The HIV Care Continuum Among Recent Offenders

最近犯罪者的艾滋病毒护理连续性

• 批准号: 8989968
• 负责人: Sarah Elizabeth Wiehe
• 金额: $ 53.13万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-01-01 至 2018-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8989968
• 关键词: Accident and Emergency department; Adolescent; Age; Area; CD4 Lymphocyte Count; Caring; Chronic Disease; Clinical; Clinical Data; Clinical Services; Collaborations; Communities; Continuity of Patient Care; County; Criminal Justice; Data; Data Set; Diagnosis; Disease; Foundations; Frequencies; HIV; HIV Seropositivity; HIV diagnosis; HIV/STD; Health; Human immunodeficiency virus test; Imprisonment; Indiana; Individual; Information Systems; Inpatients; Jail; Laboratories; Link; Location; Measures; Mental Health; Methodology; Monitor; Morbidity - disease rate; Newly Diagnosed; Outcome; Outpatients; Patient Care; Persons; Pharmaceutical Preparations; Population; Prisoner; Prisons; Public Health; Records; Research; Resources; Sexually Transmitted Diseases; Staging; Substance abuse problem; Test Result; Time; United States; Ursidae Family; Viral; Viral Load result; Visit; Vulnerable Populations; Work; antiretroviral therapy; base; care systems; clinical care; improved; innovation; juvenile arrest; metropolitan; mortality; offender; secondary outcome; therapy adherence

DESCRIPTION (provided by applicant): Incarcerated individuals bear a disproportionate burden of HIV, as well as other sexually transmitted infections, chronic disease, and substance abuse and mental health issues. In 2008, 1.4% of prison inmates in the United States was HIV-positive (HIV+), and every year, 1 in 7 HIV+ persons pass through a correctional facility. Following release, their HIV care and outcomes are largely unknown. The purpose of this study is to investigate HIV care and outcomes among newly diagnosed HIV+ individuals arrested or released from jail, prison or juvenile detention ("post-incarceration period") within Marion County (Indianapolis), Indiana over a 12-year period. We will use the HIV care continuum conceptualized as a staged or stepped cascade including HIV diagnosis, linkage to care, retention in care, initiation of antiretroviral therapy and viral suppression as a conceptual framework to guide our methodology. The central hypothesis is that HIV+ offenders in the post-incarceration period will have poorer HIV care and clinical outcomes at every stage of the care continuum, compared to prior to arrest or incarceration and compared to HIV+ individuals in the non-offender population. The rationale for this project is to identify new opportunities for improving HIV management along the HIV care continuum among this vulnerable population. In collaboration with criminal justice, clinical and public health agencies serving Marion County, all individual-level arrest, juvenile detention, jail and prison records were linked with positive STI/HIV test results over a 9- year period. Building on this foundation of expertise and resources, the proposed study will incorporate outpatient, inpatient and emergency department encounter, medication and laboratory data over a 12-year period using the Indiana Network for Patient Care system, one of the most comprehensive clinical encounter data sets for a U.S. metropolitan area. These data will give us the unprecedented ability to investigate the HIV care continuum over time among HIV+ offenders in the post-incarceration period as defined by the 12-, 24- and 36-months following release and identify when and how HIV care can be improved for this vulnerable subset of the HIV+ population. The aims are to (1) Assess linkage to care among offenders diagnosed with HIV during and following incarceration; (2) Describe if, when, where and at what frequency recent offenders who are HIV+ receive HIV-related clinical services in the post-incarceration period; (3) Among recent offenders with at least 1 HIV-related clinical visit in a post-incarceration period, assess the quality of HIV care management; and (4) Investigate clinical care outcomes among offenders in the post-incarceration period. The long-term impact of our research is to improve the care and outcomes of HIV+ individuals in the post- incarceration period. Our analyses will inform us when, where, and how best to intervene.

描述（由申请人提供）：被监禁的人承受着不成比例的艾滋病毒负担，以及其他性传播感染、慢性疾病、药物滥用和精神健康问题。2008年，美国监狱中有1.4%的囚犯是艾滋病毒阳性（HIV+），每年每7名艾滋病毒阳性的人中就有1人通过教养设施。获释后，他们的艾滋病毒护理和结果在很大程度上是未知的。本研究的目的是调查在印第安纳州马里昂县（印第安纳波利斯）12年期间被逮捕或从监狱、监狱或少年拘留所（“监禁期后”）释放的新诊断的艾滋病毒阳性个体的艾滋病毒护理和结果。我们将把艾滋病毒护理连续统概念化为一个分阶段或阶梯式的级联，包括艾滋病毒诊断、与护理的联系、护理的保留、抗逆转录病毒治疗的开始和病毒抑制，作为指导我们方法的概念框架。研究的核心假设是，与逮捕或监禁之前以及与非罪犯群体中的艾滋病毒阳性个体相比，监禁后的艾滋病毒阳性罪犯在护理连续体的每个阶段都有更差的艾滋病毒护理和临床结果。该项目的基本原理是确定在这一弱势群体的艾滋病毒护理连续体中改善艾滋病毒管理的新机会。与马里恩县的刑事司法、临床和公共卫生机构合作，在9年期间将所有个人逮捕、少年拘留、监狱和监狱记录与性传播感染/艾滋病毒检测结果呈阳性联系起来。在此专业知识和资源的基础上，拟议的研究将纳入门诊、住院和急诊部门的就诊情况、药物和实验室数据，使用印第安纳州患者护理系统网络，这是美国大都市地区最全面的临床就诊数据集之一。这些数据将使我们有前所未有的能力来调查艾滋病毒阳性罪犯在释放后的12、24和36个月的监禁期内的艾滋病毒护理连续性，并确定何时以及如何改善艾滋病毒阳性人群中这一弱势群体的艾滋病毒护理。目的是(1)评估在监禁期间和监禁后被诊断为艾滋病毒的罪犯与护理的联系；(2)描述近期HIV阳性罪犯在监禁后是否、何时、何地以及以何种频率接受与HIV相关的临床服务；(3)在服刑后至少有1次HIV相关临床就诊的近期罪犯中，评估HIV护理管理的质量；(4)调查服刑后罪犯的临床护理结果。我们研究的长期影响是改善HIV+个体在监禁后的护理和结果。我们的分析将告诉我们何时、何地以及如何进行最好的干预。