Corrections2Community: Post-release retention in HIV care for ex-inmates in South Africa

项目摘要 抗逆转录病毒疗法的提供显著降低了艾滋病毒相关死亡率， 非洲的发病率。然而，艾滋病毒仍然是成年男女死亡的主要原因， 南非由于未能启动抗逆转录病毒疗法或继续护理。2%至3%的男性艾滋病毒感染者 每年都有1000多人通过监狱系统。虽然被监禁的摄取 艺术是优秀的，不幸的是，释放后，大多数人失去了照顾。定性和定量 研究小组对南非492名前囚犯进行的研究表明， 在从惩教机构释放后，这一群体遇到了困惑， 以及何时接受护理、长时间的分娩、家庭遗弃和有限的社会资本， 制定的耻辱，经济不安全和物质使用（11%的人报告注射毒品使用） 我们的参与者）。该项目力求进一步描述释放后照料方面的损失， 制定并试行一个小组支助和艾滋病毒护理模式，以使前囚犯继续接受艾滋病毒护理。 这种支持小组的方法是基于适应南非社区的遵守 特别弱势群体的俱乐部这样一个关心和支持刑满释放人员的团体 过渡护理（过渡社区坚持俱乐部或TCAC）有可能 通过解决社会和保健问题， 交付障碍。我们假设在这些层面上进行干预将影响护理保留， 病毒学抑制、发病率和HIV传播。目前的提案将允许 制定和试行TCAC战略，以改善前囚犯的艾滋病毒护理， 关于前囚犯护理参与的知识，并为随机临床 TCAC试验的效力为无法检测到病毒的护理中的有效性结局 释放后6个月的负载。

PROJECT SUMMARY The availability of antiretroviral therapy (ART) has markedly reduced HIV-related mortality and morbidity in Africa. Yet HIV remains the leading cause of death among adult men and women in South Africa due fails to initiated ART or remain in care. Between 2 and 3% of HIV-infected men in South Africa pass through the corrections system annually. While incarcerated uptake of ART is excellent, unfortunately after release most are lost from care. Qualitative and quantitative research conducted by the research team with 492 ex-inmates in South Africa indicates that upon release from correctional settings, this population encounters confusion regarding where and when to receive care, long queueing times, family abandonment and limited social capital, enacted stigma, economic insecurity, and substance use (injection drug use reported by 11% of our participants). This project seeks to further characterize loss from care following release and to develop and pilot test a group support and HIV care model to retain ex-inmates in HIV care. This support group approach is based on adapting the South African community adherence clubs for a special vulnerable population. Such a care and support group for ex-inmates transitioning in care (a transition community adherence club or TCAC) has the potential to simultaneously address the multiple barriers to medical care through addressing social and care delivery barriers. We hypothesize that intervening on these levels will impact retention in care, virologic suppression, morbidity, and HIV transmission. The current proposal will allow for the development and piloting of this TCAC strategy to improve HIV care for ex-inmates to increase knowledge regarding care engagement for ex-inmates and to prepare for a randomized clinical trial of the TCAC powered for an effectiveness outcome of in-care with an undetectable viral load at 6 months after release.