Incarceration and HIV-Infected Inmates

描述（由申请人提供）：在美国，每年有近20%的艾滋病毒感染者通过教养设施。几项研究表明，囚犯中艾滋病毒感染的流行率比非监禁人口的流行率高8至10倍，很大一部分囚犯的感染风险较高。艾滋病毒感染风险个体的自愿咨询和检测（VCT）是艾滋病毒一级和二级预防的有效手段。北卡罗莱纳惩教局（NCDOC）有一项自愿艾滋病毒检测政策，70%的囚犯拒绝接受检测的机会。与其他31个采用自愿检测的州监狱系统的情况一样，这失去了识别感染者并将其纳入护理的机会。不幸的是，我们缺少一些信息，这些信息既可以用来确定被监禁者中艾滋病毒感染的真实流行程度，也可以用来了解新被监禁者是如何决定接受艾滋病毒检测的。在北卡罗来纳大学医学院和公共卫生学院的研究人员与NCDOC和北卡罗莱纳州卫生与人类服务部（NCDHHS）的官员的合作下，我们将对一个大型州立监狱系统中艾滋病毒检测的障碍和促进因素进行全面评估。首先，我们将确定即将入狱的囚犯中急性和慢性艾滋病毒感染的实际患病率，并描述这一群体的艾滋病毒风险行为。其次，我们将研究最近被监禁的囚犯自愿接受艾滋病毒检测与三个层面变量之间的关系：个体囚犯、NCDOC护士顾问和监狱处理设施。最后，我们将对在监狱中接受艾滋病毒诊断的风险进行初步检查。本申请中描述的研究的最终目标是获得艾滋病毒感染在这一人群中的影响的更清晰的图像，并告知干预措施的设计，以促进这一环境中的艾滋病毒VCT。具体来说，我们将：目标1。确定一个大型州立监狱系统中急性和慢性HIV感染的流行情况。目标2。确定囚犯、护士顾问和设施特征与同意艾滋病毒VCT有关。目标3。探讨在监狱中接受艾滋病毒诊断的风险。

DESCRIPTION (provided by applicant): Nearly 20% of all people infected with HIV in the US pass through a correctional facility each year. Several studies suggest that the prevalence of HIV infection among prisoners is between 8 and 10-fold higher than the prevalence in non-incarcerated populations and a significant proportion of inmates are at elevated risk for infection. Voluntary counseling and testing (VCT) of individuals at risk for HIV infection is an effective means of primary and secondary HIV prevention. The North Carolina Department of Corrections (NCDOC) has a voluntary HIV testing policy and 70% of all incoming inmates decline the opportunity to receive testing. As is the case for the other 31 state prison systems that employ voluntary testing, this is a lost opportunity to identify infected people and enroll them in care. Unfortunately, we are missing several pieces of information required both to determine the true prevalence of HIV infection among incarcerated people as well as to understand how newly incarcerated people make the decision to receive an HIV test. In a collaborative effort between researchers at the UNC Schools of Medicine and Public Health and officials at the NCDOC and the North Carolina Department of Health and Human Services (NCDHHS), we will perform a comprehensive assessment of the barriers and facilitators of HIV testing in a large state prison system. First, we will determine the actual prevalence of acute and chronic HIV infection among incoming inmates and characterize the HIV risk behaviors of this group. Second, we will examine the association between the uptake of voluntary HIV testing among recently incarcerated inmates and variables at three levels: individual inmate, NCDOC nurse-counselor and prison processing facility. Finally, we will conduct a preliminary examination of the risks associated with receiving an HIV diagnosis in prison. The ultimate goals of the studies described in this application are to obtain a clearer picture of the impact of HIV infection among this population and to inform the design of interventions to promote HIV VCT in this setting. Specifically, we will: Aim 1. Determine the prevalence of acute and chronic HIV infection in a large state prison system. Aim 2. Determine the inmate, nurse-counselor and facility characteristics associated with agreeing to HIV VCT. Aim 3. Explore the risks associated with receiving an HIV diagnosis in prison.