Youth Services Navigation Intervention for HIV+ adolescents and young adults being released from incarceration: A randomized control trial

项目总结/摘要 艾滋病毒护理的连续性迫使人们重新关注确定和有效服务高需求的紧迫性， 资源不足，而且往往是流动人口，以便利他们接受必要的持续护理， 抗逆转录病毒疗法（ART）以抑制HIV RNA病毒载量（VL）。改善护理的关键目标群体 沿着连续体是年轻人（16-25岁），性和性别少数群体（SGM）人口被释放 从监狱里出来感染艾滋病毒的被监禁青年（YLWH）的艾滋病毒流行率是2010年的三倍。 每年，总人口中有1/7的艾滋病毒阳性者遭受监禁。艾滋病毒感染率， 黑人和拉丁美洲人的患病率和监禁率高于任何其他群体-这些 在青年人中，差距尤其突出。此外，估计只有6%的艾滋病毒阳性青年是病毒感染者。 抑制，由于不良的保留和坚持艺术。现有的联系和保留服务， 不足以满足涉及刑事司法（CJI）的艾滋病毒阳性青年的迫切需要，特别是在高度需要的情况下， 从监禁中释放后。此外，由于他们缺乏经验，许多年轻人可能 努力获得所需服务并稳定其生活条件。艾滋病毒连续性成果的差异 与监禁、物质使用障碍（SUD）、无家可归和心理健康有着千丝万缕的联系 (MH)YLWH之间的问题。如果要控制艾滋病毒，广泛体验抗逆转录病毒疗法的好处， CJI YLWH的问题必须与创新，青年，性和性别少数群体（SGM）一起解决， 敏感的方法。我们计划招募240名年龄在16-25岁之间的CJI YLWH，他们被监禁在洛杉矶， 芝加哥监狱和少年拘留所。我们将参与者随机分配至YSN干预组（n=120） vs.常规治疗对照组（n=120）。青年服务导航员（YSN）将协助解决 在临床护理之前和正在进行中的即时未满足的需求，如住房，交通和食物;将指导 干预参与者获得一系列社区服务，以支持沿着艾滋病毒连续体取得进展 护理;并将提供直接的ART依从性支持。本研究有两个主要目的：1。 调整现有的成人同伴导航干预措施，以创建青年服务导航（YSN） 对SGM文化敏感的干预措施，引导青年沿着艾滋病毒护理的连续性获得所需的服务。 这种干预措施将医疗、物质使用和心理健康护理与全面重返社会相结合 2.支持从大郡监狱和少年拘留系统释放的16-25岁的CJI YLWH; 使用两组随机对照试验设计，我们将测试新的YSN的有效性，青年SGM敏感 在16-25岁的CJI YLWH中，与对照组相比，干预组提供标准的转诊服务。我们将 评估YSN干预对监禁后联系，保留，坚持和病毒的影响 抑制，以及对SUD，心理健康，服务利用和满足的需求。目标：我们 将评估YSN对累犯、成本和潜在成本抵消/效益的影响。

Project Summary/Abstract The continuum of HIV care has forced new focus on the urgency to identify and effectively serve high-need, under-resourced, and often transient populations to facilitate their receiving the necessary ongoing care and antiretroviral therapy (ART) to suppress HIV RNA viral load (VL). Crucial target groups for improving care along the continuum are young (aged 16-25), sexual and gender minority (SGM) populations being released from jail settings. HIV prevalence among incarcerated youth living with HIV (YLWH) is three times that of the general population and one in seven of all HIV+ persons experience incarceration each year. HIV incidence, prevalence, and incarceration rates are higher for blacks and Latinos than for any other group – these disparities are especially prominent among youth. Furthermore, only an estimated 6% of HIV+ youth are virally suppressed, due to poor retention and adherence to ART. Existing linkage and retention services are insufficient to meet the acute needs of criminal justice-involved (CJI) HIV+ youth, particularly in the high-need period following release from incarceration. Moreover, because of their lack of experience, many youths may struggle to obtain needed services and stabilize their living conditions. Disparities in HIV continuum outcomes are inextricably linked to incarceration, substance use disorders (SUDs), homelessness, and mental health (MH) problems among YLWH. If HIV is to be controlled and the benefits of ART experienced broadly, the problems of CJI YLWH must be addressed with innovative, youth-, and sexual and gender minority (SGM)- sensitive approaches. We propose to enroll 240 CJI YLWH, aged 16-25, incarcerated in Los Angeles and Chicago jails and juvenile detention facilities. We will randomize participants to the YSN intervention (n=120) vs. a usual-care control group (n=120). The youth services navigators (YSNs) will assist with addressing immediate unmet needs such as housing, transportation, and food prior to clinical care and ongoing; will guide intervention participants to a range of community services to support progress along the continuum of HIV care; and will provide direct ART adherence support. The proposed study has two Primary Specific Aims: 1. Adapt an existing peer navigation intervention for adults to create a Youth Service Navigation (YSN) intervention sensitive to SGM culture that guides youth to needed services along the continuum of HIV care. This intervention combines medical, substance use and mental health care with comprehensive reentry support for CJI YLWH, aged 16-25 upon release from large county jails and juvenile detention systems; 2. Using a two-group RCT design, we will test the effectiveness of the new YSN, youth SGM-sensitive intervention among CJI YLWH aged 16-25, compared to controls offered standard referrals to services. We will evaluate the YSN Intervention's effect on post-incarceration linkage, retention, adherence, and viral suppression, as well as on SUDs, mental health, services utilization, and met needs. Secondary Aims: We will assess YSN's effects on recidivism, costs and potential cost-offset/effectiveness.