Seek, Test, and Treat Strategies

描述(由申请者提供)：“一种系统的方法来寻找、检测和治疗惩教人群的策略”据估计，美国每年有25%的艾滋病毒阳性者通过惩教机构。然而，许多惩教系统和设施没有为艾滋病毒检测、治疗和过渡转诊提供全面和系统协调的办法，导致许多人错失了查明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。为了弥补这一差距，并响应RFA-DA-10-017(寻求、检测和治疗(STT)：在刑事司法系统中解决艾滋病毒问题)，我们提议：AIM1：(1)全面测试高危人群(州惩教机构中的人被释放到占所有州艾滋病毒病例近60%的主要大都市地区，艾滋病毒感染率最近显著上升，性传播感染率常年居高不下)；(2)(重新)将从国家惩教机构释放到这个大都市地区的艾滋病毒阳性者与低成本或免费的治疗和病例管理服务联系起来；(3)寻求评估艾滋病毒检测转诊的创新网络方法，以利用惩教系统中的高风险阴性者，在获释后鼓励其社会性网络中可能无法获得检测服务的其他高风险个人接受艾滋病毒检测。目的2.进行成本和成本效益分析，以评估：(1)拟议的STT计划的总体、系统成本；(2)单个计划组成部分的成本和个人支付者的成本；(3)在州立监狱和社区治疗提供者(将在监狱和当地县监狱对检测呈阳性的人进行标准的无预约检测)进行检测的比较成本效益；(4)通过在拘留设施检测之前进行风险降低筛查，可以实现的潜在经济效益的提高；以及(5)为高风险被拘留者提供释放后寻找伴侣/检测服务的成本效益。拟议的研究具有很高的创新性，因为它(1)全面解决了所有州惩教机构的所有三个STT要素，这些设施将人释放到艾滋病毒感染率上升的大城市地区；(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；以及(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/艾滋病毒部门和城市卫生部门之间独特的合作伙伴关系。 公共卫生相关性：“寻求、检测和治疗惩教人口策略的系统性方法”我们建议(1)全面测试高危人群(州立惩教机构中的人被释放到占该州所有艾滋病毒病例的近60%的主要大都市地区，最近艾滋病毒感染率显著上升，性传播感染率长期居高不下)；(2)(重新)将从州立惩教机构释放的艾滋病毒阳性者与这个大都市地区联系起来，获得低成本或免费的治疗和病例管理服务；以及(3)寻求评估艾滋病毒检测转介的创新网络方法，以利用惩教系统中的高风险阴性物，在获释后鼓励其社会性网络中其他可能无法获得检测服务的高危个人接受艾滋病毒检测。我们将进一步进行广泛的成本和成本效益分析，以评估拟议的STT计划可持续性的可能性。

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.