Finding, Testing and Treating High-risk Probationers and Parolees with HIV

说明(申请人提供)：拟议研究有两个研究目标：(1)扩大刑事司法系统中个人进行艾滋病毒检测的机会和选择，重点是社区环境中的高风险、吸毒的缓刑犯和假释犯；(2)改善这一人群中艾滋病毒阳性者获得和维持高效抗逆转录病毒治疗(HAART)的机会，实施一项注重艾滋病毒护理连续性的有希望的干预措施，并使用严格的实验设计对其进行评估。这项提案是对RFA-DA-10-017“寻求、检测和治疗：在刑事司法系统中处理艾滋病毒问题”对“寻求、检测和治疗”范式的创新和全面应用作出的回应。通过将重点放在对吸毒缓刑犯和假释犯的社区检测和治疗支持上，我们打算满足一部分参与刑事司法的人群的具体需求，这些人群很难通过更传统的以系统为基础的方法达到这一需求。这项拟议的研究将设在加利福尼亚州的奥克兰，这是一个拥有大量缓刑犯和假释犯的社区，其中超过70%是非裔美国人或拉丁裔。具体目标是：目标1：设计和实施一项有针对性的、以社区为基础的战略，以识别、招募和向2,250名缓刑或假释的强效可卡因和注射吸毒者提供快速艾滋病毒检测和咨询；以及目标2：对艾滋病毒阳性参与者进行随机对照试验，以评估Bridge项目与普通护理机构的疗效。在目标1中，将使用改进的定向抽样技术从社区环境中寻找符合条件的个人，重点放在缓刑犯和假释犯密度最高的奥克兰社区。我们将在交通便利的社区地点提供快速艾滋病毒检测和咨询。感兴趣的结果将是被识别和招募、接受艾滋病毒检测、在过去6个月内没有接受艾滋病毒检测、并报告最近艾滋病毒风险行为的合格个人的比例。我们还将评估与这些结果相关的因素，对这些结果的分析将以弱势群体行为模型为指导。在目标2中，未接受艾滋病毒护理的艾滋病毒阳性参与者(n=202)将参加随机对照试验，并每季度跟踪24个月。干预(桥梁项目)旨在让艾滋病毒呈阳性的罪犯接受医疗护理，并显示出巨大的希望，但尚未得到严格的评估。它将在一家社区公共卫生诊所交付。我们将比较干预参与者中的病毒载量、艾滋病毒护理和HAART，并与接受标准转诊至艾滋病毒护理的一组进行比较。这项拟议的研究将根据国家卫生研究院确定的优先事项，为接触高危缓刑人员和假释人员提供艾滋病毒检测的创新方法。此外，它还将有助于制定循证干预措施，在涉及刑事司法的人群中促进不间断的、在治疗上有效的艾滋病毒护理。 公共卫生相关性：针对RFA-DA-10-017(寻求、检测和治疗：在刑事司法系统中解决艾滋病毒问题)，我们建议制定和实施创新的社区战略，以发现和招募缓刑或假释的高风险吸毒者，对他们进行艾滋病毒筛查，并将艾滋病毒阳性者与治疗联系起来。如果拟议的研究成功，它将(1)确定一种接触大量高危缓刑人员和假释人员进行艾滋病毒检测的创新方法，以及(2)对一个有希望的模式进行循证评估，以确保随着缓刑人员和假释人员在社区和惩教环境之间流动，艾滋病毒护理和艾滋病毒治疗的连续性。

DESCRIPTION (provided by applicant): The proposed study has two research objectives: (1) to expand access and options for HIV testing with individuals in the criminal justice system, by focusing on high-risk, drug-using probationers and parolees in community settings; and (2) to improve access and maintenance of highly active antiretroviral treatment (HAART) among HIV-positive persons in this population, by implementing a promising intervention focused on continuity of HIV care, and evaluating it using a rigorous experimental design. This proposal is responsive to RFA-DA-10-017, "Seek, Test and Treat: Addressing HIV in the Criminal Justice System," in its innovative and comprehensive application of the "seek, test and treat" paradigm. By focusing on community-based testing and treatment support for drug-using probationers and parolees, we intend to address the specific needs of a portion of the criminal-justice-involved population that is hard to reach through more traditional systems-based methods. The proposed study will be based in Oakland, California, a community with a large number of probationers and parolees, over 70% of whom are African American or Latino. The Specific Aims are: Aim 1: To design and implement a targeted, community-based strategy to identify, recruit, and provide rapid HIV testing and counseling to 2,250 crack cocaine and injection drug users on probation or parole; and Aim 2: To conduct a randomized controlled trial (RCT) of HIV-positive participants to assess the efficacy of Project Bridge compared with a usual care arm. In Aim 1, modified targeted sampling techniques will be used to seek eligible individuals from community settings, focusing on the neighborhoods of Oakland with the highest density of probationers and parolees. We will provide rapid HIV testing and counseling at easily accessible community locales. Outcomes of interest will be the proportion of eligible individuals who are identified and recruited, accept HIV testing, have not been HIV tested in the previous 6 months, and report recent HIV risk behavior. We will also assess factors associated with these outcomes, the analyses of which will be guided by the Behavioral Model for Vulnerable Populations. In Aim 2, HIV-positive participants not in HIV care (n=202) will be enrolled in the RCT and followed quarterly for 24 months. The intervention (Project Bridge) is designed to engage and maintain HIV-positive ex-offenders in medical care, and has shown great promise, but has not yet been rigorously evaluated. It will be delivered at a community public health clinic. We will compare viral load, HIV care, and HAART among intervention participants, compared to a group that gets standard referral to HIV care. The proposed study will contribute innovative methods for reaching high- risk probationers and parolees for HIV testing, consistent with priorities identified by the National Institutes of Health. In addition, it will contribute to the development of evidence-based interventions to promote uninterrupted, therapeutically effective HIV care among criminal-justice-involved populations. PUBLIC HEALTH RELEVANCE: In response to RFA-DA-10-017 (Seek, Test, and Treat: Addressing HIV in the Criminal Justice System), we propose to develop and implement innovative community-based strategies to find and recruit high-risk drug users on probation or parole, screen them for HIV, and link those who are HIV-positive to treatment. Should the proposed study be successful, it will (1) identify an innovative way of reaching large numbers of high-risk probationers and parolees for HIV testing, and (2) provide an evidence-based evaluation of a promising model to ensure continuity of HIV care and HIV treatment as probationers and parolees move between community and correctional settings.