Transition from Prison to Community: Pilot Intervention

描述(申请人提供)：许多人首先被诊断为艾滋病毒携带者，或者在进入惩教机构时开始艾滋病毒医疗护理。此外，大多数在监狱中接受抗逆转录病毒药物治疗的患者都被释放回社区。在社区研究中，监禁史与抗逆转录病毒依从性问题的风险更大有关。坚持抗逆转录病毒疗法的失误可能会迅速导致耐药病毒株的发展，从而增加治疗反应不佳的可能性，并增加耐药艾滋病毒株传播给其他人的可能性。因此，加强艾滋病毒携带者出狱后的坚持治疗将带来重要的健康和公共卫生益处。这项申请要求提供三年的支助，以开展开发研究，设计和试行护士提供的电话干预措施，以改善从监狱到重返社区的过渡期间被监禁的艾滋病毒感染者对抗逆转录病毒的依从性。我们建议开展一系列干预活动，包括：(1)调整监狱环境中正在进行的RCT的电话干预手册，以包括更有针对性的监狱后释放内容，(2)制定和完善研究方案，以跟踪和留住重新进入社区的研究参与者，(3)完善评估措施，(4)在释放前和释放后的过渡期内进行基于动机和认知行为技能的遵守干预的随机试点测试，以及(5)评估提供电话干预会议的可行性和可接受性，将国家监狱和社区环境连接起来。在拟议的试点研究中制定的干预措施将建立在我们在监狱和社区环境中与艾滋病毒阳性男子和妇女一起开展的形成工作的基础上。在激励性访谈和认知-行为方法的指导下，拟议的社区过渡干预将提供电话支持，以促进出狱患者坚持服药和使用社区艾滋病毒护理服务。拟议的项目是下一阶段必要的研究，以解决在惩教机构接受艾滋病毒护理后重新进入社区的人保持坚持治疗这一重要的公共卫生问题。

DESCRIPTION (provided by applicant): Many people are first diagnosed with HIV or begin HIV medical care when they enter a correctional facility. Moreover, most patients treated with antiretroviral medications in prison are released back into the community. History of incarceration has been linked to greater risk of antiretroviral adherence problems in community studies. Lapses in adherence to antiretroviral regimens can quickly lead to the development of drug-resistant viral strains, thereby increasing the likelihood of a poor treatment response and raising the possibility of drug-resistant HIV strains being transmitted to others. Enhancing treatment adherence among HIV+ persons released from prison therefore carries important health and public health benefits. This application requests three years of support to conduct developmental research to design and pilot test a nurse-delivered telephone intervention to improve antiretroviral adherence among incarcerated HIV+ persons during the transitional period from prison to community re-entry. We are proposing a sequence of intervention development activities that will include: (1) adapting telephone intervention manuals from an ongoing RCT conducted in a prison setting to include more targeted post-prison release content, (2) developing and refining study protocols for tracking and retaining study participants as they re-enter the community, (3) refining assessment measures, (4) conducting a randomized pilot test of a motivational and cognitive-behavioral skills based adherence intervention during the transitional period prior to and after release from prison, and (5) evaluating the feasibility and acceptability of delivering telephone intervention sessions that bridge state prison and community settings. The intervention developed in the proposed pilot study will build on our formative work with HIV-positive men and women in prison and community settings. Guided by motivational interviewing and cognitive-behavioral approaches to behavior change, the proposed community transition intervention will provide telephone support to promote medication adherence and use of community HIV care services among patients leaving prison. The proposed project constitutes the next phase of study necessary to address the important public health issue of sustaining treatment adherence in persons who re-enter the community after receiving HIV care in correctional facilities.