Improving Linkage to HIV Care Following Release from Incarceration

描述（由申请人提供）：与社区人口相比，被监禁人口的艾滋病毒感染率高得不成比例，而且在监禁期间经常得到医疗照顾。出狱后中断护理很常见，这可能导致更糟糕的临床结果，并增加艾滋病毒传播的高风险行为。支持与护理的联系是制定寻找和治疗参与矫正的艾滋病毒感染者方案的关键组成部分。这一创新建议旨在通过以下具体目标改善出狱后与艾滋病毒护理的联系：设计和实施一项监测战略，以评估出狱后社区的后续艾滋病毒医疗护理。2. 为了测试监测策略在以下方面的临床和流行病学效用：2a)区分与护理联系高成功的地区与低成功的地区；2b)确定出狱后早期和较晚纳入护理的相关性；2c)评估现有政策和计划是否促进了与护理的更大联系和更好的艾滋病毒临床结果。3. 定性地探讨和调查影响释放前后艾滋病医疗服务联动的个人、社区、体制和政治因素。为了实现这些目标，这个创新的跨学科多站点项目将首先开发并验证一个指标，通过将新的Ryan White艾滋病毒/艾滋病项目客户级数据集与纠正发布数据联系起来，以确定对重返社会的艾滋病毒感染者的护理是否充分。然后，这一联系过程将在多个州、惩教管辖区和护理环境中应用，以评估与艾滋病毒治疗相关的联系结果。具有最高和最低联系的地点将提供评估最佳实践和联系成功的相关性的机会。我们将使用定量方法和对患者、提供者、刑事司法工作人员和政策制定者进行深入的定性访谈，以便更好地了解影响囚犯在重返监狱期间与艾滋病毒护理联系的因素。这种综合方法将允许区分影响与艾滋病毒护理联系的结构、社区和个人层面因素，并将有助于目标改进和未来的干预措施。通过Ryan White报告获得客户级数据，为更好地了解这一紧迫的公共卫生问题提供了前所未有的机会。这项研究将为正在进行的质量倡议的指标制定提供信息，以跟踪艾滋病毒感染者重返社会的护理质量，并将提供至关重要的数据，以支持改善全国各地的护理联系系统。

DESCRIPTION (provided by applicant): Incarcerated populations are disproportionately burdened by higher rates of HIV infection compared to those in the community and are often provided with medical care during their incarceration. Interruptions in care are common following release from incarceration and may lead to worse clinical outcomes and increases in high risk behaviors for HIV transmission. Support of linkage to care is a critical component of developing programs to seek and treat persons with HIV involved in corrections. This innovative proposal seeks to improve linkage to HIV care after release from incarceration through the following Specific Aims: 1. To design and implement a monitoring strategy for evaluating follow-up HIV medical care in the community after release from incarceration. 2. To test the clinical and epidemiological utility of the monitoring strategy in 2a) distinguishing areas with high success in linkage to care from those with low success, 2b) identifying correlates of earlier and later enrollment in care post release from incarceration, and 2c) assessing whether existing policies and programs promote greater linkage to care and better HIV clinical outcomes. 3. To qualitatively explore and investigate the individual, community, institutional and political factors influencing linkage to HIV medical care during the pre- and post-release periods. To accomplish these Aims, this innovative interdisciplinary multi-site project will first develop and validate an indicator of the adequacy of linkage to care for HIV infected persons undergoing reentry by linking the new Ryan White HIV/AIDS Program client level dataset to corrections release data. This linkage process will then be applied across multiple states, correctional jurisdictions, and care environments to assess HIV treatment-relevant linkage outcomes. Locations with the highest and lowest linkage will provide an opportunity to evaluate best practices and correlates of linkage success. We will use quantitative methods and in-depth qualitative interviews with patients, providers, criminal justice staff, and policy makers, to gain a better understanding of the elements influencing an inmate's linkage to HIV care throughout reentry. This comprehensive approach will permit differentiation of the structural, community, and individual level factors affecting linkage to HIV care and will help target improvements and future interventions. The availability of client level data through Ryan White reporting represents an unprecedented opportunity to better understand this pressing public health problem. This research will inform the development of metrics for ongoing quality initiatives to track the quality of care for people with HIV on reentry and will provide critically important data to support improved systems of linkage of care throughout the nation. PUBLIC HEALTH RELEVANCE: This innovative proposal will address the significant challenge of improving linkage to HIV care in the community after release from incarceration. It will capitalize on detailed client level clinical data derived from reporting required for all Ryan White HIV/AIDS program grantees, which will be linked to correctional databases to create an easily replicable monitoring strategy. The accompanying quantitative and qualitative evaluations will enhance understanding of the correlates of enhanced linkage and will help to ultimately inform the design of best practice models for the support of linkages to care following release from corrections.