Addressing risk through Community Treatment for Infectious disease and Opioid use disorder Now (ACTION) among justice-involved populations

项目摘要 改善艾滋病毒和阿片类药物使用障碍的管理和执行，以促进刑事司法(CJ)-- 涉及的个人需要有效的方法进行筛查、联系和遵守综合服务 跨社区机构和服务提供商。社区重新进入代表着一个关键的机会 个人对艾滋病毒的预防和治疗，以及我们的服务提供者。为回应RFA DA-20-028，我们 拟议的一项名为通过社区治疗传染病和阿片类药物使用来应对风险的研究 现在(行动)在涉及正义的人群中的混乱，是一种为期5年的混合I型有效性- 实施RCT，比较两种模式[患者导航(PN)或移动医疗单元(MHU)服务 提供]将最近从监狱和监狱释放的人与以社区为基础的艾滋病毒的连续体联系起来 以及预防和治疗服务的级联护理。共864名涉及CJ的个人 被释放到2个CT社区(新伦敦和温德姆/托兰县)和2个TX社区 (达拉斯县和塔兰特县)逮捕前有阿片类药物/注射毒品使用史，生活在一起或处于危险之中 将在释放后随机接受：a)用于护理的PN系统，其中患者导航器 在为期6个月的出院后干预期间，将把研究参与者与社区服务提供者联系起来 期间；将向未感染艾滋病毒的人提供初级保健服务，并向艾滋病毒携带者提供 获得ART服务，或b)通过MHU提供的服务，其中研究参与者将链接到MHU 在他们的社区内，他们将获得集成的PrEP/ART、Moud、 MHU在6个月的出院后干预期。有两个具体目标：目标1(干预 有效性)：比较PN和MHU服务交付在参与者长度上的有效性 在出院后6个月内首次服用PrEP(预防)/ART(治疗)药物的时间 从拘押中释放。次级结果将审查PrEP和艾滋病毒护理结果的连续体， 包括(但不限于)以下额外措施：针对PLH、PrEP的艾滋病毒病毒抑制 坚持，艾滋病毒危险行为；丙型肝炎病毒措施，如丙型肝炎病毒检测和与治疗的联系；性 传播感染(STI)发病率(GC/衣原体/梅毒和乙肝病毒)；以及初级医疗保健 预约。重要的是，我们还将评估与OUD和SUD相关的措施：OUD/SUD诊断、 Moud处方接收和保留，阿片类药物和兴奋剂的使用，以及过量服药事件。目标2(执行)： 评估PN和MHU的可行性、可接受性和成本。主要执行成果包括 可行性(获释个人对卫生保健利用的影响、机构间工作组的贡献 成员对结果)；可接受性(参与者满意度，感知的有用性)；维持(续 利用率)，以及实施和维持这些方法以及在其他 社区。还将评估社区提供商范围内的服务访问障碍。

Project Abstract Improving HIV and Opioid Use Disorder (OUD) management and implementation for criminal justice (CJ)- involved individuals requires effective approaches to screening, linkage and adherence to integrated services across community agencies and service providers. Community reentry represents a critical opportunity to link individuals to HIV prevention and treatment and OUD service providers. In response to RFA DA-20-028, our proposed study called Addressing risk through Community Treatment for Infectious disease and Opioid use disorder Now (ACTION) among justice-involved populations, is a 5-year Hybrid Type 1 Effectiveness- Implementation RCT that compares two models [Patient Navigation (PN) or Mobile Health Unit (MHU) service delivery] of linking individuals recently released from prison and jail to the continuum of community-based HIV and OUD prevention and treatment service cascades of care. A total of 864 CJ-involved individuals who are being released to 2 CT communities (New London and Windham/Tolland Counties) & 2 TX communities (Dallas and Tarrant Counties) with pre-arrest histories of opioid/injection drug use and are living with or at-risk of HIV will be randomized to receive at post-release either: a) a PN system for care, wherein patient navigators will link study participants to community-based service providers during the 6-month post-release intervention period; those without HIV will be provided access to PrEP services, and those living with HIV will receive access to ART services, or b) services delivered via a MHU, wherein study participants will be linked to a MHU within their community where they will receive integrated PrEP/ART, MOUD, harm reduction services on the MHU during the 6 month post-release intervention period. There are 2 specific aims: Aim 1 (Intervention Effectiveness): To compare the effectiveness of the use of PN vs. MHU service delivery on participant length of time to taking initial post-release PrEP (prevention)/ART (treatment) medication within 6 months following release from custody. Secondary outcomes will examine the continuum of PrEP and HIV care outcomes, including (but not limited to) the following additional measures: HIV viral suppression for PLH, PrEP adherence, HIV risk behaviors; HCV measures such as HCV testing & linkage to treatment; sexually transmitted infection (STI) incidence (GC/ Chlamydia/ Syphilis and HBV); and primary medical care appointments. Importantly, we will also assess OUD and SUD-related measures: OUD/ SUD diagnoses, MOUD prescription receipt &retention, opioid & stimulant use, & overdose incidents. Aim 2 (Implementation): To evaluate PN and MHU feasibility, acceptability, and costs. Primary implementation outcomes include feasibility (health care utilization impact among released individuals, contributions of interagency workgroup members on outcomes); acceptability (participant satisfaction, perceived usefulness); sustainment (continued utilization), and costs required to implement and sustain the approaches as well as to scale-up in additional communities. Barriers to service access across the community provider spectrum will be assessed as well.