Seek, Test, and Treat Strategies

描述（由申请人提供）：“为矫正人群寻找、检测和治疗策略的系统方法”据估计，美国每年有25%的艾滋病毒阳性患者通过矫正设施。然而，许多惩教系统和设施没有为艾滋病毒检测、治疗和过渡性转诊提供全面和系统协调的方法，导致许多人错过了发现以前未诊断的艾滋病毒病例并将个人与治疗和预防服务联系起来的机会。为了解决这一差距，并响应RFA-DA-10-017（寻求，测试和治疗（STT）：解决刑事司法系统中的艾滋病毒），我们建议：AIM1:(1)全面测试高风险人群（州惩教机构中的人员被释放到占全州艾滋病毒病例近60%的主要大都市地区，最近经历了艾滋病毒率的显着增加，并且性传播感染率一直很高）；(2)（重新）将从州惩教机构释放到大都市地区的艾滋病毒阳性人员与低成本或无成本的治疗和病例管理服务联系起来；(3)寻求评估一种创新的艾滋病毒检测转诊网络方法，利用惩教系统中的高风险阴性患者，在释放后，鼓励其他可能无法获得检测服务的社会-性网络中的高风险个体进行艾滋病毒检测。目标2。进行成本和成本效益分析，以评估：(1)拟议的STT计划的整体系统成本；(2)个别项目组成部分的成本和个别支付者的成本；(3)在州监狱进行检测与在社区治疗机构进行标准的上门检测的成本效益比较，社区治疗机构将排队等候监狱中检测呈阳性的人，而当地的县监狱是最近一项成本效益性STT研究的地点；(4)通过在拘留设施进行检测前进行风险降低筛查，可能提高经济效率；(5)对高风险在押人员实施释放后伴侣寻找/检测服务的成本效益。拟议的研究是高度创新的，因为它(1)全面解决了所有州惩教机构的所有3个STT要素，这些惩教机构将人们释放到艾滋病毒感染率上升的大城市；(2)促进对这种协调和系统的STT方法进行深入的成本和成本效益分析；(3)涉及学术研究人员、艾滋病毒治疗提供者、惩教部门、州艾滋病/艾滋病毒司和市卫生部门之间的独特伙伴关系。

DESCRIPTION (provided by applicant): "A Systemic Approach to Seek, Test, and Treat Strategies for Correctional Populations" It is estimated that 25% of all HIV-positive people in the U.S. pass through a correctional facility each year. Yet, many correctional systems and facilities do not provide a comprehensive and systemically coordinated approach to HIV testing, treatment, and transitional referral, resulting in many missed opportunities to identify previously undiagnosed cases of HIV and link individuals to treatment and prevention services. To address this gap, and in response to RFA-DA-10-017 (Seek, Test, and Treat (STT): Addressing HIV in the Criminal Justice System), we propose to: AIM1: (1) Comprehensively test a high-risk population (people in a state correctional facility being released to a major metropolitan area that accounts for nearly 60% of all state HIV cases, has experienced a recent and significant increase in the rate of HIV, and has perennially high rates of sexually transmitted infections); (2) (re)-link HIV-positive people being released from a state correctional facility to this metropolitan area into low- or no-cost treatment and case management services; and (3) seek to evaluate an innovative network method of HIV testing referral to utilize high-risk negatives in the correctional system to, upon release, encourage other high-risk individuals in their social-sexual networks who might not otherwise access testing services to get HIV tested. Aim 2. Conduct cost and cost-effectiveness analyses to assess: (1) the overall, systemic cost of the proposed STT program; (2) the cost of individual program components and cost to individual payers; (3) the comparative cost-effectiveness of testing in the state prison versus standard walk-in testing at the community treatment provider who will be lined to people testing positive in the prison, and a local county jail that was the site of a recent cost-effectiveness STT study; (4) the potential increase in economic efficiency that could be achieved through risk reduction screening prior to testing in detention facilities; and (5) the cost-effectiveness of implementing post-release partner seeking/testing services for high-risk detainees. The proposed study is highly innovative in that it (1) comprehensively addresses all 3 STT elements across all state correctional facilities who release people to a large metropolitan region with rising rates of HIV; (2) facilitates in-depth cost and cost-effectiveness analyses of this coordinated and systemic STT approach; and (3) involves a unique partnership between academic investigators, HIV treatment providers, a Department of Corrections, a state Division of AIDS/HIV, and a City Health Department. PUBLIC HEALTH RELEVANCE: "A Systemic Approach to Seek, Test, and Treat Strategies for Correctional Populations" We propose to (1) comprehensively test a high-risk population (people in a state correctional facility being released to a major metropolitan area that accounts for nearly 60% of all HIV cases in its state, has experienced a recent and significant increase in the rate of HIV, and has perennially high rates of sexually transmitted infections); (2) (re)-link HIV-positive people being released from a state correctional facility to this metropolitan region into low- or no-cost treatment and case management services; and (3) seek to evaluate an innovative network method of HIV testing referral to utilize high-risk negatives in the correctional system to, upon release, encourage other high-risk individuals in their social-sexual networks who might not otherwise access testing services to get HIV tested. We further will conduct extensive (4) cost and cost-effectiveness analyses to evaluate the likelihood of the proposed STT program's sustainability.