Transition from Prison to Community: A Pilot Intervention of Adherence Support

描述（由申请人提供）：许多人在进入教养设施时首次被诊断出患有艾滋病毒或开始接受艾滋病毒治疗。此外，在监狱中接受抗逆转录病毒药物治疗的大多数患者被释放回社区。在社区研究中，监禁史与抗逆转录病毒依从性问题的更大风险有关。不遵守抗逆转录病毒治疗方案可迅速导致耐药病毒株的产生，从而增加治疗反应不良的可能性，并增加耐药艾滋病毒株传播给他人的可能性。因此，加强从监狱释放的艾滋病毒阳性者坚持治疗具有重要的健康和公共卫生效益。该申请要求三年的支持，以开展发展性研究，设计和试点测试一种由护士提供的电话干预措施，以提高被监禁的艾滋病毒阳性患者在从监狱到重新进入社区的过渡期间的抗逆转录病毒依从性。我们正在提议一系列干预发展活动，其中包括：(1)从一项正在监狱环境中进行的随机对照试验中改编电话干预手册，使其包含更有针对性的出狱后内容；(2)制定和完善研究方案，以便在研究参与者重新进入社区时跟踪和留住他们；(3)完善评估措施；(4)在出狱前后的过渡时期，对基于动机和认知行为技能的依从性干预进行随机试点测试。(5)评估提供电话干预课程的可行性和可接受性，将州监狱和社区环境联系起来。在拟议的试点研究中制定的干预措施将以我们在监狱和社区环境中对艾滋病毒阳性男子和妇女进行的形成性工作为基础。在动机访谈和行为改变的认知行为方法的指导下，拟议的社区过渡干预将提供电话支持，以促进出狱患者的药物依从性和社区艾滋病毒护理服务的使用。拟议的项目是解决在教养设施接受艾滋病毒治疗后重新进入社区的人继续坚持治疗这一重要公共卫生问题所必需的下一阶段研究。

DESCRIPTION (provided by applicant): Many people are first diagnosed with HIV or begin HIV medical care when they enter a correctional facility. Moreover, most patients treated with antiretroviral medications in prison are released back into the community. History of incarceration has been linked to greater risk of antiretroviral adherence problems in community studies. Lapses in adherence to antiretroviral regimens can quickly lead to the development of drug-resistant viral strains, thereby increasing the likelihood of a poor treatment response and raising the possibility of drug-resistant HIV strains being transmitted to others. Enhancing treatment adherence among HIV+ persons released from prison therefore carries important health and public health benefits. This application requests three years of support to conduct developmental research to design and pilot test a nurse-delivered telephone intervention to improve antiretroviral adherence among incarcerated HIV+ persons during the transitional period from prison to community re-entry. We are proposing a sequence of intervention development activities that will include: (1) adapting telephone intervention manuals from an ongoing RCT conducted in a prison setting to include more targeted post-prison release content, (2) developing and refining study protocols for tracking and retaining study participants as they re-enter the community, (3) refining assessment measures, (4) conducting a randomized pilot test of a motivational and cognitive-behavioral skills based adherence intervention during the transitional period prior to and after release from prison, and (5) evaluating the feasibility and acceptability of delivering telephone intervention sessions that bridge state prison and community settings. The intervention developed in the proposed pilot study will build on our formative work with HIV-positive men and women in prison and community settings. Guided by motivational interviewing and cognitive-behavioral approaches to behavior change, the proposed community transition intervention will provide telephone support to promote medication adherence and use of community HIV care services among patients leaving prison. The proposed project constitutes the next phase of study necessary to address the important public health issue of sustaining treatment adherence in persons who re-enter the community after receiving HIV care in correctional facilities.