A Healthy Transition for Newly Released HIV-Infected Prisoners

描述(由申请人提供)：约有700万人接受管教，200万人在监狱和监狱中(Maruschack，2002)。由于进入监狱的人有很高的性行为和吸毒危险行为(Altices等人，2005年；1998年)，囚犯中的艾滋病毒流行率是普通人群的四到七倍。由于管教机构中艾滋病毒感染率很高，它们已成为检测艾滋病毒和引入治疗的重要哨所(Altices等人，2001年；Mostashari等人，1998年)。艾滋病毒流行率因地理位置不同而不同，东北部的感染率最高。康涅狄格州是全国囚犯中艾滋病毒感染率第二高的州(仅次于纽约)；它关押了大约20,000名囚犯，我们已经证明，其中男性的艾滋病毒血清流行率为6.1%(Mostashari，1998年)，女性的艾滋病毒血清流行率为9.2%(Altice等人，2005年)。在康涅狄格州，任何一天都有大约1000名囚犯感染艾滋病毒并接受治疗，其中超过650人正在接受HAART治疗。公共卫生面临的重大挑战之一是确保感染艾滋病毒的囚犯在获释后继续得到与艾滋病毒有关的护理。在康涅狄格州，每天约有150名囚犯被释放到社区，其中9至14人知道自己感染了艾滋病毒。虽然感染艾滋病毒的囚犯已被证明对惩教系统内的HAART反应非常好，但在获释后很快就失去了收益(Springer等人，2004年)。迫切需要以艾滋病毒为重点的过渡方案，以优化艾滋病毒感染囚犯在获释后降低艾滋病毒风险和遵守HAART的情况。在这份修订的R21申请中，我们建议创建“健康过渡”，这是一种基于证据的艾滋病毒风险降低和HAART遵守干预措施，并将其作为创新过渡计划的组成部分进行评估，该计划已获得资助，为康涅狄格州新释放的感染艾滋病毒的囚犯提供临床护理。这种新的方法，如果被发现是有效的，很可能是具有成本效益的，并且很容易在城市中心等地区复制，这些地区目前正在努力实现从监狱到社区的艾滋病毒相关护理的连续性。

DESCRIPTION (provided by applicant): Approximately seven million people are under correctional supervision and two million are in prisons and jails (Maruschack, 2002). As a consequence of high sexual and drug use risk behaviors among people who enter prisons (Altice, et al., 2005; 1998), the HIV prevalence among prisoners is four to seven times greater than in the general population. Because of the high prevalence of HIV infection in correctional institutions, they have become important sentinel sites for the detection of HIV as well as for the introduction of treatment (Altice, et al., 2001; Mostashari, et al., 1998). HIV prevalence varies by geography, with the highest rate in the northeast. Connecticut has the second highest HIV prevalence (2nd only to New York) among prisoners nationally; it houses approximately 20,000 inmates of whom we have demonstrated the HIV sero-prevalence to be 6.1% among men (Mostashari, 1998) and 9.2% among women (Altice, et al., 2005). On any given day, about 1,000 inmates in Connecticut are known to be HIV-infected and receiving care and, of these, over 650 are on HAART. One of the great public health challenges is ensuring that HIV-infected prisoners continue to receive HIV-related care when they are released. In Connecticut, about 150 prisoners are released to the community daily and 9 to 14 of these individuals are aware of their HIV-infected status. While HIV-infected prisoners have been demonstrated to respond extremely well to HAART within the correctional system, the benefit gain is soon lost after release (Springer, et al., 2004). There is an urgent need for HIV focused transition programs that optimize HIV risk reduction and HAART adherence among HIV-infected prisoners upon their release. In this revised R21 application, we propose to create 'Healthy Transition', an evidence- based HIV risk reduction and HAART adherence intervention - and evaluate it as a component of an innovative transition program that has already been funded to provide clinical care to newly released HIV- infected prisoners in Connecticut. This novel approach, if found to be effective, would likely be cost-effective and easy to replicate in areas such as urban centers that currently struggle with the continuity of HIV-related care from the prison to the community.