Health and Justice: A Continuum of Care for HIV and SU for Justice-involved Youth

18-24岁的司法参与青年（JIY）面临感染艾滋病毒的重大风险，但不太可能知道自己的艾滋病毒状况。 司法人员中的艾滋病毒感染率比一般人口高2-5倍，但尽管存在这种风险， 在司法环境中，特别是在社区监督方案中，测试并不普遍。即使 数据还表明，司法人员与社区艾滋病毒护理联系要低得多， 与一般人口比率相比，由于系统/组织、工作人员和个人因素， 特别是青年物质使用（SU）。克服SU筛查和SU护理登记的障碍， 因此，减少JIY的负面艾滋病毒相关结果的核心。加紧努力增加筛查 并改善与艾滋病毒的联系（包括艾滋病毒的PrEP-行为合格的青年）和SU服务， 需要JIY来解决青少年以及司法和健康/行为健康系统层面的障碍。这 该项目建议将艾滋病毒检测外展工作者从一个以青年为重点的医疗和艾滋病毒治疗机构中嵌入 替代性量刑方案（ASP），以提供新的服务提供模式（Link 2CARE） 整合JIY的循证方案，以a）促进艾滋病毒和性传播感染检测，艾滋病毒和SU风险 筛查和B）提供现场干预和c）与艾滋病毒、性传播感染和SU护理的跨系统联系。这是一 具有丰富司法工作经验的拟议主要研究者提交的第一份R 01提案 我们的研究团队拥有强大的多学科高级研究人员团队，以实现研究目标。指导 根据CFIR和Andersen的卫生服务使用行为模型，我们的具体目标是：1）在450个JIY中， （18-24岁），随机分配至Link 2CARE或标准治疗（SOC），以确定 Link 2CARE由ASP内部的卫生工作人员提供，内容涉及：（a）艾滋病毒成果：艾滋病毒检测的采用 （B）性传播感染的结果：接受性传播感染检测/重复检测，与护理的联系 JIY与STI;（c）SU结果：SU筛查、SU和与SU JIY护理的联系;（d）（探索性）联系 照顾HIV+ JIY和HIV- JIY，他们在行为上符合PrEP的条件; 2）确定 基于理论的改变干预机制（例如，易感特征，有利资源， 感知的需求、组织氛围、工作人员的态度）对拟议的艾滋病毒和支助股成果的影响;以及3） 描述Link 2CARE的实施情况，并阐明系统/组织、员工和青年层面 影响实施Link 2CARE的因素（即可接受性，可持续性，可行性） ASP将制定一项计划，在纽约市推广和扩大Link 2CARE。我们提出了一个2阶段 study.在第1阶段：Link 2CARE的适应性调整中，我们将调整JIY和 用n=8 JIY试验所得到的协议;并最终确定所得到的Link 2CARE干预。在第2阶段： Link 2CARE疗效试验和实施评价，我们将在入组的N=450名JIY患者中测试Link 2CARE， ASP（阶段2a），并与医疗保健人员和ASP工作人员进行过程评估（阶段2b）。

Justice-involved youth (JIY) aged 18-24 are at significant risk for HIV but are unlikely to know their HIV status. Rates of HIV in justice populations are 2-5 times higher than the general population, yet despite this risk, HIV testing in justice settings, particularly community supervision programs, is not universal. Even after identification, data also suggest that linkage to community HIV care in justice populations is much lower compared to general population rates, due to system/organization-, staff-, and individual-level factors, particularly youth substance use (SU). Overcoming barriers to SU screening and enrollment in SU care is, therefore, central to decreasing JIY’s negative HIV-related outcomes. Intensive efforts to increase screening and improve linkage to HIV (including PrEP for HIV– youth who are behaviorally eligible) and SU services for JIY are needed that address youth as well as justice and health/behavioral health system-level barriers. This project proposes to embed HIV testing outreach workers from a youth focused medical and HIV treatment program into and alternative sentencing program (ASP) to deliver a new service delivery model (Link2CARE) that integrates evidenced-based protocols for JIY to a) promote HIV and STI testing, HIV and SU risk screening and b) provide onsite intervention and c) cross-system linkage to HIV, STI and SU care. This is a first R01 proposal from proposed Principal Investigator with significant experience working within justice settings and supported by a strong multi-disciplinary team of senior researchers to achieve study aims. Guided by CFIR and Andersen’s Behavioral Model of Health Services Use, our Specific Aims are: 1) Among 450 JIY (18-24 y.o.), randomized to either Link2CARE or standard of care (SOC), to determine the efficacy of Link2CARE delivered by health staff embedded within the ASP, on (a) HIV outcomes: uptake of HIV testing /repeat testing; HIV risk behaviors; (b) STI outcomes: uptake of STI testing/repeat testing, linkage to care of JIY with STIs; (c) SU outcomes: SU screening, SU, and linkage to care of SU JIY; and (d) (exploratory) linkage to care of HIV+ JIY and HIV– JIY who are behaviorally eligible for PrEP; 2) to determine the influence of theoretically-based intervention mechanisms of change (e.g., predisposing characteristics, enabling resources, perceived need, organizational climate; staff attitudes) on the proposed HIV and SU outcomes; and 3) To describe Link2CARE implementation and elucidate the system/organizational-, staff-, and youth-level factors that influence implementation (i.e. acceptability, sustainability, feasibility) of Link2CARE in an ASP to develop a plan for dissemination and scale-up of Link2CARE in New York City. We propose a 2-phase study. In Phase 1: Adaptation for Link2CARE, we will adapt the intervention components for use among JIY and pilot the resulting protocols with n=8 JIY; and finalize the resulting Link2CARE intervention. In Phase 2: Link2CARE Efficacy Trial and Implementation Evaluation, we will test Link2CARE among N=450 JIY enrolled at the ASP (Phase 2a) and conduct process evaluations with healthcare staff and ASP staff (Phase 2b).