Identifying Opportunities to Reduce STI/HIV Disparities among Recent Offenders

 描述(由申请人提供)：少年犯和成年罪犯在被捕或出狱后，性传播感染(STI)和艾滋病毒的发生率很高。 青少年设施，尽管很少有研究确定这一群体何时何地接受临床护理或接受性传播感染/艾滋病毒检测。这些现在可以识别的人口--即那些有犯罪记录的人--可能是加强性传播感染和艾滋病毒监测的目标。然而，到目前为止，在这些人中提供性传播感染/艾滋病毒筛查、治疗和预防的数据很少，因为我们不知道他们何时何地接受临床护理，以及他们是否在这些环境中接受性传播感染/艾滋病毒护理。这项研究的长期目标是开发知情干预措施，以改善社区和临床环境中新近犯罪者的健康，特别是通过减轻性传播感染和艾滋病毒的负担。这项研究的目的是调查罪犯在被捕或出狱后何时何地出现在卫生系统中，以及在他们获得临床护理的点上，他们是否正在接受性传播感染和艾滋病毒的筛查。假设是罪犯在被捕或出狱后有不同的临床护理接触模式，包括较少的常规预防性就诊，以及 因此，与非犯罪者相比，性传播感染/艾滋病毒筛查测试较少。与为印第安纳州马里恩县(印第安纳波利斯)提供服务的刑事司法、临床和公共卫生机构合作，所有个人级别的逮捕、少年拘留、监狱和监狱记录都与9年内STI/艾滋病毒检测阳性结果联系在一起。在专业知识和资源的基础上，这项研究将使用印第安纳州患者护理系统网络纳入住院患者、急诊室和门诊患者遇到的数据，该系统是美国大都市地区最全面的临床遇到数据集之一。具体目的是：(1)描述近期罪犯是否、何时、何地和出于何种目的在逮捕或获释后1年内接受临床护理，与1年内非罪犯人口进行比较；(2)评估近期罪犯在逮捕或获释后1年内至少有1次临床接触的性传播感染/艾滋病毒护理质量。该项目非常符合AHRQ预防和护理管理组合的范围，因为它将产生针对这一弱势群体的性传播感染/艾滋病毒筛查建议，以在监禁后期间预防这两名罪犯及其社区的疾病。

 DESCRIPTION (provided by applicant): Juvenile and adult offenders have high rates of sexually transmitted infections (STI) and incident HIV after arrest or release from prison, jail or juvenile facilities, though few studies have identified when and where this population presents for clinical care or are tested for STI/HIV. This now-identifiable population - i.e., those with a criminal record - may be targeted for increased STI and HIV surveillance. To date, however, there are few data to inform STI/HIV screening, treatment and prevention among these individuals because we do not know when and where they present for clinical care and whether they receive STI/HIV care in these settings. The long-term goal of this research is to develop informed interventions to improve the health of recent offenders in community and clinical settings, particularly by reducing the burden of STI and HIV. The purpose of this study is to investigate when and where offenders after arrest or release from incarceration are seen in the health system and, at points where they access clinical care, whether they are being screened for STI and HIV. The hypothesis is that offenders following arrest or release from incarceration have different patterns of clinical care encounters, including fewer routine preventive visits, and thus fewer STI/HIV screening tests compared to non-offenders. In collaboration with criminal justice, clinical and public health agencies serving Marion County (Indianapolis), Indiana, all individual-level arrest, juvenile detention, jail and prison records were linked with positive STI/HIV test results over a 9-year period. Building on this foundation of expertise and resources, this study will incorporate inpatient, emergency room and outpatient encounter data using the Indiana Network for Patient Care system, one of the most comprehensive clinical encounter data sets for a U.S. metropolitan area. The specific aims are to: (1) describe if, when, where and for what purposes recent offenders present for clinical care in the 1-year after arrest or release from incarceration, compared to the non-offender population during a 1-year period; and (2) assess the quality of STI/HIV care among recent offenders with at least 1 clinical encounter in the 1-year after arrest or release from incarceration. This project fits well within the scope of AHRQ's Prevention and Care Management Portfolio as it will result in STI/HIV screening recommendations for this vulnerable population to prevent disease among both offenders in the post-incarceration period as well as their communities.