Assessing the HIV care cascade in a large southern prison system

评估南部大型监狱系统的艾滋病毒护理级联

• 批准号: 8929156
• 负责人: DAVID L ROSEN
• 金额: $ 38万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-18 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8929156
• 关键词: Address; Area; Caring; Characteristics; Clinical; Communities; Continuity of Patient Care; Criminal Justice; Detection; Diagnosis; Epidemic; Failure; Focus Groups; Future; General Population; Goals; HIV; HIV Seropositivity; Health; Healthcare; Human immunodeficiency virus test; Imprisonment; Individual; Infection; Intervention; Interview; Jail; Link; Literature; Measures; Modeling; North Carolina; Outcome; Patients; Pattern; Patterns of Care; Perception; Population; Populations at Risk; Prevalence; Prisoner; Prisons; Process; Provider; Qualitative Methods; Research; Risk; Staging; Statistical Models; Structure; System; Testing; Time; United States National Institutes of Health; Viral; Work; base; community setting; design; improved; insight; metropolitan; routine care; therapy design; transmission process

 DESCRIPTION (provided by applicant): The overlap in the dual epidemics of HIV and imprisonment in the U.S. is well-documented with a prevalence of HIV among prison populations more than three times that of the general population. Prisons are widely recognized as an important setting to address the HIV epidemic: testing and treating HIV-infected prisoners and linking those prisoners into community-based HIV care upon their release may both improve their health and reduce their risk of transmission in communities to which prisoners return. This strategy is commonly referred to as Seek, Test, Treat, and Retain (STTR). There are several NIH-sponsored ongoing and completed studies to evaluate components of the STTR strategy for criminal justice populations. Most focus on ways to increase HIV testing among inmates or improve continuity of HIV care from prisons and jails to the community. However, little research has addressed factors influencing entry into and retention in HIV care during imprisonment. This gap in the literature is significant considering that as many as 63% of known HIV-positive (HIV+) prisoners have not attained viral suppression at their time of release. Failure to attain routine HIV care in prison may portend a high likelihood of failure to enter into community HIV care at release, resulting in poor health and a heightened risk of transmission. Recently, a cascade of HIV care has been used to conceptualize HIV care across a continuum that starts with detection of infection and ends in suppression of viral replication. The strength f this popular model is that it provides a snap shot of gaps across progressive stages of HIV care; a limitation is that the cascade does not convey patients longitudinal patterns of care. This cascade has been enumerated to provide community estimates of engagement in care, but the HIV care cascade has not been applied to correctional settings, where opportunities and barriers to detect and treat HIV may be distinct from those in the community. We propose to examine the HIV care cascade and identify barriers and facilitators to entering and maintaining care and achieving viral suppression in a large southern prison system. In the process, we will evaluate the utility of the cascade outcomes in a prison setting. Specifically we plan to estimate the proportion of prisoners across each stage of the prison HIV care cascade. We will then evaluate whether the cross- sectional Cascade metrics provide a reasonable surrogate for longitudinal patterns of care, and we will identify individual- and system-level factors associated with failing to link into and retain prison HIV care. Finally, we will conduct interviews to understand barriers and facilitators to care from the perspectives of HIV+ prisoners and prison HIV care providers. These proposed activities are key steps in designing and evaluating interventions to strengthen the implementation of the STTR model, with the ultimate goal of improving the health of HIV+ prisoners and diminishing their risk of transmission in prison and in the communities to which they return.

 描述（由申请人提供）：在美国，艾滋病毒和监禁双重流行病的重叠是有据可查的，监狱人口中艾滋病毒的流行率是一般人口的三倍多。监狱被广泛认为是应对艾滋病毒流行的一个重要环境：检测和治疗感染艾滋病毒的囚犯，并在这些囚犯获释后将他们与社区艾滋病毒护理联系起来，既可改善他们的健康，又可减少他们在囚犯返回的社区中传播的风险。这种策略通常被称为寻找、测试、治疗和保留（STTR）。 有几个NIH赞助的正在进行和完成的研究，以评估刑事司法人口的STTR战略的组成部分。大多数方案侧重于如何增加囚犯中的艾滋病毒检测，或改善从监狱和监狱到社区的艾滋病毒护理的连续性。然而，很少有研究涉及影响在监禁期间接受和继续接受艾滋病毒护理的因素。考虑到多达63%的已知艾滋病毒阳性（艾滋病毒+）囚犯在释放时没有获得病毒抑制，文献中的这一差距是显著的。在监狱中无法获得常规艾滋病毒护理可能预示着很有可能无法进入监狱。 释放时的社区艾滋病毒护理，导致健康状况不佳和传播风险增加。 最近，一系列艾滋病毒护理已被用于概念化艾滋病毒护理，从检测感染开始，到抑制病毒复制结束。这种流行模式的优势在于，它提供了艾滋病毒护理各个渐进阶段之间差距的快照;一个局限性是级联不能传达患者的纵向护理模式。列举这一系列是为了提供社区参与护理的估计数，但艾滋病毒护理系列尚未适用于惩教环境，因为在惩教环境中，发现和治疗艾滋病毒的机会和障碍可能与社区不同。 我们建议检查艾滋病毒护理级联，并确定进入和保持护理和实现病毒抑制在一个大型的南方监狱系统的障碍和促进者。在这个过程中，我们将评估级联结果在监狱环境中的效用。具体而言，我们计划估计监狱艾滋病毒护理级联中每个阶段的囚犯比例。然后，我们将评估横截面Cascade指标是否为纵向护理模式提供了合理的替代，我们将确定与纵向护理模式相关的个人和系统水平因素。 未能与监狱的艾滋病护理联系起来并保持下去。最后，我们将进行访谈，以了解艾滋病毒阳性囚犯和监狱艾滋病毒护理提供者的角度来看，护理的障碍和促进因素。这些拟议的活动是设计和评价干预措施的关键步骤，以加强STTR模式的实施，最终目标是改善艾滋病毒阳性囚犯的健康状况，降低他们在监狱和返回的社区中的传播风险。