PS06-011, HIV Prevention Research with HIV+ Incarcerated Populations

简介（由申请人提供）：摘要：囚犯中的艾滋病毒感染率是普通社区的几倍。每年有超过四分之一的艾滋病毒携带者在美国的惩教系统中循环。惩教设施是一个结构化的，但重要的接触点，为高风险的艾滋病毒感染者返回我们的社区。到目前为止，还没有完全全面的监狱释放计划，旨在满足释放的囚犯及其社区的需求。它们主要仅基于各种病例管理模型进行预测，并且在释放后的艾滋病毒结果未显示出持续的稳定性。因此，综合方案缺乏抗逆转录病毒治疗的依从性，也缺乏降低艾滋病毒阳性囚犯向社区过渡时艾滋病毒风险的干预措施。在本提案中，我们寻求整合康涅狄格州现有的两个项目（TLC项目和CONNECT项目），并在此基础上增加一个修改后的降低艾滋病毒风险的干预措施，该干预措施改编自“整体健康恢复计划”（HHRP），将在监狱内实施，并在释放后三个月作为促进会议。我们打算将HHRP修改为在释放前90天在监狱环境中进行四次干预。我们将此称为发布前健康过渡（PHT）。PHT与现有的TLC项目（释放囚犯的过渡性病例管理服务）和CONNECT项目（对释放后需要阿片类药物激动剂治疗的阿片类药物依赖患者进行直接抗逆转录病毒治疗与标准护理的随机对照试验）相结合，将形成现在被称为TLC+项目的综合监狱释放项目。TLC项目和CONNECT项目现有资源的可用性使基础设施能够全面实施艾滋病毒阳性囚犯的综合过渡方案。该提案的另一个优势是，一个社区组织与监狱释放项目（哈特福德艾滋病项目）、耶鲁大学监狱艾滋病项目以及康涅狄格州惩教和公共卫生部门之间的合作。现有的资源、强有力的合作、在社区和惩教机构工作的调查人员的经验以及这些项目过去的记录显著地影响了成功实施有效干预和完成拟议研究的可能性。

DESCRIPTION (provided by applicant): ABSTRACT: The prevalence of HIV among prisoners is several-fold greater than found in the general community. Over one quarter of all HIV+ individuals cycle through the U.S. correctional system annually. Correctional facilities are a structured, but important point of contact for high risk HIV+ individuals who return to our communities. To date, there have not been fully comprehensive prison-release programs that are designed to meet the needs of released prisoners and their community. They have primarily been predicated only on various case management models and have not demonstrated continued stability in HIV outcomes after release. Hence, integrated programs have lacked adherence to antiretroviral therapy and reduction in HIV risk taking interventions for HIV+ prisoners transitioning to the community. In this proposal, we seek to integrate two existing programs in Connecticut (Project TLC and Project CONNECT) and layer on a modified HIV risk reduction intervention, adapted from the Holistic Health Recovery Program (HHRP), to be administered within prison and as a booster session three months after release. We intend to modify the HHRP to a four-session intervention within the prison setting during the 90 days prior to release. We will call this the Pre-Release Healthy Transition (PHT). Combining the PHT with the existing Project TLC (transitional case management services for released prisoners) and Project CONNECT (a randomized controlled trial of directly administered antiretroviral therapy versus standard of care for opioid dependent patients who are linked to opiate agonist therapy after release) will result in the comprehensive prison release program now called Project TLC+. The availability of existing resources for Project TLC and Project CONNECT allow for the infrastructure to fully implement a comprehensive transitional program for HIV+ prisoners. Additional strengths of this proposal are the collaborations between a community based organization experienced with prison release programs (AIDS Project Hartford), the HIV in Prisons Program at Yale University, and the Connecticut Departments of Correction and Public Health. The existing resources, the strong collaborations, the experience of the investigators working in community and correctional settings and past track record of these programs markedly influence the likelihood of successfully implementing an effective intervention and completing the proposed research.