Improving Linkage to HIV Care Following Release from Incarceration

描述（由申请人提供）：与社区中的人相比，被监禁的人群因艾滋病毒感染率较高而负担过重，并且在监禁期间经常提供医疗服务。从监禁中释放后，护理中断是常见的，可能导致更糟糕的临床结果和增加艾滋病毒传播的高危行为。支持与护理挂钩是制定方案以寻找和治疗参与教养的艾滋病毒感染者的一个关键组成部分。这一创新性建议旨在通过以下具体目标，改善与出狱后艾滋病毒护理的联系：1.设计和实施一项监测战略，以评估从监禁中释放后社区中的后续艾滋病毒医疗护理。2.为了测试监测策略在以下方面的临床和流行病学效用：2a）区分与护理相关的成功率高的地区与成功率低的地区，2b）确定从监禁中释放后早期和晚期登记护理的相关性，以及2c）评估现有政策和计划是否促进与护理的更大联系和更好的艾滋病毒临床结果。3.定性探索和调查影响释放前和释放后期间与艾滋病毒医疗保健联系的个人、社区、机构和政治因素。为了实现这些目标，这一创新的跨学科多地点项目将首先通过将新的Ryan白色艾滋病毒/艾滋病方案客户级数据集与更正发布数据联系起来，制定并验证一项指标，以衡量对重返社会的艾滋病毒感染者的护理联系是否充分。然后，将在多个州、惩教管辖区和护理环境中应用这一联系过程，以评估与艾滋病毒治疗相关的联系结果。具有最高和最低联系的地点将提供一个机会来评价最佳做法和联系成功的相关因素。我们将使用定量的方法和深入的定性访谈与患者，供应商，刑事司法工作人员和政策制定者，以获得更好地了解影响囚犯的链接到整个重返艾滋病毒护理的因素。这一综合办法将允许区分影响与艾滋病毒护理联系的结构、社区和个人因素，并将有助于有针对性地改进和未来的干预措施。通过Ryan白色报告提供客户层面的数据，为更好地了解这一紧迫的公共卫生问题提供了前所未有的机会。这项研究将为正在进行的质量倡议的衡量标准的制定提供信息，以跟踪艾滋病毒感染者重返社会时的护理质量，并将提供至关重要的数据，以支持改善全国各地的护理联系系统。

DESCRIPTION (provided by applicant): Incarcerated populations are disproportionately burdened by higher rates of HIV infection compared to those in the community and are often provided with medical care during their incarceration. Interruptions in care are common following release from incarceration and may lead to worse clinical outcomes and increases in high risk behaviors for HIV transmission. Support of linkage to care is a critical component of developing programs to seek and treat persons with HIV involved in corrections. This innovative proposal seeks to improve linkage to HIV care after release from incarceration through the following Specific Aims: 1. To design and implement a monitoring strategy for evaluating follow-up HIV medical care in the community after release from incarceration. 2. To test the clinical and epidemiological utility of the monitoring strategy in 2a) distinguishing areas with high success in linkage to care from those with low success, 2b) identifying correlates of earlier and later enrollment in care post release from incarceration, and 2c) assessing whether existing policies and programs promote greater linkage to care and better HIV clinical outcomes. 3. To qualitatively explore and investigate the individual, community, institutional and political factors influencing linkage to HIV medical care during the pre- and post-release periods. To accomplish these Aims, this innovative interdisciplinary multi-site project will first develop and validate an indicator of the adequacy of linkage to care for HIV infected persons undergoing reentry by linking the new Ryan White HIV/AIDS Program client level dataset to corrections release data. This linkage process will then be applied across multiple states, correctional jurisdictions, and care environments to assess HIV treatment-relevant linkage outcomes. Locations with the highest and lowest linkage will provide an opportunity to evaluate best practices and correlates of linkage success. We will use quantitative methods and in-depth qualitative interviews with patients, providers, criminal justice staff, and policy makers, to gain a better understanding of the elements influencing an inmate's linkage to HIV care throughout reentry. This comprehensive approach will permit differentiation of the structural, community, and individual level factors affecting linkage to HIV care and will help target improvements and future interventions. The availability of client level data through Ryan White reporting represents an unprecedented opportunity to better understand this pressing public health problem. This research will inform the development of metrics for ongoing quality initiatives to track the quality of care for people with HIV on reentry and will provide critically important data to support improved systems of linkage of care throughout the nation.