katherine et al. (2018) Alcohol use and relationship quality among South African couples. Subst Use Misuse :1-10
Saberi, Parya; Ming, Kristin; Legnitto, Dominique et al. (2018) Novel methods to estimate antiretroviral adherence: protocol for a longitudinal study. Patient Prefer Adherence 12:1033-1042
Sauceda, John A; Neilands, Torsten B; Johnson, Mallory O et al. (2018) An update on the Barriers to Adherence and a Definition of Self-Report Non-adherence Given Advancements in Antiretroviral Therapy (ART). AIDS Behav 22:939-947
Merlin, Jessica S; Westfall, Andrew O; Johnson, Mallory O et al. (2018) Cost-effectiveness of a chronic pain intervention for people living with HIV (PLWH). J Med Econ 21:122-126
Conroy, Amy A; McKenna, Stacey A; Leddy, Anna et al. (2017) ""If She is Drunk, I Don't Want Her to Take it"": Partner Beliefs and Influence on Use of Alcohol and Antiretroviral Therapy in South African Couples. AIDS Behav 21:1885-1891
Webel, Allison R; Perazzo, Joseph D; Dawson-Rose, Carol et al. (2017) A multinational qualitative investigation of the perspectives and drivers of exercise and dietary behaviors in people living with HIV. Appl Nurs Res 37:13-18
Edmonds, Andrew; Ludema, Christina; Eron Jr, Joseph J et al. (2017) Effects of Health Insurance Interruption on Loss of Hypertension Control in Women With and Women Without HIV. J Womens Health (Larchmt) 26:1292-1301
Gamarel, Kristi E; Neilands, Torsten B; Conroy, Amy A et al. (2017) A longitudinal study of persistent smoking among HIV-positive gay and bisexual men in primary relationships. Addict Behav 66:118-124

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