Effectiveness of Peer Navigation to Link Released HIV+ Jail Inmates to HIV Care

摘要 寻找、检测和治疗模式坚持广泛、一致的抗逆转录病毒治疗(ART) 可以降低社区中可供传播的艾滋病毒RNA病毒载量水平。然而，有一些 在获释的艾滋病毒+被监禁人口中实施这一战略面临着无数挑战，因为 出院后经常中断护理。具体地说，许多出狱的囚犯没有链接到基于社区的 艾滋病毒护理足够长的时间来维持病毒载量抑制，否则他们无法重新启动任何监禁前的联系。 因此，艾滋病毒阳性的前囚犯迫切需要干预措施，以改善他们在艾滋病毒护理中的留存状态。最早的 已经对监狱进行了研究；然而，监狱中的人更没有机会确定 最佳的抗逆转录病毒治疗方案，但在释放时面临同样的治疗中断。更多的人通过 监狱而不是监狱。被监禁的人还经常面临累犯，导致监狱和监狱之间有一扇旋转门。 社区。这项提案的目标是调整现有的、基于理论的干预措施，以最大限度地提高其 艾滋病毒阳性的前囚犯的可行性和可接受性。我们将对176个新发布的产品采用随机设计 分配给干预的HIV+前囚犯和176名对照受试者实施干预 评估其有效性。这项研究将在从洛杉矶释放的HIV+男性前囚犯中进行 洛杉矶县监狱系统，世界上最大的市政监狱系统。拟议的干预措施将使用 个人提供的、以同伴为基础的学习方法，以解决艾滋病毒护理的障碍和促进者 被释放的艾滋病毒+监狱囚犯的滞留情况。 该提案有两个主要的具体目标： 1.审查出狱后艾滋病毒护理的个人和结构层面的障碍，使用 与刑满释放人员、个案经理和艾滋病毒护理提供者进行形成性的半结构化访谈； 使用我们获得的信息来告知调整和调整旨在 改善与艾滋病毒携带者和前囚犯的艾滋病毒护理的联系和保留； 2.使用两组试验性随机对照试验设计，测试自适应的基于同伴的卫生系统导航 与通常的护理条件相比，艾滋病毒感染者出狱后的干预条件，以及 为了评估干预措施在改善与艾滋病毒护理的联系和保留方面的有效性，自我 报告ART依从性和HIV RNA病毒载量抑制； 其次，我们将评估药物滥用的潜在缓和作用、潜在的调解作用 药物滥用治疗的影响，以及该计划对累犯率和成本的影响。 如果成功，具有成本效益，并被采纳为所有获释囚犯的更广泛战略，社区将 前囚犯返回的病毒可能会受益于总体社区病毒载量的减少，这可能会增加 除了改善被释放囚犯的健康状况外，现有的预防战略也是必要的。

ABSTRACT The Seek, Test, and Treat model holds that broad, consistent treatment with antiretroviral therapy (ART) could lower the level of HIV RNA viral load in the community available for transmission. However, there are myriad challenges to implementing this strategy among released HIV+ incarcerated populations given the frequent discontinuity in care following release. Specifically, many ex-inmates fail to link to community-based HIV care long enough to sustain viral load suppression, or they fail to re-initiate any pre-incarceration linkage. Consequently, HIV+ ex-inmates urgently need interventions to improve their retention in HIV care. Most prior research has been conducted on prisons; however persons in jails have even less opportunity to establish optimal ART regimens, yet face equal disruption of treatment upon release. Far greater numbers pass through jails than prisons. Jailed persons also face frequent recidivism, resulting in a revolving door between jail and the community. The goal of this proposal is to adapt an existing, theory-based intervention to maximize its feasibility and acceptability to HIV+ ex-inmates. We will utilize a randomized design for 176 newly released HIV+ ex-inmates assigned to the intervention and 176 control subjects to implement the intervention and evaluate its effectiveness. The study will be conducted among HIV+ male ex-inmates released from the Los Angeles County Jail System, the largest municipal jail system in the world. The proposed intervention will use individually delivered, peer-based learning approaches to address barriers to and facilitators of HIV care retention among released HIV+ jail inmates. The proposal has two Primary Specific Aims: 1. To examine individual-level and structural-level barriers to HIV care after release from jail, using formative semi-structured interviews with ex-inmates, case managers, and HIV care providers; and to use the information we obtain to inform the adaptation and tailoring of an intervention designed to improve linkage with and retention to HIV care for HIV+ ex-inmates; 2. Using a two-group experimental RCT design, to test the adapted peer-based health system navigation intervention condition for HIV+ inmates upon release from jail compared to a usual care condition, and to evaluate the intervention's effectiveness at improving linkage with and retention in HIV care, self- reported ART adherence, and HIV RNA viral load suppression; Secondarily, we will assess the potential moderating effects of substance abuse, the potential mediating effects of substance abuse treatment, and the program's effects on recidivism, and costs. If successful, cost-effective, and adopted as a broader strategy for all released inmates, the community to which the ex-inmate returns may benefit from reduced overall community viral load, which could augment existing prevention strategies, in addition to improving the ex-inmates' health outcomes.