Prevention Needs of HIV+ Persons Awaiting Release from Prison

描述（由申请人提供）：艾滋病毒影响了不成比例的被监禁者。因此，美国疾病控制和预防中心和美国人权和安全管理局将惩教设施作为艾滋病毒预防和治疗工作的主要场所。已知艾滋病毒阳性囚犯从事传播风险行为的影响具有明显的公共卫生意义，特别是因为大多数人将返回社区。然而，对艾滋病毒阳性囚犯的预防需求的了解远远少于艾滋病毒阴性囚犯。为了为出狱的艾滋病毒阳性者设计可接受、可行和有效的减少传播风险干预措施，必须明确探讨和确定这一人群的具体预防需求，特别是在减少风险信息、动机和行为技能方面的优势和劣势。在监禁期间开始并在释放后跟踪囚犯的干预措施被认为最有可能随着时间的推移影响行为。然而，关于如何在监禁期间和监禁后立即最好地设计和调整“积极预防”方案的关键问题仍然没有答案。需要拟议的研究来解决这些问题。我们将进行两项形成性研究，这些研究在概念上由费舍尔的信息-动机-行为技能（IMB）艾滋病毒预防模型指导。在将IMB模式应用于新人口时，建议将启发式研究作为制定有针对性的干预措施和措施的第一步。在研究1中，我们将对30名等待从监狱释放的被监禁的HIV+患者进行个人启发式访谈，以确定特定的基于理论的风险降低信息，动机和行为技能的优势和劣势。我们还将评估可能在监禁期间和监禁后实施的“积极预防”干预措施的可接受性和可行性。在IMB模型的指导下，将采用扎根理论方法进行定性分析。在研究2中，研究1的结果将被用来修改现有的风险降低信息，动机和行为技能的量化措施，使其在文化上适合于对艾滋病毒阳性监狱人口的电话管理。经调整的IMB调查将在20名等待释放的艾滋病毒阳性被监禁者中进行预先测试。将采用专家预审查程序和迭代认知访谈方法进行调查。认知访谈“大声思考”技术被认为对设计包括敏感或侵入性问题的调查和对识字率较低的人口特别有用。这一形成性项目将评估艾滋病毒阳性囚犯在等待出狱时的预防需求，并将指导制定适合他们需要的文化上适当的、基于理论的干预和评估材料。 更清楚地了解如何减少已知艾滋病毒阳性囚犯中的艾滋病毒传播风险行为具有重要的公共卫生意义。这一形成性项目将评估艾滋病毒阳性囚犯的预防需要，并将指导制定适合他们需要的文化上适当的、以理论为基础的干预和评估材料。这一研究重点有可能产生很大的影响，因为艾滋病毒疾病和监禁的发生率极高，随着时间的推移，几乎所有艾滋病毒阳性的囚犯都被释放回社区。

DESCRIPTION (provided by applicant): HIV affects a disproportionate number of incarcerated persons. Correctional facilities have therefore been targeted by the CDC and HRSA as key settings for HIV prevention and treatment efforts. The impact of known HIV+ prisoners engaging in transmission risk behavior is of clear public health significance, particularly because most will return to the community. However, far less is known about the prevention needs of HIV- positive than of HIV-negative prison inmates. In order to design acceptable, feasible, and effective transmission risk reduction interventions for HIV+ persons leaving prison, the specific prevention needs of this population must be clearly explored and identified, particularly in terms of their risk reduction information, motivation, and behavioral skills strengths and weaknesses. Interventions that begin during incarceration and follow inmates after release are thought to have the greatest chance of impacting behavior over time. However, key questions remain unanswered regarding how best to design and tailor "prevention for positives" programs during and immediately following incarceration. The proposed research is needed to address these issues. We will conduct two formative studies that are conceptually guided by Fisher's Information-Motivation-Behavioral Skills (IMB) Model of HIV prevention. In applying the IMB model to new populations, elicitation research is recommended as the first step in developing tailored interventions and measures. In Study 1, we will conduct individual elicitation interviews with 30 incarcerated HIV+ persons awaiting release from prison to identify specific theory-based risk reduction information, motivation, and behavioral skills strengths and weaknesses. We will also assess the acceptability and feasibility of potential protocols for "prevention for positives" interventions that could be implemented during and following incarceration. A grounded theory approach to qualitative analysis will be used, guided by the IMB model. In Study 2, findings from Study 1 will be used to modify an existing quantitative measure of risk reduction information, motivation and behavioral skills to be culturally appropriate for telephone administration to an HIV+ prison population. The adapted IMB survey will be pre-tested with 20 incarcerated HIV+ persons awaiting release. An expert pre-review process and an iterative cognitive interviewing approach to survey development will be employed. Cognitive interviewing "think aloud" techniques are considered particularly useful for designing surveys that include sensitive or intrusive questions and for lower literacy populations. This formative project will evaluate the prevention needs of HIV+ inmates awaiting release from prison, and will serve to guide the development of culturally appropriate, theory-based intervention and assessment materials tailored to their needs. Gaining a clearer understanding of how to reduce HIV transmission risk behaviors among known HIV-positive prisoners is of great public health significance. This formative project will evaluate the prevention needs of HIV- positive inmates awaiting release from prison, and will serve to guide the development of culturally appropriate, theory-based intervention and assessment materials tailored to their needs. This research focus has the potential for high impact because HIV disease and incarceration co-occur at extremely high rates, with nearly all HIV-positive inmates released back in to the community over time.