Contextualizing & responding to HIV risk behaviors among Black drug offenders

描述（由申请人提供）：以前被监禁的黑人毒品罪犯感染艾滋病毒的风险较高。尽管大量研究表明，释放后的前罪犯需要艾滋病毒预防服务，但这一群体获得与减少艾滋病毒风险有关的高质量方案和服务的机会有限。此K01应用程序旨在告知和调整艾滋病毒风险降低干预措施，以满足从纽约市大都市区监狱释放的前监禁黑人毒品罪犯的需求。这个应用程序支持主要研究者的兴趣，成为一个独立的行为科学家，专门从事艾滋病毒预防，干预，发展和适应。拟议的指导和培训计划将侧重于以下关键领域：混合方法研究;适应科学;和干预措施的实施。拟议的研究将在五年内分三个阶段进行。形成阶段将包括对艾滋病毒知识的调查管理，实施保护行为的需求和障碍，以及对120名最近释放的黑人毒品罪犯进行艾滋病毒检测。此外，在此阶段，还将对24名参与者（12名男性和12名女性参与者）进行深入访谈，以收集更全面的信息，探讨采取艾滋病毒保护行为的需求和障碍。干预措施的制定和适应阶段将包括分析调查研究和深入访谈的数据，以使其适用于最近释放的黑人毒品罪犯。在第三阶段，将使用随机临床试验对适应性干预的可行性和可接受性进行初步测试，其中64名参与者被随机分配到适应性干预或增强转介干预组。本研究将基于信息-动机和行为技能模型，解决以下具体目标：1）研究影响艾滋病毒相关风险行为的个人水平、环境和背景因素（即非法药物使用和危险的性行为）在以前被监禁的黑人男性和女性毒品罪犯中; 2）利用目标1收集的数据，调整START项目，这是一项针对前被监禁男子的减少艾滋病毒风险的干预措施，以增加获得艾滋病毒检测的机会，并解决最近获释的黑人男性和女性毒品罪犯中艾滋病毒脆弱性的驱动因素; 采用64名参与者（32名男性，32名女性）的随机临床试验改编了START项目。这项拟议的研究将利用混合方法来调查最近释放的黑人毒品罪犯中艾滋病毒风险的驱动因素。通过提供更多关于风险行为的背景信息，可以开发和快速部署未来的循证方法，推进艾滋病毒预防科学，并为在获得艾滋病毒预防服务方面不断遇到障碍的弱势群体提供必要的支持。

DESCRIPTION (provided by applicant): Formerly incarcerated Black drug offenders are at an elevated risk for HIV infection. Despite substantial research expressing the need for HIV prevention services for ex-offenders post-release, this population has limited access to quality programming and services related to HIV risk reduction. This K01 application seeks to inform and adapt an HIV risk reduction intervention to address the needs of formerly incarcerated Black drug offenders who are being released from prisons in the New York City metropolitan area. This application supports the Principal Investigator's interest in becoming an independent behavioral scientist specializing in HIV prevention intervention development and adaptation. The proposed mentorship and training program will focus on the following key areas: mixed methods research; adaptation science; and intervention implementation. The proposed study will occur in three phases implemented over the course of five years. The formative phase will consist of survey administration on HIV literacy, needs and barriers to practicing protective behaviors, and HIV testing from 120 recently released Black drug offenders. Also during this phase, in-depth interviews with a subsample of 24 participants (12 male and 12 female participants) will also be conducted to gather more comprehensive information exploring needs and barriers to practicing HIV protective behaviors. The intervention development and adaptation phase, will consist of analyzing data from the survey research and in-depth interviews to tailor it for use with recently released Black drug offenders. In phase 3, the feasibility and acceptability of the adapted intervention will be pilot tested using a randomized clinical trial with 64 participants who are randomized to the adapted intervention or an Enhanced Referral Intervention arm. Building on the Information-Motivation and Behavioral Skills Model, this study will address the following specific aims: 1) To examine individual-level, environmental and contextual factors that affect HIV risk-related behaviors (i.e. illicit drug use and risky sexual behavior) among formerly incarcerated Black male and female drug offenders; 2) To adapt Project START, an HIV risk reduction intervention for formerly incarcerated men, using data gathered from Aim 1, to increase access to HIV testing and address drivers of HIV vulnerability among recently released Black male and female drug offenders; and 3) To pilot test the feasibility and acceptability of the adapted Project START using a randomized clinical trial with 64 participants (32 men, 32 women). The proposed study will utilize a mixed-methods approach to investigate drivers of HIV risk among recently released Black drug offenders. By providing more contextual information on risk behaviors, future evidence-based approaches can be developed and rapidly deployed, advancing HIV prevention science, and providing essential support for a vulnerable population that consistently experiences barriers in accessing HIV prevention services.