Evaluating the use of long-acting antiretroviral treatment for HIV during community re-entry: Addressing community and structural barriers

摘要 经历监禁的人不成比例地受到艾滋病毒感染的影响。释放的时间从 对于艾滋病毒携带者来说，囚禁环境，即所谓的社区重返，是一个特别高风险的时期。在.期间 这一次，人们面临着更大的病毒反弹风险，原因是ART依从性差，药物使用复发， 无法与社区艾滋病毒提供者接触，无法满足抗逆转录病毒药物处方，以及 个体返回的混乱环境。长效注射(LAI)ART是一种新的帮助 克服每天坚持口服药物治疗的挑战。然而，人们对此知之甚少。 最好在这一人群中发展和优化LAI ART干预措施。因此，我们提出了探索性的 实施研究，将提供额外的初步数据，以加强我们对LAI ART的理解 在大西洋中部地区结束艾滋病毒流行的不同地区的执行情况：乔治王子 马里兰州县城和华盛顿特区。使用综合框架进行执行研究--a 我们提出了指导影响执行因素调查的理论模型 采访上述每个领域的利益相关者，并进行德尔福研究。具体的重点将是 与广泛的健康服务相联系(例如，精神健康、药物使用、需要同伴或 社区卫生工作者服务)和每个地点可能存在的结构性障碍(卫生 保险、住房、就业、贫困)。我们的具体目标是：1)确定如何优化未来的赖艺术 通过在每个地点采访15个利益攸关方对社区重新进入人群进行干预(总共n=45人)，以及2人) 通过与30人进行德尔福研究，共同为未来的LAI ART干预制定最佳实践指南 专家。拟议的项目与拨款公告的目标相对应，因为我们将进行 开展LAI干预的实施研究，以解决多层面的关键因素 促进与创新的艾滋病毒治疗模式的联系。来自附录的研究结果将支持研究 是未来R01应用程序的基础，重要的是，它将与我们的EHE实施共享， 每个EHE站点的政府、社区合作伙伴。

Abstract Persons who experience incarceration are disproportionately impacted by HIV infection. The time of release from carceral settings, known as community re-entry, is a period of particularly high risk for persons with HIV. During this time, people are at an increased risk of viral rebound due to poor ART adherence, substance use relapse, inability to engage with community HIV providers, inability to fill ART prescriptions, and competing needs in the chaotic environment to which individuals return. Long-acting injectable (LAI) ART is a new alternative to help overcome the challenges of adhering to a daily regimen of oral medication. However, little is known about how best to develop and optimize LAI ART interventions in this population. Therefore, we propose exploratory implementation research that will provide additional preliminary data to enhance our understanding of LAI ART implementation in diverse Ending the HIV Epidemic (EHE) areas in the mid-Atlantic region: Prince Georges County, MD; and Washington, DC. Using the Consolidated Framework for Implementation Research—a theoretical model that guides investigation into the factors that influence implementation, we propose interviewing stakeholders in each of the above EHE areas and conducting a Delphi study. Specific focus will be placed on linkage to a broad array of health services (e.g., mental health, substance use, the need for peer or community health worker services) and the structural barriers that might be present in each location (health insurance, housing, employment, poverty). Our specific aims are to: 1) identify how to optimize future LAI ART interventions in community re-entry populations by interviewing 15 stakeholders at each site (total n=45), and 2) co-produce best practice guidelines for future LAI ART interventions by conducting a Delphi study with 30 experts. The proposed project maps onto the objectives of the funding announcement in that we will conduct implementation research to develop a LAI intervention that addresses multi-level factors that are key to facilitating linkage to innovative HIV treatment modalities. Findings from the supplement supported research will be the foundation of a future R01 application and, importantly, will be shared back with our EHE implementation, governmental, and community partners at each EHE site.