Linking High-Risk Jail Detainees to HIV pre-exposure prophylaxis: PrEP-LINK

摘要 刑事司法(CJ)涉及的个人与艾滋病毒相关的风险因素的流行率极高 感染，包括贫困、药物使用、交易性行为、性伴数量多、患病率高 性传播感染和精神疾病。非洲裔美国人(AA)在这两种疾病中的风险都不成比例 监禁和艾滋病毒感染。越来越多的证据突显了每日一次药物的疗效， 恩曲他滨/替诺福韦，也称为暴露前预防(PrEP)，在减少艾滋病毒感染方面的作用。然而， 结构性和社会障碍可能会破坏PrEP的最佳摄取、坚持和保留，并且必须 特别是在那些最近有CJ经验的人中。我们建议的研究直接与 NIMHD科学愿景促进改善少数群体健康或降低健康的干预方法 差距。我们拟议的研究将：提供对PrEP的促进者和障碍的新探索；使我们能够 针对难以接触到的人群，包括男男性接触者和药物使用者(这两者都是最高资金优先事项 国家卫生研究院的小组)经历艾滋病毒风险交叉标记的人；并告知 防治艾滋病毒和艾滋病重叠流行的区域、可能还有国家的干预办法 监禁：该项目的具体目标是：目标1：对调解人进行定性评估 以及在高危监狱被拘留者、系统和行为者之间采用PrEP的障碍；目标2： 制定PrEP链接干预措施，并对高危人群进行开放式标签评估 从Pulaski县监狱释放；目标3：对PrEP-LINK进行试点RCT 从普拉斯基县监狱释放的高危男子的干预。结果将通知 随后的多点随机对照试验，以测试干预在改善PrEP摄取、依从性和 有CJ经验的男性在护理中的保留。

Abstract Criminal justice (CJ) involved individuals have extremely high prevalence of risk factors associated with HIV infection including poverty, substance use, transactional sex, high numbers of sex partners, high prevalence of sexually transmitted infections and mental illness. African Americans (AA) are at disproportionate risk for both incarceration and HIV infections. A growing body of evidence highlights the efficacy of a once daily medication, emtricitabine/tenofovir, also known as pre-exposure prophylaxis (PrEP), in reducing HIV acquisition. However, structural and social barriers can undermine optimal PrEP uptake, adherence, and retention in care and must be addressed especially among those with recent CJ experience. Our proposed study is directly aligned with NIMHD Science Visioning to advance intervention approaches to improve minority health or to reduce health disparities. Our proposed study will: provide a novel exploration of facilitators and barriers to PrEP; allow us to target hard to reach populations, including MSM and substance users (both of which are top funding priority groups for the National Institutes of Health) who experience intersecting markers of HIV risk; and inform regional, and possibly national, intervention approaches to combat the overlapping epidemic of HIV and incarceration: The specific aims of the project are: Aim 1: Perform a qualitative assessment of facilitators and barriers to PrEP uptake among high-risk jail detainees, systems and interactor levels; Aim 2: Develop the PrEP-LINK intervention and perform an open label evaluation with high-risk individuals being discharged from the Pulaski County Jail; Aim 3: Conduct a pilot RCT of the PrEP-LINK intervention among high-risk men being released from the Pulaski County Jail. Results will inform a subsequent multi-site RCT to test efficacy of the intervention in improving PrEP uptake, adherence, and retention in care among men with CJ-experience.