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

项目摘要/摘要 艾滋病毒护理的连续性迫使人们将新的重点放在确定和有效服务高需求人群的紧迫性上， 资源不足，而且往往是暂住人口，以方便他们接受必要的持续护理和 抗逆转录病毒治疗(ART)以抑制HIV RNA病毒载量(VL)。改善护理的关键目标群体 在这一连续不断的过程中，年轻人(16-25岁)、性少数群体和性别少数群体(SGM)被释放 从监狱环境中。在被监禁的青年艾滋病毒携带者中，艾滋病毒感染率是 普通人口和所有艾滋病毒携带者中每年就有一人被监禁。艾滋病毒发病率， 黑人和拉丁裔的流行率和监禁率比其他任何群体都高--这些 不平等现象在年轻人中尤为突出。此外，估计只有6%的艾滋病毒携带者是病毒携带者。 被压抑，因为对艺术的保留和坚持很差。现有的联系和保留服务是 不足以满足涉及刑事司法的艾滋病毒+青年的迫切需求，特别是在高需求群体中 出狱后的一段时间。此外，由于缺乏经验，许多年轻人可能会 努力获得所需的服务和稳定他们的生活条件。艾滋病毒连续结果的差异 与监禁、物质使用障碍、无家可归和精神健康有着千丝万缕的联系 (MH)青瓦台存在的问题。如果艾滋病毒得到控制，抗逆转录病毒疗法的好处得到广泛体验， CJI YLWH的问题必须与创新的、青年的、性和性别少数群体(SGM)一起解决-- 敏感的方法。我们建议招募240名CJI YLWH，年龄16-25岁，监禁在洛杉矶和 芝加哥监狱和青少年拘留所。我们将随机选择参加YSN干预的参与者(n=120) 对照组(n=120)。青少年服务导航员(YSN)将协助 在临床护理之前和正在进行的当前未得到满足的需求，如住房、交通和食物；将指导 一系列社区服务的干预参与者，以支持艾滋病毒连续传播的进展 护理；并将提供直接的艺术坚持支持。拟议的研究有两个主要的具体目标：1. 调整现有的成人同伴导航干预，以创建青少年服务导航(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统一体获得所需的服务。 这种干预将医疗、药物使用和精神卫生保健与全面重返大气层结合起来 在大型县监狱和少年拘留系统释放后，为16-25岁的儿童提供支持；2. 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中进行干预，与提供标准转诊服务的对照组进行比较。我们会 评估YSN干预对监禁后联系、滞留、依从性和病毒感染的影响 压制，以及对肥胖症、精神健康、服务利用和满足需求的抑制。次要目标：我们 将评估YSN对累犯率、成本和潜在成本抵消/效果的影响。

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.