Mapping a behavioral economics-informed intervention to promote linkage to HIV prevention and behavioral health services for people releasing from jails and prisons in Washington State

项目总结 从监狱或监狱释放的人感染艾滋病毒的风险高得不成比例。这群人 精神健康或物质使用障碍的患病率也很高，这可能会进一步增加艾滋病毒风险。 虽然强有力的服务和有针对性的资源改善了艾滋病毒携带者的结果，但当他们 从监狱或监狱出狱后，数量较多的艾滋病毒高危人群获释后资源较少 可以为他们提供支持。因此，需要低成本、可扩展的方式来连接这些 接受艾滋病毒预防服务的个人，包括接触前预防(PrEP)。行为经济学 方法，包括轻推(鼓励参与健康行为的小过程或试探法； 例如，服务中的自动注册)可以提供低成本且有效的方式来增加服务 订婚。然而，引入Nudge需要深入了解所选择的体系结构 被监禁或最近获释的人。此外，识别高危个人，将他们与 服务，并实施微调需要了解复杂和交叉的系统，其中 个人接受服务。因此，我们建议开展形成性工作，以绘制现有服务的地图， 服务差距，以及艾滋病毒高危人群出狱后的关键决策要点。我们的 经验丰富的跨学科项目团队包括两名在艾滋病毒预防方面具有专业知识的临床研究人员 (Graham)和矫治健康(Jack)，行为经济学家(Hauber)，定性研究专家 (斯塔克斯)和一位实施科学家(韦纳)。核心团队还将包括一名项目经理、一名 有获得艾滋病毒预防服务经验的人，曾在社区工作 为这一人群服务的组织。我们将对华盛顿监狱进行半结构化的深度采访 和监狱工作人员和提供者(n=15)、社区服务提供者(n=20)，最近获释 人(n=15)。实施研究综合框架(CFIR)将通知提供商 面谈指导和分析，促进系统评估实施机会和 挑战。轻推理论将为分析服务使用者的决策过程提供信息。我们将专注于 这项关于在华盛顿州人口最多的金县提供服务和释放人员的形成性工作 县和一个EHE焦点站点。我们建议的形成性工作对于了解社区需求是必不可少的 以及加强与服务提供商的关系，以实现社区与未来的强大互动 研究或实施。在这项开创性的工作之后，我们将处于有利地位，可以寻求未来的资金 开发和实施离散选择实验(DCES)，以评估提供商和服务用户对 旨在推动人们采用PrEP的服务包组件和实施战略 以及参与艾滋病毒预防服务，最好是与行为健康服务相结合。

PROJECT SUMMARY People who are releasing from jail or prison are at disproportionately high risk of acquiring HIV. This population also has high prevalence of mental health or substance use disorders, which can further increase HIV risk. While robust services and targeted resources have improved outcomes for people living with HIV when they release from jail or prison, the larger numbers of people at high risk for HIV upon release have fewer resources available to support them. Consequently, there is a need for low-cost, scaleable ways to connect these individuals with HIV prevention services including pre-exposure prophylaxis (PrEP). Behavioral economics approaches, including nudges (small processes or heuristics that encourage engagement in healthy behavior; for example, auto-enrollment in services), may provide a low-cost and effective way to increase service engagement. However, introducing nudges necessitates an in-depth understanding of the choice architecture of incarcerated or recently released individuals. In addition, identifying high-risk individuals, linking them with services, and implementing nudges requires knowledge of the complex and intersecting systems in which individuals receive services. Accordingly, we propose to conduct formative work to map existing services, service gaps, and key decision points for people at high risk for HIV upon release from prison or jail. Our experienced, interdisciplinary project team includes two clinical researchers with expertise in HIV prevention (Graham) and correctional health (Jack), a behavioral economist (Hauber), a qualitative research expert (Starks), and an implementation scientist (Weiner). The core team will also include a Project Manager, a person with lived experience accessing HIV prevention services who has worked for a community-based organization serving this population. We will conduct semi-structured in-depth interviews with Washington jail and prison staff and providers (n=15), community-based service providers (n=20), and recently released people (n=15). The Consolidated Framework for Implementation Research (CFIR) will inform the provider interview guide and analysis, facilitating systematic assessment of implementation opportunities and challenges. Nudge theory will inform analyses of the decision-making processes of service users. We will focus this formative work on services within and people releasing to King County, Washington State’s most populous county and an EHE focus site. The formative work we propose is essential for understanding community needs and strengthening relationships with service providers to enable robust community engagement with future research or implementation. After this formative work, we will be well positioned to seek future funding to develop and conduct discrete choice experiments (DCEs) to assess provider and service user preferences for service package components and implementation strategies designed to nudge people toward PrEP uptake and engagement in HIV prevention services, ideally integrated with behavioral health services.