Over the four years of this proposal, Dr. Culbert will achieve his career goal of establishing an independent career path developing, testing, and disseminating interventions for HIV and addiction through three training objectives: (1 Develop expertise in research methods to develop, test, and evaluate evidence-based interventions for HIV and addiction with a focus on HIV+ prisoners in low and middle-income countries; (2 Gain experience delivering and testing complex interventions for behavior change with individuals through well-designed clinical trials; 3) Increase proficiency in statistical methods for analyzing clinical trials and techniques for evaluating processes of implementation. A mentored career development award is essential at this stage to provide the candidate with training and experience to develop and test complex interventions with prisoners. Although the candidate received excellent postdoctoral mentoring, he has no prior experience developing, testing, or evaluating evidence-based interventions, which are his career aims. Dr. Culbert has assembled an outstanding team of mentors in the fields of HIV, intervention development, and clinical trials. Under their guidance, he will complete formal coursework and conduct research to achieve his career goals and submit a highly competitive R01/R34 upon completion of the K award. The HIV epidemic in Indonesia is expanding and closely intertwined with substance use and incarceration. Very few people living with HIV (<8%) receive treatment with antiretroviral therapy (ART), and HIV-related mortality has increased 427% from 2005-13, despite global reductions. At the core of Indonesia's HIV epidemic are people who inject drugs, and prisoners for whom ART adherence is problematic, especially after prison release. Effective use of ART in prisoners at the point of release could improve health outcomes and limit the spread of HIV. Set in the context of Indonesia's large treatment gap, the proposed mentored research projects are highly innovative because they are the first studies outside the U.S. to develop and test a medication adherence intervention for released prisoners, who globally are at markedly increased risk of ART non-adherence and mortality.
These aims directly address NIDA (FY2016) priority areas for AIDS research including: 1) engaging and retaining substance users in care; and 2) developing evidence-based interventions for challenging, real-world settings. In Project 1, we will develop an ART adherence intervention for released prisoners in Indonesia, using ATHENA (Adherence Through Home Education and Nursing Assessment), an evidence-based intervention, as our conceptual framework. In Project 2, we will conduct a pilot randomized controlled trial to examine cultural acceptability and organizational feasibility of the intervention. This is not a replication study. Rather, we use a coherent methodology (ADAPT-ITT) to culturally adapt ATHENA to address the transition from prison ? resulting in a new evidence-based intervention. Dr. Culbert is uniquely poised to conduct this work because of his strong background in nursing, his Indonesian language skills, and previous research experience in Indonesian prisons. The candidate requires substantial training, however, to be able to develop, test, and evaluate complex interventions with prisoners in international settings.
Globally, incarceration represents a strategic opportunity to diagnose and treat HIV and support people living with HIV to adhere to prescribed treatments after prison release. Medications used to treat HIV have direct therapeutic benefits and can reduce the risk of future transmission. Effective use of HIV medications in prisoners at the point of release could improve health outcomes and limit the spread of HIV. Yet very few interventions for medication adherence have been developed for released prisoners, most of whom have co-occurring substance use disorders. This study addresses these gaps by developing an evidence-based medication adherence intervention for HIV-infected prisoners in Indonesia where HIV-related transmission and mortality are increasing. Findings from this research will be applied to develop interventions for HIV and addiction in criminal justice settings in the U.S. and internationally.
| Culbert, Gabriel J; Williams, Ann B (2018) Cultural Adaptation of a Medication Adherence Intervention With Prisoners Living With HIV in Indonesia: A Pragmatic Approach to Intervention Development. J Assoc Nurses AIDS Care 29:454-465 |
| Culbert, Gabriel J; Crawford, Forrest W; Murni, Astia et al. (2017) Predictors of Mortality within Prison and after Release among Persons Living with HIV in Indonesia. Res Rep Trop Med 8:25-35 |
