Health Promotion Coaching/Vaccine for Homeless Parolees

为无家可归假释者提供健康促进指导/疫苗

• 批准号: 8469452
• 负责人: Adeline M Nyamathi
• 金额: $ 58.5万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8469452
• 关键词: Adult; Aftercare; Alcohol consumption; Alcohol or Other Drugs use; Behavior; Behavioral; California; Car Phone; Case Manager; Cellular Phone; Communicable Diseases; Communication; Communities; Comprehensive Health Care; Coupled; Data; Dose; Drug usage; Education; Effectiveness; Employment; Enrollment; Family; Foundations; Funding; General Population; HBV Vaccination; HIV; Health; Health Policy; Health Promotion; Health Services; Health Services Accessibility; Healthcare; Hepatitis; Hepatitis A; Hepatitis B; Hepatitis B Prevalence; Hepatitis B Vaccines; Hepatitis B Virus; Hepatitis C; Hepatitis C virus; Homeless persons; Homelessness; Housing; Imprisonment; Individual; Infection; Injection of therapeutic agent; Intervention; Knowledge; Lead; Leadership; Link; Measures; Mediating; Mental Health; Mentors; National Institute of Drug Abuse; Needle Sharing; Outcome; Participant; Patient Self-Report; Pharmaceutical Preparations; Policies; Population; Prevention; Prisoner; Prisons; Program Effectiveness; Provider; Randomized; Recording of previous events; Relative (related person); Research Personnel; Residential Treatment; Risk; Risk Behaviors; Risk Reduction; Schedule; Series; Services; Sex Behavior; Social Health Services; Social Work; Subgroup; Substance abuse problem; Technology; Telephone; Time; Unemployment; Urine; Vaccination; Vaccines; Virus; Virus Diseases; Visit; Work; base; compare effectiveness; condoms; coping; cost; design; experience; follow-up; health care service utilization; high risk; housing instability; improved; injection drug use; innovation; intervention program; male; men; novel strategies; offender; parole; parolee; prevent; programs; prospective; rearrest; recidivism; reincarceration; sex risk; skills; social; substance abuse treatment; success; treatment as usual; treatment program

DESCRIPTION (provided by applicant): Homeless parolees are at high risk for Hepatitis B virus (HBV), Hepatitis C virus (HCV) and HIV infection due to high rates of injection drug use and unprotected sexual activity. Although HBV is a vaccine-preventable illness, 12% to 25% of formerly incarcerated individuals are infected with HBV. Homeless parolees pose a particular challenge for successful reentry as they have underlying mental health issues combined with substance use and abuse and must contend with unstable housing situations, disorganized lives, unemployment, and limited access to health care and social services. Generally about 50% of all parolees scheduled to enroll in community-based drug treatment fail to enroll and less than 10% of enrollees actually complete treatment. Not surprisingly, about two-thirds of all individuals on parole are rearrested and return to custody within three years of release from prison. Our recent data also revealed homeless persons least likely to complete a HAV/HBV vaccine series were young (< 40), and were men who had been discharged from prison. Therefore, it is critical to engage paroled adults in comprehensive intervention programs that not only protect them from HBV, but also reduce risky behavior, promote access to health care, social and employment services, and enable positive coping and communication skills. With advice from our community partners who have successfully treated parolees and our experience with hepatitis vaccination work, we propose to conduct a prospective, three-group study that randomly assigns 700 ready-for- discharge parolees, scheduled to enter a community residential drug treatment program, to enter one of three groups: 1) a PCPC (Parolee Comprehensive Care + Phone Coaching Program), which includes nurse case management and specialized hepatitis education sessions and referrals, the HAV/HBV vaccination series (to all eligible) and coach- facilitated mentoring (mostly by cell-phone); 2) a Parolee Brief Hepatitis Education + HBV vaccination + Phone Coaching (PBCP) Program, which includes brief hepatitis/HIV education, the HAV/HBV vaccination and coach-facilitated mentoring; or 3) a Usual Care (UC) control program, which includes brief general health information, and the HAV/HBV vaccine. For the randomized parolees, the primary aims will be to examine: reincarceration (any vs none), number of days to first reincarceration, completion of HAV/HBV vaccination (among those HBV-negative), and completion of six months of the Amity community-based residential drug treatment program. Secondary aims are to examine program- related differences in potential mediating variables, such as reduction in drug and alcohol use and sexual risk behaviors, visit to health care or social service providers, and improved knowledge of Hepatitis/HIV and communication skills, between 6 and 12 months or over the one-year study period, depending on the measure, and to assess the relative costs of the three programs. This study will advance our knowledge about drug treatment and HBV vaccine completion and recidivism among homeless parolees. Findings from this study can inform targeted interventions and lay the groundwork for health policy decisions that may impact hepatitis and HIV risk reduction and recidivism in this group who are a reservoir for these viruses in the general population, and are returning to prison at unprecedented numbers.

描述（由申请人提供）：无家可归的假释犯由于注射吸毒和无保护的性活动的高比率而处于B肝炎病毒（HBV）、丙型肝炎病毒（HCV）和艾滋病毒感染的高风险中。虽然HBV是一种疫苗可预防的疾病，但12%至25%的前监禁人员感染了HBV。无家可归的假释犯对成功重返社会构成了特别的挑战，因为他们有潜在的心理健康问题，加上药物使用和滥用，必须与不稳定的住房状况，混乱的生活，失业以及有限的医疗保健和社会服务作斗争。一般来说，计划参加社区药物治疗的所有假释犯中约有50%没有参加，只有不到10%的参加者实际完成治疗。毫不奇怪，大约三分之二的假释人员在出狱后三年内再次被捕并被重新拘留。我们最近的数据还显示，最不可能完成HAV/HBV疫苗系列的无家可归者是年轻人（< 40岁），并且是从监狱释放的男性。因此，至关重要的是让假释的成年人参与全面的干预计划，不仅保护他们免受HBV感染，而且减少危险行为，促进获得医疗保健，社会和就业服务，并使积极的应对和沟通技能。根据我们成功治疗假释犯的社区合作伙伴的建议以及我们在肝炎疫苗接种工作方面的经验，我们建议进行一项前瞻性的三组研究，随机分配700名准备出院的假释犯，计划进入社区住宅药物治疗计划，进入三组之一：1）PCPC（假释综合护理+电话辅导计划），其中包括护士病例管理和专门的肝炎教育课程和转介，甲肝/乙肝疫苗系列（面向所有合格人员）和教练协助的指导（主要通过手机）; 2）假释犯简短肝炎教育+乙肝疫苗接种+电话辅导（PBCP）计划，其中包括简短的肝炎/艾滋病毒教育，HAV/HBV疫苗接种和教练促进的指导;或3）家庭护理（UC）控制计划，其中包括简要的一般健康信息和HAV/HBV疫苗。对于随机化的假释犯，主要目的是检查：重新监禁（任何与无），第一次重新监禁的天数，完成HAV/HBV疫苗接种（在HBV阴性者中），以及完成6个月的阿米蒂社区住院药物治疗计划。第二个目的是检查在6至12个月或一年的研究期间（取决于测量），潜在中介变量（如减少吸毒和酗酒以及性风险行为、访问卫生保健或社会服务提供者以及提高肝炎/艾滋病毒知识和沟通技能）中与方案相关的差异，并评估三个方案的相对成本。这项研究将推进我们对无家可归的假释犯的药物治疗和乙肝疫苗接种完成和累犯的认识。这项研究的结果可以为有针对性的干预措施提供信息，并为可能影响这一群体中肝炎和艾滋病毒风险降低和累犯的卫生政策决策奠定基础，这一群体是这些病毒在普通人群中的储存库，并且正在以前所未有的数量返回监狱。