This application is a request for a Mentored Patient-Oriented Research Career Development Award (K23) to prepare Dr. Jennifer Mitty to design and implement studies to increase medication adherence and provide secondary prevention to HIV(+) individuals being released from the correctional setting. Dr. Mitty is an Assistant Professor of Medicine at Brown Medical School. The clinical research training environments at the Miriam Hospital and Brown Medical School are ideal for a K23 because of their extensive experience in prevention, directly observed therapy for HIV(+) patients and their work within corrections as well as following individuals being released from prison. The primary mentor for this award is Timothy Flanigan, MD, who has extensive experience in substance abuse, prevention and observed therapy research, and is involved in many research projects with HIV(+) individuals leaving prison. Dr Mitty will also have the full support of a strong mentorship team including Dr. Kenneth Mayer who is a leader in the field of H1V prevention, Dr. Kathleen Morrow whose expertise is in behavioral prevention and qualitative research, and Dr. Rick Altice who will serve as an off-site mentor and has an expertise in medication adherence, directly observed therapy, substance use and incarcerated populations. Drs Macalino and Hogan will be involved in study design, instrument development and analysis. HIV(+) persons leaving prison on highly active antiretroviral therapy are at increased risk of medication non-adherence and increased plasma viral load. In addition, our site and others have documented an increase in HIV risk behaviors after release from prison. Through this project a combined modified directly observed therapy and secondary prevention intervention will be developed for HIV(+) individuals leaving prison. Phase I of this study will use quantitative and qualitative techniques to evaluate facilitators and barriers to the intervention. During Phase II, a pilot intervention will be developed, modeled on existing DOT and secondary prevention programs. In phase III, this intervention will be piloted on 50 HIV(+) individuals transitioning to the community after release from the Adult Correctional Institution in Rhode Island. Acceptability and feasibility of the intervention will be evaluated, as well as efficacy of the intervention on plasma viral load suppression and self-reported HIV-risk behaviors during the first 6 months post release.
