Finding, Testing and Treating High-risk Probationers and Parolees with HIV

描述（申请人提供）：拟议的研究有两个研究目标：（1）通过关注社区环境中的高风险、吸毒缓刑犯和假释犯，扩大刑事司法系统中个人艾滋病毒检测的机会和选择;和（2）改善这一人群中艾滋病毒阳性者获得和维持高效抗逆转录病毒治疗的机会，通过实施一项有希望的干预措施，重点是艾滋病毒护理的连续性，并使用严格的实验设计对其进行评估。该提案是对RFA-DA-10-017“寻求、检测和治疗：在刑事司法系统中处理艾滋病毒问题”的回应，其创新和全面地应用了“寻求、检测和治疗”范式。通过侧重于对吸毒缓刑犯和假释犯的社区检测和治疗支持，我们打算解决一部分刑事司法所涉人口的具体需求，这些人口很难通过更传统的基于系统的方法达到。这项拟议中的研究将以加州的奥克兰为基地，这个社区有大量的缓刑犯和假释犯，其中70%以上是非洲裔美国人或拉丁美洲人。具体目标是：目标1：设计和实施一项有针对性的、以社区为基础的战略，以识别、招募和向2 250名处于缓刑或假释期的快克可卡因和注射毒品使用者提供快速艾滋病毒检测和咨询;目标2：对HIV阳性受试者进行随机对照试验（RCT），以评估Project Bridge与常规护理组相比的疗效。修改后的有针对性的抽样技术将用于从社区环境中寻找符合条件的个人，重点是奥克兰缓刑犯和假释犯密度最高的社区。我们将在方便的社区地点提供快速艾滋病毒检测和咨询。感兴趣的结果将是被识别和招募的合格个人的比例，接受艾滋病毒检测，在过去6个月内没有接受艾滋病毒检测，并报告最近的艾滋病毒风险行为。我们还将评估与这些结果相关的因素，分析将以弱势群体行为模式为指导。在目标2中，未接受HIV护理的HIV阳性受试者（n=202）将入组RCT，并每季度随访24个月。干预措施（桥梁项目）旨在使艾滋病毒阳性的前罪犯参与并保持医疗保健，并显示出很大的希望，但尚未得到严格的评估。它将在社区公共卫生诊所提供。我们将比较干预参与者的病毒载量、HIV护理和HAART，并与接受标准HIV护理的一组进行比较。拟议的研究将有助于创新的方法，以达到高风险的缓刑犯和假释犯进行艾滋病毒检测，符合美国国立卫生研究院确定的优先事项。此外，它还将促进制定循证干预措施，以促进在涉及刑事司法的人群中提供不间断、治疗有效的艾滋病毒护理。

DESCRIPTION (provided by applicant): The proposed study has two research objectives: (1) to expand access and options for HIV testing with individuals in the criminal justice system, by focusing on high-risk, drug-using probationers and parolees in community settings; and (2) to improve access and maintenance of highly active antiretroviral treatment (HAART) among HIV-positive persons in this population, by implementing a promising intervention focused on continuity of HIV care, and evaluating it using a rigorous experimental design. This proposal is responsive to RFA-DA-10-017, "Seek, Test and Treat: Addressing HIV in the Criminal Justice System," in its innovative and comprehensive application of the "seek, test and treat" paradigm. By focusing on community-based testing and treatment support for drug-using probationers and parolees, we intend to address the specific needs of a portion of the criminal-justice-involved population that is hard to reach through more traditional systems-based methods. The proposed study will be based in Oakland, California, a community with a large number of probationers and parolees, over 70% of whom are African American or Latino. The Specific Aims are: Aim 1: To design and implement a targeted, community-based strategy to identify, recruit, and provide rapid HIV testing and counseling to 2,250 crack cocaine and injection drug users on probation or parole; and Aim 2: To conduct a randomized controlled trial (RCT) of HIV-positive participants to assess the efficacy of Project Bridge compared with a usual care arm. In Aim 1, modified targeted sampling techniques will be used to seek eligible individuals from community settings, focusing on the neighborhoods of Oakland with the highest density of probationers and parolees. We will provide rapid HIV testing and counseling at easily accessible community locales. Outcomes of interest will be the proportion of eligible individuals who are identified and recruited, accept HIV testing, have not been HIV tested in the previous 6 months, and report recent HIV risk behavior. We will also assess factors associated with these outcomes, the analyses of which will be guided by the Behavioral Model for Vulnerable Populations. In Aim 2, HIV-positive participants not in HIV care (n=202) will be enrolled in the RCT and followed quarterly for 24 months. The intervention (Project Bridge) is designed to engage and maintain HIV-positive ex-offenders in medical care, and has shown great promise, but has not yet been rigorously evaluated. It will be delivered at a community public health clinic. We will compare viral load, HIV care, and HAART among intervention participants, compared to a group that gets standard referral to HIV care. The proposed study will contribute innovative methods for reaching high- risk probationers and parolees for HIV testing, consistent with priorities identified by the National Institutes of Health. In addition, it will contribute to the development of evidence-based interventions to promote uninterrupted, therapeutically effective HIV care among criminal-justice-involved populations.