The HIV Care Continuum Among Recent Offenders

描述(由申请人提供)：被监禁的人承受着不成比例的艾滋病毒负担，以及其他性传播感染、慢性病、药物滥用和精神健康问题。2008年，美国1.4%的监狱囚犯艾滋病毒阳性(HIV+)，每年每7名艾滋病毒阳性者中就有1人通过惩教机构。获释后，他们的艾滋病毒护理和结果在很大程度上是未知的。这项研究的目的是调查印第安纳州马里恩县(印第安纳波利斯)12年来从监狱、监狱或少年拘留(“监禁后时期”)被捕或释放的新诊断艾滋病毒感染者的艾滋病毒护理和结果。我们将使用艾滋病毒护理连续体作为概念框架，作为指导我们方法的概念框架，该连续体系被概念化为一个阶段性或阶梯式级联，包括艾滋病毒诊断、与护理的联系、保留护理、开始抗逆转录病毒治疗和病毒抑制。中心假设是，与逮捕或监禁前相比，与非罪犯人群中艾滋病毒+者相比，监禁后艾滋病毒+罪犯在护理连续过程的每个阶段的艾滋病毒护理和临床结果都会更差。该项目的基本原理是确定在这一弱势群体的艾滋病毒护理连续体中改善艾滋病毒管理的新机会。与马里昂县的刑事司法、临床和公共卫生机构合作，所有个人级别的逮捕、少年拘留、监狱和监狱记录都与9年内STI/艾滋病毒检测阳性结果联系在一起。在专业知识和资源的基础上，这项拟议的研究将利用印第安纳州患者护理系统网络纳入12年期间的门诊、住院和急诊科接触、药物和实验室数据，该网络是美国大都市地区最全面的临床接触数据集之一。这些数据将使我们能够根据获释后12个月、24个月和36个月的定义，调查艾滋病毒+罪犯在监禁后一段时间内艾滋病毒护理的连续性，并确定何时以及如何改善对艾滋病毒+人群中这一脆弱群体的艾滋病毒护理。其目的是(1)评估在监禁期间和监禁后被诊断感染艾滋病毒的罪犯与护理的联系；(2)描述最近感染艾滋病毒的罪犯在监禁后期间是否、何时、在哪里以及以什么频率接受艾滋病毒相关的临床服务；(3)对于在监禁后期间至少有一次与艾滋病毒有关的临床访问的最近罪犯，评估艾滋病毒护理管理的质量；以及(4)调查囚犯在监禁后期间的临床护理结果。我们研究的长期影响是改善监禁后艾滋病毒携带者的护理和结果。我们的分析将告诉我们何时、何地以及如何最好地进行干预。

DESCRIPTION (provided by applicant): Incarcerated individuals bear a disproportionate burden of HIV, as well as other sexually transmitted infections, chronic disease, and substance abuse and mental health issues. In 2008, 1.4% of prison inmates in the United States was HIV-positive (HIV+), and every year, 1 in 7 HIV+ persons pass through a correctional facility. Following release, their HIV care and outcomes are largely unknown. The purpose of this study is to investigate HIV care and outcomes among newly diagnosed HIV+ individuals arrested or released from jail, prison or juvenile detention ("post-incarceration period") within Marion County (Indianapolis), Indiana over a 12-year period. We will use the HIV care continuum conceptualized as a staged or stepped cascade including HIV diagnosis, linkage to care, retention in care, initiation of antiretroviral therapy and viral suppression as a conceptual framework to guide our methodology. The central hypothesis is that HIV+ offenders in the post-incarceration period will have poorer HIV care and clinical outcomes at every stage of the care continuum, compared to prior to arrest or incarceration and compared to HIV+ individuals in the non-offender population. The rationale for this project is to identify new opportunities for improving HIV management along the HIV care continuum among this vulnerable population. In collaboration with criminal justice, clinical and public health agencies serving Marion County, all individual-level arrest, juvenile detention, jail and prison records were linked with positive STI/HIV test results over a 9- year period. Building on this foundation of expertise and resources, the proposed study will incorporate outpatient, inpatient and emergency department encounter, medication and laboratory data over a 12-year period using the Indiana Network for Patient Care system, one of the most comprehensive clinical encounter data sets for a U.S. metropolitan area. These data will give us the unprecedented ability to investigate the HIV care continuum over time among HIV+ offenders in the post-incarceration period as defined by the 12-, 24- and 36-months following release and identify when and how HIV care can be improved for this vulnerable subset of the HIV+ population. The aims are to (1) Assess linkage to care among offenders diagnosed with HIV during and following incarceration; (2) Describe if, when, where and at what frequency recent offenders who are HIV+ receive HIV-related clinical services in the post-incarceration period; (3) Among recent offenders with at least 1 HIV-related clinical visit in a post-incarceration period, assess the quality of HIV care management; and (4) Investigate clinical care outcomes among offenders in the post-incarceration period. The long-term impact of our research is to improve the care and outcomes of HIV+ individuals in the post- incarceration period. Our analyses will inform us when, where, and how best to intervene.