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

说明(申请人提供)：监禁是为艾滋病毒和其他传染病提供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。被监禁人口受艾滋病毒和病毒性肝炎的影响不成比例，许多囚犯可能被社区的医疗资源边缘化。鉴于监禁时间短，筛查和干预交付需要高效率和高成本效益地进行。这项研究将调整和评价以信息和通信技术(ICT)为基础的工具，用于艾滋病毒检测和改善对艾滋病毒治疗的遵守情况，将丙型肝炎病毒(丙型肝炎病毒)快速检测和预防添加到为被监禁人口提供的艾滋病毒服务中。这些工具将促进：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在押人员的社区护理挂钩；3)向社区释放抗逆转录病毒药物，为监狱在押人员提供病毒抑制。具体地说，该项目将调整CARE(计算机评估和减少风险教育)，这是为临床和社区环境开发的艾滋病毒预防咨询和快速艾滋病毒检测，以及CARE，这是为艾滋病毒感染者提供护理的一个版本，供被监禁人口使用。新的工具，CARE校正和CARE校正，将包含与被监禁人口相关和特定的内容，包括丙型肝炎病毒感染、药物使用行为，以及在获释后与社区护理挂钩的艾滋病毒治疗的维持。这也将包括新的功能，将允许自动短信，以支持与社区艾滋病毒(关怀矫正‘呼叫’系统)的联系。在罗德岛惩教署监狱和华盛顿特区监狱系统内进行的一项两站点随机对照试验中，我们将评估：1)在n=840名艾滋病毒阴性的获释人员中，关怀惩教提供的咨询是否比工作人员提供的咨询更有效地减少艾滋病毒和丙型肝炎的传播行为；2)在将n=320名感染艾滋病毒的监狱在押人员与以社区为基础的艾滋病毒护理联系起来并在社区重新进入监狱后实现或维持艾滋病毒抑制方面，关怀惩教电话是否比标准的出狱计划服务更有效；以及3)在监狱设施内使用关怀和惩教电话与传统服务相比是否具有成本效益。这一创新方法将扩大监狱中的检测、预防和治疗，并解决寻求、检测和治疗战略的基本组成部分。此外，这项研究将通过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测试和与关怀的联系)。该项目有可能产生有效的信息和通信技术工具，这些工具可以很容易地传播到各种教养设施，以促进在监禁环境中执行寻找、测试和治疗战略。 公共卫生相关性：这项研究将调整和评估基于技术的工具，以促进普罗维登斯RI和华盛顿特区被监禁人口的艾滋病毒和丙型肝炎快速检测、一级和二级预防咨询以及坚持艾滋病毒治疗。这项创新研究将使用计算机化的咨询和量身定制的短信，在艾滋病毒流行率低和高的监狱环境中扩大检测、预防和治疗，解决刑事司法人群中寻求、检测和治疗战略的基本组成部分。这项研究有可能创造有效的基于技术的工具，这些工具可以很容易地传播到美国各地的各种惩教机构，以促进有效的识别、治疗和与护理艾滋病毒感染者的联系。

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.