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: 9193615
• 负责人: Sarah Elizabeth Wiehe
• 金额: $ 47.71万
• 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/9193615
• 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; 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; 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; metropolitan; mortality; offender; public health relevance; 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）：被监禁的个人承担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，药物滥用和心理健康问题。2008年，美国1.4%的监狱囚犯是艾滋病毒阳性（艾滋病毒+），每年有七分之一的艾滋病毒+者通过惩教设施。释放后，他们的艾滋病毒护理和结果基本上是未知的。本研究的目的是调查艾滋病毒的护理和结果之间的新诊断的艾滋病毒+个人逮捕或释放的监狱，监狱或少年拘留（“监禁后的时期”）在马里恩县（印第安纳波利斯），印第安纳州超过12年的时间。我们将使用艾滋病护理连续体 概念上是一个阶段性或阶梯式级联，包括艾滋病毒诊断、与护理的联系、继续护理、开始抗逆转录病毒治疗和病毒抑制 作为一个概念框架来指导我们的方法。核心假设是，与逮捕或监禁前相比，以及与非罪犯人口中的艾滋病毒阳性者相比，监禁后的艾滋病毒阳性罪犯在护理连续体的每个阶段的艾滋病毒护理和临床结果都较差。该项目的基本原理是确定新的机会，以改善艾滋病毒管理，沿着艾滋病毒护理的连续性，在这一弱势群体中。在与马里恩县的刑事司法、临床和公共卫生机构合作下，在9年的时间里，所有个人层面的逮捕、少年拘留、监狱和监狱记录都与性传播感染/艾滋病毒检测结果呈阳性有关。在专业知识和资源的基础上，拟议的研究将使用印第安纳州网络患者护理系统，美国大都市地区最全面的临床就诊数据集之一，在12年的时间内整合门诊、住院和急诊科就诊、药物和实验室数据。这些数据将使我们有前所未有的能力来调查艾滋病毒感染者在监禁后12个月、24个月和36个月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感染者中这一脆弱群体的艾滋病毒护理。其目的是：（1）评估在监禁期间和监禁之后被诊断感染艾滋病毒的罪犯与护理的联系;（2）说明新近感染艾滋病毒的罪犯在监禁后是否、何时、何地和以何种频率接受与艾滋病毒有关的临床服务;（3）在监禁后至少接受过一次与艾滋病毒有关的临床就诊的新近犯罪者中，评估艾滋病毒护理管理的质量;（4）调查罪犯在监禁后的临床护理结果。我们的研究的长期影响是改善艾滋病毒+个人在监禁后时期的护理和结果。我们的分析将告诉我们何时、何地以及如何进行最佳干预。