Improving HIV care continuum outcomes among formerly incarcerated individuals through critical time legal interventions

项目摘要。以前被监禁的个人受到损害健康的法律的需要和风险的影响， 包括缺乏艾滋病毒护理，不安全的住房安全，不稳定的就业，以及其他问题， 破坏艾滋病护理。提供获得法律的服务的机会可以消除艾滋病毒护理的障碍，改善艾滋病毒护理 对以前被监禁的个人的连续性结果。这项由中央大学领导的拟议研究 佛罗里达（西班牙裔服务机构），连同迈阿密大学，希望和帮助公司，旨在试点 测试一种全面的关键时间干预医疗法律的伙伴关系（CTI-MLP）方法， 曾被监禁者中的艾滋病毒关联、滞留和病毒抑制。MLP已被用于 以社会正义为导向的医疗、卫生、社会和法律的服务实践，以确定和解决健康损害 法律的需求和风险，为几种健康状况的治疗、护理和康复造成障碍。MLPs 提供一个综合的结构性干预措施，可以改善艾滋病毒护理的连续性和心理社会结果 在以前被监禁的人中。我们的CTI-MLP干预方案包括：1）为所有MLP提供培训 工作人员（临床、社会和行为服务，以及法律的）对艾滋病毒的持续护理、危害健康的法律的需求 和风险影响以前被监禁的个人，以及MLP的结构和运作，以确保 综合和协作的环境是建立从该计划的最早阶段; 2）培训， 案件管理员和法院律师提供法律的连续性护理; 3）将法律的专门知识嵌入 定期举行案件管理小组会议; 4）通过MLP在卫生保健机构共同提供法律的服务 组织间伙伴关系; 5）调整和实施组织最佳做法， MLP内提供者之间的沟通和信息共享协议，以患者自主权为基础 和选择在第一年，我们将聘请当地社区咨询委员会，科学咨询委员会和法律的 专家小组最后确定议定书和医疗法律的伙伴关系培训手册。第二年，我们将实施 培训和试点测试的CTI-MLP倡议与前监禁的艾滋病毒感染者（n=100）。超过 在6个月的时间内，该团队将收集（1）患者的健康和功能，包括整体身体健康， 心理健康、社会健康、疼痛、疲劳和总体感知生活质量;（2）关于法律的需求和风险的数据 因素;（3）患者艾滋病毒护理临床结果;（4）临床水平指标，包括提供者-患者 沟通和准备继续实施和可持续性。本研究将遵循以下指导原则： 覆盖面、有效性、采用、实施和维护以及 实施研究框架。积极参与将确保有效的翻译和 将我们的发现付诸实践。完成这个项目将导致一个创新的，以证据为基础的， 社区驱动的结构性干预措施，以改善前监禁者的艾滋病毒护理连续性成果 个体

Project Summary. Formerly incarcerated individuals are impacted by health-harming legal needs and risks, including lack of access to HIV care, unsafe housing safety, unstable employment, and other issues that often disrupt HIV care. Providing access to legal services can address barriers to HIV care and improve HIV care continuum outcomes for formerly incarcerated individuals. The proposed study, led by the University of Central Florida (Hispanic Serving Institution), together with the University of Miami, and Hope and Help Inc., aims to pilot test a comprehensive critical-time intervention medical legal partnership (CTI-MLP) approach to optimize timely HIV linkage, retention and viral suppression among formerly incarcerated individuals. MLPs have been used by social justice-oriented medical, health, social, and legal service practices to identify and address health-harming legal needs and risks that create barriers to treatment, care, and recovery for several health conditions. MLPs offer an integrated structural intervention that could improve HIV care continuum and psychosocial outcomes among formerly incarcerated individuals. Our CTI-MLP intervention package consists of: 1) training for all MLP staff (clinical, social and behavioral services, and legal) on HIV continuum of care, health-harming legal needs and risks impacting formerly incarcerated individuals, and MLP structure and operations to ensure that an integrated and collaborative environment is established from the earliest stages of the program; 2) training for case managers and court advocate on the legal continuum of care; 3) embedding of legal expertise within regularized case management team meetings; 4) co-locating legal services in health care agencies through MLP inter-organizational partnership; and 5) tailoring and implementing organizational best-practices in communication and information-sharing protocols among providers within MLP, anchored in patient autonomy and choice. In year 1, we will engage a local community advisory board, scientific advisory board, and legal expert panel to finalize protocols and the Medical Legal Partnership Training Manual. In year 2, we will implement the training and pilot test a CTI-MLP initiative with formerly incarcerated individuals living with HIV (n=100). Over a 6-month period, the team will collect (1) patients' health and functioning, including overall physical health, mental health, social health, pain, fatigue, and overall perceived quality of life; (2) data on legal needs and risk factors; (3) patient HIV care clinical outcomes; and (4) clinic-level indicators, including provider-patient communication and readiness for continued implementation and sustainability. The study will be guided by Reach, Effectiveness, Adoption, Implementation, and Maintenance and Consolidated Framework for Implementation Research frameworks. Active engagement will ensure the effective translation and dissemination of our findings into practice. Completion this project will result in an innovative, evidence-based, community driven structural intervention to improve HIV care continuum outcomes among formerly incarcerated individuals.