Comprehensive HIV Testing Strategies for Jails

描述(由申请人提供)：这个K23职业发展奖的目标是让Beckwith博士获得必要的技能，成为一名独立的临床调查员，专门为吸毒者提供艾滋病毒检测服务，特别是在监禁环境中。职业目标包括以下方面的培训：1)特别注意传染病流行病学的临床研究方法；2)卫生服务研究；3)在吸毒者中进行研究；以及4)在监禁环境下进行研究的道德规范。研究计划建议：1)分析现有的Project Start数据库，以评估监狱环境中艾滋病毒检测和咨询的障碍和促进者；2)对监狱中的提供者和监狱在押人员进行定性访谈，以评估监狱中快速艾滋病毒检测的障碍和促进者；以及3)在罗德岛惩教部门监狱进行前瞻性随机对照试验，比较快速艾滋病毒检测和咨询干预与标准艾滋病毒检测和咨询干预。干预措施将包括基于项目方面的个人化艾滋病毒风险降低咨询、简短咨询干预以及艾滋病毒快速检测。监狱在押人员将随机接受快速艾滋病毒检测和咨询干预(干预组)或仅接受标准艾滋病毒检测和咨询(控制组)。据假设，干预组中的受试者：1)将更频繁地收到他们的艾滋病毒检测结果；2)出狱后从事艾滋病毒危险行为的比率较低；以及3)对于新诊断为艾滋病毒感染的受试者，在获释后将更有效地与社区的艾滋病毒护理联系起来。为了评估这些结果，所有受试者都将在监狱中完成基线艾滋病毒风险行为评估。受试者将被随机分配到各自的研究部门，并将在获释后6周和24周进行计划的后续访问，以评估对艾滋病毒检测结果的接收情况，出狱后艾滋病毒危险行为的变化，以及社区建立艾滋病毒护理。贝克维斯博士将由罗德岛州普罗维登斯市布朗医学院的蒂莫西·P·弗拉尼根博士指导。通过这一奖项，贝克维斯博士的目标是推动向被监禁的人提供艾滋病毒检测和预防服务。

DESCRIPTION (provided by applicant): The goal of this K23 Career Development Award is for Dr. Beckwith to acquire the skills necessary to become an independent clinical investigator specializing in the delivery of HIV testing services to substance users, particularly in the incarcerated setting. Career goals include training in: 1) the methodologies of clinical research with special attention to infectious diseases epidemiology; 2) health services research; 3) conducting research among substance users; and 4) ethics of conducting research in the incarcerated setting. The research plan proposes to: 1) analyze the existing Project START database to assess barriers and facilitators to HIV testing and counseling in the jail setting; 2) conduct qualitative interviews with in-prison providers and jail detainees to assess barriers and facilitators to rapid HIV testing in jail; and 3) perform a prospective randomized controlled trial in the Rhode Island Department of Corrections jail comparing a rapid HIV testing and counseling intervention with standard HIV testing and counseling. The intervention will consist of individualized HIV risk reduction counseling based on the Project RESPECT brief counseling intervention coupled with rapid HIV testing. Jail detainees will be randomized to receive either the rapid HIV testing and counseling intervention (intervention arm) or standard HIV testing and counseling only (control arm). It is hypothesized that subjects in the intervention arm: 1) will receive their HIV test results more often; 2) will engage in lower rates of HIV risk behavior following release from jail; and 3) for subjects newly diagnosed with HIV infection, will be more efficiently linked to HIV care in the community following jail release. To evaluate these outcomes, all subjects will complete a baseline HIV risk behavior assessment in jail. Subjects will be randomized to their respective study arm and there will be follow-up visits scheduled six weeks and 24 weeks following jail release in order to evaluate receipt of HIV test results, changes in HIV risk behavior following release from jail, and establishment of HIV care in the community. Dr. Beckwith will be mentored by Dr. Timothy P. Flanigan from Brown Medical School in Providence, Rl. Through this award, Dr. Beckwith aims to advance the delivery of HIV testing and prevention services to persons incarcerated in jail.