The role of prisons in community spread of COVID-19: Disparate epidemiologic profiles in rural, racial/ethnic minority, and low socioeconomic US counties

摘要 刑事司法（CJ）涉及的个人有极高的患病率与艾滋病毒相关的危险因素 感染，包括贫穷、吸毒、性交易、性伴侣人数多、 性传播感染和精神疾病。非裔美国人（AA）在这两个不成比例的风险 监禁和艾滋病毒感染。越来越多的证据强调了每日一次药物的疗效， 恩曲他滨/替诺福韦，也被称为暴露前预防（PrEP），在减少艾滋病毒感染。然而，在这方面， 结构和社会障碍可能会破坏最佳的PrEP吸收，坚持和保留护理，必须 特别是那些最近有CJ经验的人。我们提出的研究直接与 NIMHD科学愿景，以推进干预方法，以改善少数群体的健康或减少健康 差距。我们提出的研究将：提供一个新的探索促进者和障碍准备;让我们 以难以接触到人群为目标，包括男男性行为者和药物使用者（这两者都是最优先的供资对象 美国国立卫生研究院的团体），他们经历了艾滋病毒风险的交叉标志物;并告知 采取区域、可能还有国家干预办法，防治艾滋病毒的重叠流行， 目标1：对协助者进行定性评估 以及高风险监狱被拘留者、系统和互动者层面接受PrEP的障碍;目标2： 制定PrEP-LINK干预措施，并对高风险个体进行开放标签评价 从普拉斯基县监狱出院;目标3：进行PrEP-LINK的试点RCT 对从普拉斯基县监狱释放的高危男女进行干预。结果将 通知后续的多中心随机对照试验，以测试干预措施在改善PrEP吸收，依从性， 有CJ经验的男性中的护理保留率。

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 and women 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.