The role of prisons in community spread of COVID-19: Disparate epidemiologic profiles in rural, racial/ethnic minority, and low socioeconomic US counties

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Abstract Criminal justice (CJ) involved individuals have extremely high prevalence of risk factors associated with HIV infection including poverty, substance use, transactional sex, high numbers of sex partners, high prevalence of sexually transmitted infections and mental illness. African Americans (AA) are at disproportionate risk for both incarceration and HIV infections. A growing body of evidence highlights the efficacy of a once daily medication, emtricitabine/tenofovir, also known as pre-exposure prophylaxis (PrEP), in reducing HIV acquisition. However, structural and social barriers can undermine optimal PrEP uptake, adherence, and retention in care and must be addressed especially among those with recent CJ experience. Our proposed study is directly aligned with NIMHD Science Visioning to advance intervention approaches to improve minority health or to reduce health disparities. Our proposed study will: provide a novel exploration of facilitators and barriers to PrEP; allow us to target hard to reach populations, including MSM and substance users (both of which are top funding priority groups for the National Institutes of Health) who experience intersecting markers of HIV risk; and inform regional, and possibly national, intervention approaches to combat the overlapping epidemic of HIV and incarceration: The specific aims of the project are: Aim 1: Perform a qualitative assessment of facilitators and barriers to PrEP uptake among high-risk jail detainees, systems and interactor levels; Aim 2: Develop the PrEP-LINK intervention and perform an open label evaluation with high-risk individuals being discharged from the Pulaski County Jail; Aim 3: Conduct a pilot RCT of the PrEP-LINK intervention among high-risk men and women being released from the Pulaski County Jail. Results will inform a subsequent multi-site RCT to test efficacy of the intervention in improving PrEP uptake, adherence, and retention in care among men with CJ-experience.