Comprehensive HIV Testing Strategies for Jails

描述（由申请人提供）：这个K23职业发展奖的目标是让贝克威斯博士获得必要的技能，成为一名独立的临床研究者，专门为药物使用者提供艾滋病毒检测服务，特别是在监禁环境中。职业目标包括以下方面的培训：1)特别关注传染病流行病学的临床研究方法；2)卫生服务研究；3)对药物使用者进行研究；4)在监狱环境中进行研究的伦理问题。研究计划建议：1)分析现有的START项目数据库，评估监狱环境中艾滋病毒检测和咨询的障碍和促进因素；2)对监狱提供者和监狱被拘留者进行定性访谈，以评估监狱中快速艾滋病毒检测的障碍和促进因素；3)在罗德岛监狱进行前瞻性随机对照试验，比较快速艾滋病毒检测和咨询干预与标准艾滋病毒检测和咨询。干预将包括基于RESPECT项目的个性化艾滋病毒风险降低咨询，简短的咨询干预加上快速的艾滋病毒检测。监狱在押人员将随机接受快速艾滋病毒检测和咨询干预（干预组）或仅接受标准艾滋病毒检测和咨询（对照组）。假设干预组的受试者：1)将更频繁地收到他们的HIV检测结果；2)出狱后将从事低艾滋病毒风险行为；3)对于新诊断为艾滋病毒感染的受试者，将在出狱后更有效地与社区艾滋病毒护理联系起来。为了评估这些结果，所有受试者将在监狱中完成一项基线艾滋病毒风险行为评估。受试者将被随机分配到各自的研究组，并将在出狱后6周和24周进行随访，以评估收到艾滋病毒检测结果、出狱后艾滋病毒风险行为的变化以及社区中艾滋病毒护理的建立。贝克威斯博士将接受来自罗德岛普罗维登斯布朗医学院的Timothy P. Flanigan博士的指导。通过这一奖项，贝克威斯博士旨在推动向监狱服刑人员提供艾滋病毒检测和预防服务。

DESCRIPTION (provided by applicant): The goal of this K23 Career Development Award is for Dr. Beckwith to acquire the skills necessary to become an independent clinical investigator specializing in the delivery of HIV testing services to substance users, particularly in the incarcerated setting. Career goals include training in: 1) the methodologies of clinical research with special attention to infectious diseases epidemiology; 2) health services research; 3) conducting research among substance users; and 4) ethics of conducting research in the incarcerated setting. The research plan proposes to: 1) analyze the existing Project START database to assess barriers and facilitators to HIV testing and counseling in the jail setting; 2) conduct qualitative interviews with in-prison providers and jail detainees to assess barriers and facilitators to rapid HIV testing in jail; and 3) perform a prospective randomized controlled trial in the Rhode Island Department of Corrections jail comparing a rapid HIV testing and counseling intervention with standard HIV testing and counseling. The intervention will consist of individualized HIV risk reduction counseling based on the Project RESPECT brief counseling intervention coupled with rapid HIV testing. Jail detainees will be randomized to receive either the rapid HIV testing and counseling intervention (intervention arm) or standard HIV testing and counseling only (control arm). It is hypothesized that subjects in the intervention arm: 1) will receive their HIV test results more often; 2) will engage in lower rates of HIV risk behavior following release from jail; and 3) for subjects newly diagnosed with HIV infection, will be more efficiently linked to HIV care in the community following jail release. To evaluate these outcomes, all subjects will complete a baseline HIV risk behavior assessment in jail. Subjects will be randomized to their respective study arm and there will be follow-up visits scheduled six weeks and 24 weeks following jail release in order to evaluate receipt of HIV test results, changes in HIV risk behavior following release from jail, and establishment of HIV care in the community. Dr. Beckwith will be mentored by Dr. Timothy P. Flanigan from Brown Medical School in Providence, Rl. Through this award, Dr. Beckwith aims to advance the delivery of HIV testing and prevention services to persons incarcerated in jail.