Addressing overdose risk among recently incarcerated people living with HIV/AIDS

点击翻译按钮获取中文摘要

PROJECT SUMMARY People released from correctional facilities are at a greater risk of all-cause death in the first two weeks after their release compared to the general population.1 During this period, people who use drugs have a 3.8 times greater risk of death for drug-related causes than they have at other times.2 At an additional elevated risk for death among people who use opioids are people living with HIV/AIDS (PLWHA).5 There is an urgent need for evaluated, evidence-based programs designed to address overdose risk in these populations before they enter the most critical risk period for an overdose death. The long-term goal of the proposed study is to inform future policies and interventions to reduce overdose deaths in people exiting incarceration as they reenter their communities. The overall objective of this proposal, which is the next step toward attainment of the long-term goal, is to evaluate the intervention's effectiveness among HIV-positive inmates, specifically within the context of other inmate outcomes. The rationale for the proposed research is that outcomes can be used to develop tailored interventions to reduce overdose deaths among high-risk correctional populations. The proposed research objectives will be achieved through the following specific aims: Aim 1: Evaluate a pilot program to provide HIV+ inmates with 1:1 overdose prevention training while incarcerated; Aim 2: identify the criminal justice, health, and HIV-related factors associated with overdose risk; and Aim 3: use a risk environment approach to describe the overdose risk experiences of HIV+ former inmates who use opioids after release. The first aim will longitudinally evaluate changes in overdose knowledge and attitudes. The second aim will investigate overdose risk behaviors in recently released people living with HIV/AIDS, and the third aim will qualitatively describe facilitators and barriers to using risk reduction training content after release from jail. This contribution is important because evidence accumulated from this study has applications for correctional facilities and HIV clinical practice throughout the United States. The proposed research is innovative, in the applicant's opinion, because it represents a substantive departure from the status quo by addressing risk specific to HIV and incarceration status and contextualizing risk in the months after release from jail. Findings will provide evidence on (i) whether overdose training produces sustained positive changes in overdose knowledge and attitudes for this population, (ii) what factors influence the overdose risks of trained inmates, (iii) specific considerations for these populations when addressing overdose risk. Study findings will inform scalable, evidence-based interventions that can be used in a variety of correctional settings and will inform those who provide services to these groups about best practices in overdose prevention.