Addressing risk through Community Treatment for Infectious disease and Opioid use disorder Now (ACTION) among justice-involved populations

项目摘要 改进艾滋病毒和阿片类药物使用障碍的管理和刑事司法的实施（CJ）- 参与的个人需要有效的方法来筛选，联系和坚持综合服务 在社区机构和服务提供商之间。重返社区是一个关键的机会， 艾滋病毒预防和治疗以及OUD服务提供者。为了响应RFA DA-20-028，我们的 一项名为“通过社区治疗传染病和阿片类药物使用来解决风险”的拟议研究 在涉及司法的人群中，现在的障碍（行动）是一个5年的混合1型有效性- 比较两种型号[患者导航（PN）或移动的医疗单元（MHU）服务]的实施RCT 将最近从监狱和监狱释放的个人与社区艾滋病毒连续体联系起来 和OUD预防和治疗服务的级联护理。共有864名CJ参与者， 被释放到2个CT社区（新伦敦和温德姆/托兰县）和2个TX社区 （达拉斯和塔兰特县），逮捕前有阿片类药物/注射药物使用史，并且与 的HIV患者将在出院后随机接受：a）用于护理的PN系统，其中患者导航员 将在6个月的释放后干预期间将研究参与者与社区服务提供者联系起来 没有艾滋病毒的人将获得PrEP服务，艾滋病毒感染者将获得 获得ART服务，或B）通过MHU提供的服务，其中研究受试者将与MHU相关联 在他们的社区内，他们将获得综合的PrEP/ART，MOUD， 在6个月的释放后干预期间的MHU。有两个具体目标：目标1（干预 有效性）：比较使用PN与MHU服务对受试者长度的有效性 在以下6个月内使用初始发布后PrEP（预防）/ART（治疗）药物的时间 释放次要结果将检查PrEP和艾滋病毒护理结果的连续性， 包括（但不限于）以下额外措施：HIV病毒抑制PLH，PrEP 依从性，HIV风险行为; HCV检测等HCV措施与治疗的联系;性 传播感染发病率（GC/衣原体/梅毒和HBV）;和初级医疗保健 约会.重要的是，我们还将评估OUD和SUD相关指标：OUD/ SUD诊断， MOUD处方收据和保留，阿片类药物和兴奋剂使用，以及过量事件。目标2（执行）： 评价PN和MHU的可行性、可接受性和成本。主要实施成果包括 可行性（获释人员的医疗保健利用影响，机构间医疗保健机构的贡献） 成果）;可接受性（参与者满意度、认为有用）;可持续性（续 利用率），以及实施和维持这些方法以及扩大额外的 社区.还将评估社区提供商范围内获得服务的障碍。

Project Abstract Improving HIV and Opioid Use Disorder (OUD) management and implementation for criminal justice (CJ)- involved individuals requires effective approaches to screening, linkage and adherence to integrated services across community agencies and service providers. Community reentry represents a critical opportunity to link individuals to HIV prevention and treatment and OUD service providers. In response to RFA DA-20-028, our proposed study called Addressing risk through Community Treatment for Infectious disease and Opioid use disorder Now (ACTION) among justice-involved populations, is a 5-year Hybrid Type 1 Effectiveness- Implementation RCT that compares two models [Patient Navigation (PN) or Mobile Health Unit (MHU) service delivery] of linking individuals recently released from prison and jail to the continuum of community-based HIV and OUD prevention and treatment service cascades of care. A total of 864 CJ-involved individuals who are being released to 2 CT communities (New London and Windham/Tolland Counties) & 2 TX communities (Dallas and Tarrant Counties) with pre-arrest histories of opioid/injection drug use and are living with or at-risk of HIV will be randomized to receive at post-release either: a) a PN system for care, wherein patient navigators will link study participants to community-based service providers during the 6-month post-release intervention period; those without HIV will be provided access to PrEP services, and those living with HIV will receive access to ART services, or b) services delivered via a MHU, wherein study participants will be linked to a MHU within their community where they will receive integrated PrEP/ART, MOUD, harm reduction services on the MHU during the 6 month post-release intervention period. There are 2 specific aims: Aim 1 (Intervention Effectiveness): To compare the effectiveness of the use of PN vs. MHU service delivery on participant length of time to taking initial post-release PrEP (prevention)/ART (treatment) medication within 6 months following release from custody. Secondary outcomes will examine the continuum of PrEP and HIV care outcomes, including (but not limited to) the following additional measures: HIV viral suppression for PLH, PrEP adherence, HIV risk behaviors; HCV measures such as HCV testing & linkage to treatment; sexually transmitted infection (STI) incidence (GC/ Chlamydia/ Syphilis and HBV); and primary medical care appointments. Importantly, we will also assess OUD and SUD-related measures: OUD/ SUD diagnoses, MOUD prescription receipt &retention, opioid & stimulant use, & overdose incidents. Aim 2 (Implementation): To evaluate PN and MHU feasibility, acceptability, and costs. Primary implementation outcomes include feasibility (health care utilization impact among released individuals, contributions of interagency workgroup members on outcomes); acceptability (participant satisfaction, perceived usefulness); sustainment (continued utilization), and costs required to implement and sustain the approaches as well as to scale-up in additional communities. Barriers to service access across the community provider spectrum will be assessed as well.