Multilevel challenges to engagement in HIV care after prison release: a theory-informed qualitative study comparing prisoners' perspectives before and after community reentry.
Multilevel challenges to engagement in HIV care after prison release: a theory-informed qualitative study comparing prisoners' perspectives before and after community reentry.
复制标题
DOI：
10.1186/1471-2458-14-1253
复制
发表时间：
2014-12-09
影响因子：
4.5
通讯作者：
Parker SD
中科院分区：
文献类型：
--
作者：
Haley DF;Golin CE;Farel CE;Wohl DA;Scheyett AM;Garrett JJ;Rosen DL;Parker SD
虽然监狱提供了艾滋病毒诊断和获得监狱护理的机会，但许多感染艾滋病毒的囚犯在获释后经历了临床挫折，包括不坚持使用抗逆转录病毒药物、病毒载量增加和艾滋病毒疾病进展。感染艾滋病毒的前囚犯在成功重返社区和获得医疗保健方面面临许多障碍。然而，人们对感染艾滋病毒的囚犯获释后的预期结果知之甚少，他们的释放后生活如何与释放前的预期相一致，以及这些过程如何影响出狱后参与艾滋病毒护理。我们进行了半结构化的采访（24前和13后释放）与艾滋病毒感染的囚犯参加了一项随机对照试验的情况下，管理干预，以加强释放后的联系，以照顾。两名研究人员使用一个共同的密码本独立编码数据。编码器间的可靠性很强（kappa = 0.86）。我们使用扎根理论方法和应用主题分析来分析数据。我们收集并比较了所有队列参与者的基线社会人口统计学和行为特征，这些参与者使用Fisher精确检验进行分类测量，使用Wilcoxon秩和检验进行连续测量。大多数参与者是异性恋，中年，单身，非洲裔美国男性和女性，有药物使用史。子研究参与者更有可能预期与家人/朋友住在一起，并在释放后需要收入援助。大多数人在释放前服用抗逆转录病毒药物，并预计在释放后需要帮助确保健康福利和药物。在释放之前，大多数参与者都对自己能够控制艾滋病毒感到有信心。然而，在释放后，许多人经历了间歇性或长期的抗逆转录病毒不遵守，主要是由于药物使用复发或护理开始的延迟。物质使用是由紧张的生活经历促成的，包括耻辱和与吸毒社交网络的接触。正如社会认知理论和艾滋病毒污名框架所告知的那样，研究结果说明了物质使用、污名经历、释放前和释放后环境以及从事艾滋病毒护理所需技能之间的相互关系。这些调查结果强调，需要全面的循证干预措施，使囚犯从监禁过渡到自由，特别是那些加强与艾滋病毒护理的联系，并侧重于重返社会的现实，包括耻辱，满足基本需求，防止药物滥用，并确定社区资源。
Although prison provides the opportunity for HIV diagnosis and access to in-prison care, following release, many HIV-infected inmates experience clinical setbacks, including nonadherence to antiretrovirals, elevations in viral load, and HIV disease progression. HIV-infected former inmates face numerous barriers to successful community reentry and to accessing healthcare. However, little is known about the outcome expectations of HIV-infected inmates for release, how their post-release lives align with pre-release expectations, and how these processes influence engagement in HIV care following release from prison. We conducted semi-structured interviews (24 pre- and 13 post-release) with HIV-infected inmates enrolled in a randomized controlled trial of a case management intervention to enhance post-release linkage to care. Two researchers independently coded data using a common codebook. Intercoder reliability was strong (kappa = 0.86). We analyzed data using Grounded Theory methodology and Applied Thematic Analysis. We collected and compared baseline sociodemographic and behavioral characteristics of all cohort participants who did and did not participate in the qualitative interviews using Fisher’s Exact Tests for categorical measures and Wilcoxon rank-sum tests for continuous measures. Most participants were heterosexual, middle-aged, single, African American men and women with histories of substance use. Substudy participants were more likely to anticipate living with family/friends and needing income assistance post-release. Most were taking antiretrovirals prior to release and anticipated needing help securing health benefits and medications post-release. Before release, most participants felt confident they would be able to manage their HIV. However, upon release, many experienced intermittent or prolonged periods of antiretroviral nonadherence, largely due to substance use relapse or delays in care initiation. Substance use was precipitated by stressful life experiences, including stigma, and contact with drug-using social networks. As informed by the Social Cognitive Theory and HIV Stigma Framework, findings illustrate the reciprocal relationships among substance use, experiences of stigma, pre- and post-release environments, and skills needed to engage in HIV care. These findings underscore the need for comprehensive evidence-based interventions to prepare inmates to transition from incarceration to freedom, particularly those that strengthen linkage to HIV care and focus on realities of reentry, including stigma, meeting basic needs, preventing substance abuse, and identifying community resources.
登录
查看更多内容
影响因子：
4.4
作者：
Chen, Nadine E.;Meyer, Jaimie P.;Avery, Ann K.;Draine, Jeffrey;Flanigan, Timothy P.;Lincoln, Thomas;Spaulding, Anne C.;Springer, Sandra A.;Altice, Frederick L.
通讯作者：
Altice, Frederick L.
影响因子：
4.9
作者：
Baillargeon, Jacques;Giordano, Thomas P.;Paar, David P.
通讯作者：
Paar, David P.
DOI：
10.1080/09540121.2013.859650
发表时间：
2014-07-03
影响因子：
1.7
作者：
Binswanger, Ingrid A.;Mueller, Shane R.;Corsi, Karen F.
通讯作者：
Corsi, Karen F.
DOI：
10.1177/0306624x09342435
发表时间：
2010-10-01
影响因子：
1.5
作者：
Bahr, Stephen J.;Harris, Lish;Armstrong, Anita Harker
通讯作者：
Armstrong, Anita Harker
影响因子：
4.4
作者：
Althoff, Amy L.;Zelenev, Alexei;Meyer, Jaimie P.;Fu, Jeannia;Brown, Shan-Estelle;Vagenas, Panagiotis;Avery, Ann K.;Cruzado-Quinones, Jacqueline;Spaulding, Anne C.;Altice, Frederick L.
通讯作者：
Altice, Frederick L.