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

项目摘要 从监狱或监狱释放的人感染艾滋病毒的风险特别高。该人群 精神健康或药物使用障碍的患病率也很高，这可能进一步增加艾滋病毒的风险。 虽然强有力的服务和有针对性的资源改善了艾滋病毒感染者的成果， 从监狱或监狱中释放出来的人越多，释放后感染艾滋病毒的高危人群越少， 来支持他们。因此，需要低成本、可扩展的方式来连接这些网络。 艾滋病毒预防服务，包括暴露前预防（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技巧; 例如，服务中的自动注册）可以提供一种低成本和有效的方式来增加服务 订婚然而，引入轻推需要深入了解选择架构 被监禁或最近释放的人。此外，识别高风险个体，将他们与 服务，实施助推需要了解复杂和交叉的系统， 个人接受服务。因此，我们建议开展初步工作，以规划现有服务， 服务差距，以及从监狱或监狱释放后艾滋病毒高危人群的关键决策点。我们 经验丰富的跨学科项目团队包括两名具有艾滋病毒预防专业知识的临床研究人员 （格雷厄姆）和矫正健康（杰克），行为经济学家（豪伯），定性研究专家 （斯塔克斯）和一个实施科学家（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的生活经验的人，他们曾在社区工作， 服务于这一人群。我们将对华盛顿监狱进行半结构化的深入采访 和监狱工作人员和提供者（n=15），社区服务提供者（n=20），以及最近获释的 人（n=15）。实施研究综合框架（CFIR）将告知提供商 访谈指南和分析，促进对执行机会的系统评估， 挑战助推理论将为服务用户的决策过程分析提供信息。我们将重点 这项关于华盛顿州人口最多的金郡的服务和人们释放的形成性工作 县和一个EHE重点站点。我们建议的形成性工作对于了解社区需求至关重要 加强与服务提供者的关系，使社区能够积极参与未来的工作， 研究或实施。在这项形成性工作之后，我们将有能力寻求未来的资金， 开发和进行离散选择实验（DCE），以评估提供者和服务用户的偏好， 旨在推动人们接受PrEP的服务包组件和实施战略 并参与艾滋病毒预防服务，最好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.