CARE Corrections: Technology for Jail HIV/HCV Testing, Linkage, and Care (TLC)

描述（由申请人提供）：监禁是提供艾滋病毒和其他传染病检测和治疗以及向感染或传播风险增加的人提供预防教育的重要机会。被监禁的人群受到艾滋病毒和病毒性肝炎的影响不成比例，许多囚犯可能被边缘化，无法获得社区的医疗资源。鉴于监禁时间较短，筛查和干预措施的提供需要高效率和具有成本效益。这项研究将调整和评估用于艾滋病毒检测和改善艾滋病毒治疗依从性的基于信息和通信技术（ICT）的工具，将快速丙型肝炎病毒（HCV）检测和预防添加到向监禁人群提供艾滋病毒服务中。这些工具将有助于：1)艾滋病毒和丙型肝炎病毒风险评估、检测和预防咨询；2)与感染艾滋病毒的监狱被拘留者社区护理联系起来；3)病毒抑制监狱在押人员抗逆转录病毒药物释放到社区。具体而言，该项目将调整为在临床和社区环境中使用的艾滋病毒预防咨询和快速艾滋病毒检测而开发的计算机评估和减少风险教育（CARE）和针对艾滋病毒感染者的CARE+ (CARE+)，以便在监狱服刑人员中使用。新工具CARE矫正和CARE+矫正将包含与被监禁人群相关且具体的内容，包括HCV感染、药物使用行为以及维持与出狱后社区护理相关的艾滋病毒治疗。这还将包括新的功能，允许自动发送短信，以支持与社区艾滋病毒的联系（CARE+ Corrections“Call”系统）。在罗德岛监狱和华盛顿特区监狱系统中进行的一项两点随机对照试验中，我们将评估：1)在n=840名HIV阴性出狱人员中，CARE监狱提供的咨询是否比工作人员提供的咨询更有效地减少了HIV和HCV传播行为；2)在将n=320名感染艾滋病毒的监狱被拘留者与基于社区的艾滋病毒护理联系起来，并在重返社区后实现或维持艾滋病毒抑制方面，CARE+惩戒电话是否比标准的监狱释放规划服务更有效；3)与传统服务相比，在监狱设施中使用CARE和CARE +惩戒电话的成本效益。这一创新方法将扩大监狱中的检测、预防和治疗，并解决“寻找、检测和治疗”战略的基本组成部分。此外，这项研究将通过重点关注监狱系统来补充华盛顿特区正在进行的一项重大倡议（HPTN 065测试和与关怀- plus的联系）。该项目有可能创造出有效的信息通信技术工具，这些工具可以很容易地传播到广泛的惩教机构，以促进在监禁环境中实施“寻找、检测和治疗”战略。

DESCRIPTION (provided by applicant): Incarceration represents an important opportunity to provide testing and treatment for HIV and other infectious diseases and to deliver prevention education to persons at increased risk of infection or transmission. Incarcerated populations are disproportionately affected by HIV and viral hepatitis, and many inmates may be marginalized from healthcare resources in their communities. Given the short length of jail incarceration, screening and intervention delivery need to be conducted efficiently and cost-effectively. This research will adapt and evaluate information and communication technology-(ICT) based tools used for HIV testing and for improving adherence to HIV treatment, adding rapid hepatitis C virus (HCV) testing and prevention to the delivery of HIV services for jailed populations. These tools will facilitate: 1) HIV and HCV risk assessment, testing, and prevention counseling; 2) linkage to community-based care for HIV-infected jail detainees; and 3) viral suppression for jail detainees on antiretrovirals being released to the community. Specifically, this project will adapt CARE (Computer Assessment and Risk-Reduction Education), an HIV prevention counseling and rapid HIV testing developed for use in clinical and community settings, and CARE+, a version of CARE for HIV-infected persons, for use among jailed populations. The new tools, CARE Corrections and CARE+ Corrections, will have content relevant and specific to incarcerated populations including HCV infection, substance use behaviors, and maintenance of HIV treatment with linkage to community care following jail release. This also will include new functionality that will allow for automated text messaging to support linkage to community HIV (CARE+ Corrections 'Call' system). In a two-site randomized controlled trial conducted within the Rhode Island Department of Corrections jail and the Washington DC jail system, we will evaluate: 1) whether CARE Corrections delivered counseling is more effective than staff delivered counseling in decreasing HIV and HCV transmission behaviors among n=840 HIV-negative persons released from jail; 2) whether CARE+ Corrections Call is more effective than standard jail discharge planning services with respect to linking n=320 HIV-infected jail detainees to community based HIV care and achieving or maintaining HIV viral suppression following community re-entry; and 3) the cost-effectiveness of using CARE and CARE + Corrections Call within jail facilities compared to traditional services. This innovative approach will expand testing, prevention, and treatment in jails and address the essential components of the Seek, Test, and Treat strategy. In addition, this research will complement a major initiative underway in Washington DC (HPTN 065 Testing and Linkage to Care-Plus) by focusing on the jail system. This project has the potential to result in the creation of effective ICT tools that can be easily disseminated to a broad array of correctional facilities in order to facilitate the implementation of the Seek, Test, and Treat strategy in the incarcerated setting. PUBLIC HEALTH RELEVANCE: This research will adapt and evaluate technology-based tools to facilitate rapid HIV and hepatitis C testing, primary and secondary prevention counseling, and adherence to HIV treatment for jailed populations in Providence RI and Washington DC. This innovative research will use computerized counseling and tailored text messaging to expand testing, prevention, and treatment in both low- and high-HIV prevalence jail settings, addressing essential components of the Seek, Test, and Treat strategy among criminal justice populations. This research has the potential to result in the creation of effective technology-based tools that can be readily disseminated to a broad array of correctional facilities across the U.S in order to facilitate efficient identification, treatment, and linkage to care for HIV-infected persons.