Delivering HIV Risk Reduction Services in Drug Court

描述（由申请人提供）：人们越来越认识到艾滋病毒感染的巨大负担以及刑事司法系统监督下个人之间艾滋病毒传播的可能性。这在一定程度上是由于受监督的吸毒者人数众多，以及注射和非注射吸毒与艾滋病毒风险行为和感染之间的密切联系。虽然已经开发和测试了越来越多的干预措施，以减少个人在监禁期间和返回社区时感染艾滋病毒的风险，但在越来越多的被转移到以社区为基础的监督和治疗的个人中，很少有艾滋病毒预防干预措施得到测试。这项拟议的研究旨在评估在费城的药物治疗法庭项目中，对滥用药物的罪犯进行简短、个性化和自动化的艾滋病毒预防干预的效果。尽管毒品法庭在减少再犯和吸毒方面具有公认的功效（Festinger et al., 2002; Marlowe, Festinger, Dugosh et al., 2007），但它们在降低艾滋病毒风险方面的能力尚未得到评估。鉴于高危行为的普遍存在（例如，Belenko等人，2004年）以及刑事罪犯中艾滋病毒感染和性传播感染的惊人比率（14%-26%:Hammet等人，2002年；Spaulding等人，2009年），毒品法庭是提供降低风险干预措施的一个重要但尚未开发的机会。作为毒品法庭的一个集中组成部分，案件管理单位通常帮助客户获得辅助服务，并就就业、住房和常规医疗等一些重要的社会和健康问题提供咨询。虽然减少艾滋病毒/艾滋病风险属于毒品法庭案件管理人员提供的服务范围，但增加更密集的服务受到人员和资源有限的限制。幸运的是，有证据支持计算机化简短干预对降低艾滋病毒风险的有效性（见Noar等人，2009年）。我们将随机分配400名重罪毒品法庭参与者，在他们的前三次案件管理会议后接受简短的计算机化艾滋病毒干预或注意力控制程序。我们将比较两组的一些结果，包括参与高风险行为、艾滋病毒检测率和避孕套采购（除了将避孕套作为一种风险行为来衡量）。我们还将研究干预对毒品法庭相关结果的影响，包括案件管理出勤率，毕业率和尿检确认吸毒。这项研究将首次检验在毒品法庭上使用简短的、计算机化的艾滋病毒风险降低干预措施的效果。研究结果将提供有用的信息，说明在我们社区中不断增长的物质使用罪犯人口中减少艾滋病毒风险的实用战略的效用。调查结果还将对扩大毒品法庭和其他社区矫正项目的重点产生重大影响，而不仅仅是减少犯罪累犯和毒品使用。

DESCRIPTION (provided by applicant): There is growing recognition of the substantial burden of HIV infection and the potential for HIV transmission among individuals under the supervision of the criminal justice system. This is, in part, attributable to the high number of drug users under supervision and the close linkages between injection and non-injection drug use and HIV risk behaviors and infection. While there have been a growing number of interventions developed and tested to reduce HIV risk among individuals while they are incarcerated and when they return to the community, few HIV prevention interventions have been tested among the growing numbers of individuals who are diverted to community based supervision and treatment. The proposed study is designed to evaluate the efficacy of a brief, personalized and automated HIV prevention intervention delivered to substance abusing offenders in the City of Philadelphia's drug treatment court program. Despite their well established efficacy in reducing recidivism and drug use (Festinger et al, 2002, Marlowe, Festinger, Dugosh et al., 2007), drug courts have yet to be evaluated in their ability to reduce HIV risk. Given the prevalence of high risk behaviors (e.g., Belenko at al., 2004) and the alarming rates of HIV infection and STIs among criminal offenders (14%-26%: Hammet et al, 2002; Spaulding et al., 2009), drug courts represent an important yet unexplored opportunity to deliver risk reduction interventions. As a centralized component of drug court, case management units typically help clients access adjunctive services and provide consultation on a number of important social and health related issues such as employment, housing, and routine medical care. Although HIV/AIDS risk reduction fits within the domain of services provided by drug court case managers, the addition of more intensive services is constrained by limited staff and resources. Fortunately, there is support for the efficacy of computerized brief interventions for reducing HIV risk (see Noar et al., 2009). We will randomly assign 400 felony drug court participants to receive either a brief computerized HIV intervention or an attention control procedure following their first three case management sessions. We will compare the groups on a number of outcomes including engagement in high risk behaviors, rates of HIV testing, and condom procurement (in addition to condom use measured as a risk behavior). We will also examine the effect of the intervention on drug court related outcomes including case management attendance, graduation rates, and urinalysis confirmed drug use. This study will be the first to examine the efficacy of using a brief, computerized HIV risk reduction intervention in drug courts. Findings will provide useful information on the utility of a practical strategy for reducing HIV risk in the growing population of substance using offenders in our communities. Findings will also have major implications for expanding the focus of drug courts and other community based correction programs beyond reducing criminal recidivism and drug use. PUBLIC HEALTH RELEVANCE: Although a number of effective interventions have been employed to reduce HIV risk among individuals while they are incarcerated, few HIV prevention interventions have been tested among the growing numbers of individuals who are diverted to community based supervision and treatment. This study will be the first to examine the efficacy of a promising and practical strategy for reducing HIV risk in the growing population of substance using offenders diverted to drug courts. Findings will have major implications for expanding the focus of drug courts and other community based correction programs to include HIV prevention.