A Healthy Transition for Newly Released HIV-Infected Prisoners

描述（由申请人提供）：大约有700万人处于惩教监督之下，200万人在监狱和看守所（Maruschack，2002年）。由于进入监狱的人中的高性和药物使用风险行为（Altice等人，2005年; 1998年），囚犯中的艾滋病毒流行率是一般人口的四到七倍。由于教养机构中艾滋病毒感染的高流行率，它们已成为检测艾滋病毒以及引入治疗的重要哨点（Altice等人，2001; Mostashari等人，1998年）。艾滋病毒流行率因地理位置而异，东北部的流行率最高。康涅狄格州在全国囚犯中的艾滋病毒流行率第二高（仅次于纽约）;它收容了大约20，000名囚犯，我们已经证明其中男性的艾滋病毒血清流行率为6.1%（Mostashari，1998年），女性为9.2%（Altice等人，2005年）。在任何一天，康涅狄格州都有大约1,000名囚犯感染艾滋病毒并接受治疗，其中650多人正在接受HAART治疗。公共卫生方面的重大挑战之一是确保感染艾滋病毒的囚犯在获释后继续获得与艾滋病毒有关的护理。在康涅狄格州，每天约有150名囚犯被释放到社区，其中9至14人知道自己感染艾滋病毒的状况。虽然已经证明感染HIV的囚犯在惩教系统内对HAART反应非常好，但释放后很快就失去了收益（Springer等人，2004年）。迫切需要以艾滋病毒为重点的过渡方案，以优化艾滋病毒风险降低和艾滋病毒感染囚犯在释放后的HAART坚持。在这份修订后的R21申请中，我们提议创建“健康过渡”，这是一项基于证据的艾滋病毒风险降低和HAART依从性干预措施，并将其作为创新过渡计划的一个组成部分进行评估，该计划已获得资助，为新释放的艾滋病毒提供临床护理-康涅狄格州感染囚犯。这种新的方法，如果被发现是有效的，可能是具有成本效益的，很容易复制的地区，如城市中心，目前与艾滋病毒相关的护理从监狱到社区的连续性斗争。

DESCRIPTION (provided by applicant): Approximately seven million people are under correctional supervision and two million are in prisons and jails (Maruschack, 2002). As a consequence of high sexual and drug use risk behaviors among people who enter prisons (Altice, et al., 2005; 1998), the HIV prevalence among prisoners is four to seven times greater than in the general population. Because of the high prevalence of HIV infection in correctional institutions, they have become important sentinel sites for the detection of HIV as well as for the introduction of treatment (Altice, et al., 2001; Mostashari, et al., 1998). HIV prevalence varies by geography, with the highest rate in the northeast. Connecticut has the second highest HIV prevalence (2nd only to New York) among prisoners nationally; it houses approximately 20,000 inmates of whom we have demonstrated the HIV sero-prevalence to be 6.1% among men (Mostashari, 1998) and 9.2% among women (Altice, et al., 2005). On any given day, about 1,000 inmates in Connecticut are known to be HIV-infected and receiving care and, of these, over 650 are on HAART. One of the great public health challenges is ensuring that HIV-infected prisoners continue to receive HIV-related care when they are released. In Connecticut, about 150 prisoners are released to the community daily and 9 to 14 of these individuals are aware of their HIV-infected status. While HIV-infected prisoners have been demonstrated to respond extremely well to HAART within the correctional system, the benefit gain is soon lost after release (Springer, et al., 2004). There is an urgent need for HIV focused transition programs that optimize HIV risk reduction and HAART adherence among HIV-infected prisoners upon their release. In this revised R21 application, we propose to create 'Healthy Transition', an evidence- based HIV risk reduction and HAART adherence intervention - and evaluate it as a component of an innovative transition program that has already been funded to provide clinical care to newly released HIV- infected prisoners in Connecticut. This novel approach, if found to be effective, would likely be cost-effective and easy to replicate in areas such as urban centers that currently struggle with the continuity of HIV-related care from the prison to the community.