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

18-24岁的正义青年(Jiy)感染艾滋病毒的风险很大，但不太可能知道他们的艾滋病毒状况。 司法人群中的艾滋病毒感染率是普通人群的2-5倍，然而尽管存在这种风险，艾滋病毒 在司法环境中进行测试，特别是社区监督项目，并不是普遍的。即使在那之后 数据还表明，在司法人群中，与社区艾滋病毒护理的联系要低得多 与一般人口率相比，由于系统/组织、工作人员和个人因素， 特别是青少年药物使用(SU)。克服SU筛选和SU CARE招生的障碍， 因此，减少Jiy的艾滋病毒相关阴性结果的关键是。加大力度加大筛查力度 并改善与艾滋病毒的联系(包括为行为符合条件的艾滋病毒青年提供预防接种)和SU服务 需要解决青年问题以及司法和健康/行为健康系统层面障碍的综合保健方案。这 该项目建议嵌入艾滋病毒检测外展工作人员，由青年进行重点医疗和艾滋病毒治疗 纳入和替代量刑计划(ASP)，以提供新的服务交付模式(Link2CARE) 为JiY整合了基于证据的方案，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。这是一个 由具有丰富司法工作经验的拟议首席调查员提出的第一份R01提案 并由一支强大的多学科高级研究人员团队提供支持，以实现研究目标。引导式 根据CFIR和Andersen的卫生服务利用行为模型，我们的具体目标是：1)在450个济南 (18-24岁)，随机分为Link2CARE或标准护理(SOC)，以确定 由嵌入ASP的卫生工作人员提供的Link2CARE，关于(A)艾滋病毒结果：对艾滋病毒检测的接受 /重复检测；艾滋病毒危险行为；(B)性传播感染结果：接受性传播感染检测/重复检测，与护理的联系 (C)SU结局：SU筛查、SU和关爱SU的关联；和(D)(探索性)关联 照顾行为上符合预防接种条件的HIV Jiy和HIV-Jiy；2)确定 以理论为基础的改变干预机制(例如，诱因特征，使能资源， 对拟议的艾滋病毒和SU结果的感知需求、组织气氛、工作人员态度)；以及3) 描述Link2CARE实施并阐明系统/组织、员工和青年级别 影响Link2CARE在企业中实施的因素(即可接受性、可持续性、可行性) ASP制定了在纽约市传播和扩大Link2CARE的计划。我们建议分两个阶段 学习。在第1阶段：适应Link2CARE中，我们将调整干预组件以在Jiy和 试验n=8 Jiy；的结果协议，并最终确定产生的Link2CARE干预。在第二阶段： Link2CARE有效性试验和实施评估，我们将在注册的N=450 Jiy中测试Link2CARE ASP(阶段2a)，并与医护人员和ASP工作人员一起进行流程评估(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).