权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

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

基本信息

批准号：
9444446
负责人：
DIANE S MORSE
金额：
$ 11.55万
依托单位：
UNIVERSITY OF ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-07-15 至 2019-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9444446
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 Hepatitis C High Risk Woman Immune System Diseases 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 Regulation Research Risk Risk Behaviors Risk Factors Risk Reduction Self Determination Serum Service setting 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&apos s Health Work barrier to care base behavior change cohort community setting control trial 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 care services primary outcome recidivism recruit reduced substance use service engagement service intervention success theories therapy design transitional housing treatment adherence treatment as usual

项目摘要

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.

最近从监狱获释的妇女人数迅速增加，并患有艾滋病毒、物质使用障碍(SUD)、创伤、医疗问题和再次犯罪。在一项非对照研究中研究背景，我们的性别和创伤特定干预基于动机，妇女支持健康倡议(WISH)，展示了让妇女参与到需要的工作中的希望治疗。这项拟议的随机对照试验将检验WISH在社区卫生环境，以改善最近出狱妇女的健康。招聘网站包括法院、监狱、过渡性住房和社区服务设施。我们之前的工作为美国将与社区合作伙伴合作，并在未来更大范围内审查该项目的实施学习。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问题。愿望是特定于文化的，因为它是由一位训练有素的曾被监禁的同龄人提供的，他既增强了患者的选择，也增强了患者对改变行为的能力，并帮助他们在复杂的医疗系统中导航。除最近发布的女性经历中提到的其他健康风险、压力和精神健康问题他们面临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志物会受到Wish的影响。为了了解愿望是如何起作用的，我们将还考察了参与者基于自我决定理论的关于健康变化的调解措施行为，以及任何行为更改。由于个人和结构性障碍都阻碍了最近 Wish将女性从健康中解放出来，在这两个层面上运作。单独而言，许愿会议是一对一的- 一名妇女和她的同龄人社区卫生工作者之间的一次。从结构上讲，对等点通知提供商有关妇女的治疗需求和准备情况，并帮助妇女与所需的服务和克服护理方面的系统性障碍。对照组中的妇女将随机接受强化治疗，因为通常与初级保健挂钩的援助，但将获得艾滋病毒预防信息，而不是愿望干预。如果在最近获释的女性中成功，Wish在以下女性中也有成功的潜力社区矫正具有类似的风险因素，而且有可能节省成本。我们的建议是对新的美国国立卫生研究院艾滋病毒/艾滋病研究指南：我们将检查希望帮助提供者的可行性和可接受性识别有艾滋病毒风险的人，并促进进入和坚持艾滋病毒预防；同时检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方面的差距。我们的结构和个人自决理论为基础干预措施独特地解决艾滋病毒问题，服务于最近获释的妇女，有针对创伤的做法，利用同行导航，并将免疫生物标记物作为潜在的中介进行检查。