Availability is Not Access: Recently Incarcerated Women, HIV Risk, and Substance Use Disorders

可用性并不等于访问：最近被监禁的妇女、艾滋病毒风险和药物滥用障碍

• 批准号: 9314551
• 负责人: DIANE S MORSE
• 金额: $ 30.78万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-15 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9314551
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Alcohol or Other Drugs use; Behavior; Behavioral; Behavioral Mechanisms; Biological; Biological Markers; Blood; C-reactive protein; Caring; Clinical; Coagulation Process; Communities; Community Health; Community Health Aides; Community Services; Competence; Complex; Continuity of Patient Care; Control Groups; Cost Savings; Counseling; Effectiveness; Feedback; Feeling; Fibrin fragment D; Foundations; Funding; Future; Gender; Guidelines; HIV; HIV Infections; HIV risk; HIV/HCV; Health; Health Services; Health behavior; Health behavior change; High Risk Woman; Immune System Diseases; Immune System and Related Disorders; Immunologic Markers; Immunologics; Imprisonment; Individual; Infection; Inflammation; Inflammatory; Interleukin-6; Interleukin-8; Intervention; Jail; Link; Measures; Mediating; Mediation; Mediator of activation protein; Medical; Medical Care Team; Mental Depression; Mental Health; Mental disorders; Methods; Motivation; National Institute of Drug Abuse; Outcome; Participant; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Prevention; Preventive care; Preventive service; Primary Health Care; Procedures; Prophylactic treatment; Protocols documentation; Provider; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Readiness; Recruitment Activity; Regulation; Research; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Self Determination; Serum; Services; Sexually Transmitted Diseases; Site; Stress; Substance Use Disorder; Symptoms; System; Training; Training and Infrastructure; Trauma; Uncontrolled Study; United States National Institutes of Health; Variant; Vulnerable Populations; Woman; Women' s Health; Work; base; behavior change; cohort; community setting; court; depressive symptoms; disparity reduction; empowerment; experience; fighting; health care service utilization; health service use; high risk; improved; innovation; intervention effect; intimate partner violence; novel; peer; pre-exposure prophylaxis; prevent; prevention service; primary outcome; recidivism; reduced substance use; service intervention; success; theories; therapy design; transitional housing; treatment adherence; treatment as usual

Women recently released from incarceration are rapidly growing in number and suffer from syndemic risk of HIV, substance use disorders (SUD), trauma, medical problems, and recidivism. In uncontrolled studies in a research setting, our gender and trauma-specific intervention grounded in the Self-Determination Theory of motivation, Women's Initiative Supporting Health (WISH), shows promise in engaging women into needed treatment. This proposed randomized control trial will examine the feasibility and acceptability of WISH in a community health setting to improve health of women recently released from incarceration. Recruitment sites include court, jail, transitional housing, and community service settings. Our prior work lays the foundation for us to collaborate with community partners and examine implementation of this project in a larger scale future study. The specific aims include engaging women in behavioral and medication treatment to prevent HIV infections and address SUD, mental health, and intimate partner violence. WISH is culturally-specific because it is delivered by a trained formerly incarcerated peer who both enhances patients' choice and feelings of competence to change behaviors and helps them navigate the complex medical system. In addition to the other health risks noted, stress and mental health problems which recently released women experience put them at risk of immune dysfunction that can lessen their ability to fight infection. We will also examine whether participants' immune markers in their blood are impacted by WISH. To understand how WISH works, we will also examine participants' Self-Determination Theory-based mediation measures regarding changes in health behavior, along with any behavior changes. Since both individual and structural barriers prevent recently released women from being healthy, WISH operates on both levels. Individually, WISH sessions are one-on- one between the woman and her peer community health worker. Structurally peers inform providers regarding women's treatment needs and readiness, and help women navigate linkage with needed services and overcome systemic barriers to care. Women in the control group will be randomized to enhanced treatment as usual with assistance linking to primary care but will receive HIV prevention information in lieu of the WISH intervention. If successful among recently released women, WISH has potential for success with women under community corrections with similar risk factors and is potentially cost-saving. Our proposal is responsive to new NIH HIV/AIDS research guidelines: we will examine feasibility and acceptability of WISH to help providers identify people at HIV risk, and promote entry and adherence to HIV prevention; while examining biological and behavioral mechanisms of changes in HIV risk, we will develop community and training infrastructures which will reduce disparities in HIV acquisition. Our structural and individual Self-Determination Theory-based intervention uniquely addresses HIV, serves recently released women, has trauma-specific practices, utilizes peer navigation, and examines immunologic biomarkers as potential mediators.

最近从监禁中获释的妇女人数迅速增加，她们面临着新冠病毒流行的风险。 艾滋病毒，物质使用障碍（SUD），创伤，医疗问题和累犯。在一项非对照研究中， 研究设置，我们的性别和创伤的具体干预扎根于自我决定理论， 妇女支持健康倡议（WISH）显示了让妇女参与所需活动的希望。 治疗这项拟议的随机对照试验将研究WISH在一个 社区保健环境，以改善最近从监禁中释放的妇女的健康。招聘网站 包括法院、监狱、过渡性住房和社区服务场所。我们之前的工作为以下方面奠定了基础 我们将与社区合作伙伴合作，并研究在未来更大规模地实施该项目 study.具体目标包括让妇女参与预防艾滋病毒的行为和药物治疗 感染和解决SUD，心理健康和亲密伴侣暴力。WISH是特定文化的，因为 它是由一个受过训练的前监禁同行谁既增强病人的选择和感情， 改变行为的能力，并帮助他们驾驭复杂的医疗系统。除了有 注意到的其他健康风险，最近公布的妇女经历的压力和心理健康问题， 他们有免疫功能障碍的风险，这可能会降低他们抵抗感染的能力。我们还将研究是否 参与者血液中的免疫标记物受到WISH的影响。要了解WISH如何工作，我们将 还研究了参与者关于健康变化的基于自我决定理论的调解措施 行为，沿着任何行为变化。由于个人和结构性障碍， WISH在这两个层面上运作。个别地，WISH会话是一对一的- 一个是妇女和她的同伴社区卫生工作者之间的。从结构上讲，对等体通知提供商， 妇女的治疗需求和准备情况，并帮助妇女与所需服务建立联系， 克服护理的系统性障碍。对照组中的女性将随机接受强化治疗， 通常与初级保健有关的援助，但将获得艾滋病毒预防信息，而不是WISH 干预如果在最近获释的妇女中取得成功，WISH有可能在未成年妇女中取得成功。 社区矫正具有类似的风险因素，有可能节省费用。我们的建议是响应新的 美国国立卫生研究院艾滋病毒/艾滋病研究指南：我们将研究WISH的可行性和可接受性，以帮助提供者 查明艾滋病毒高危人群，促进进入和坚持艾滋病毒预防工作;同时审查生物和 艾滋病毒风险变化的行为机制，我们将发展社区和培训基础设施， 将减少艾滋病毒感染的不平等。我们的结构和个人自决理论为基础的 干预措施专门针对艾滋病毒，为最近获释的妇女提供服务，有针对创伤的做法，利用 同行导航，并检查免疫生物标志物作为潜在的介质。