Psychiatric barriers to outpatient care in released HIV-infected offenders

刑满释放艾滋病毒感染者门诊治疗的精神障碍

• 批准号: 7492308
• 负责人: JACQUES G BAILLARGEON
• 金额: $ 7.93万
• 依托单位: UNIVERSITY OF TEXAS MED BR GALVESTON
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-03 至 2010-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7492308
• 关键词: Adherence; Ambulatory Care; Anti-Retroviral Agents; Appointment; Bipolar Disorder; CD4 Lymphocyte Count; Caring; Clinic; Clinical; Cohort Studies; Communities; Complex; Computerized Medical Record; Condition; County; Criminal Justice; DSM-IV; Data; Databases; Disease; Disease Resistance; Drug resistance; Drug usage; Dysthymic Disorder; Electronics; Exhibits; Failure; Funding; HIV; HIV Infections; HIV drug resistance; Health; Healthcare Systems; Highly Active Antiretroviral Therapy; Historical Cohort Studies; Human immunodeficiency virus test; Imprisonment; Individual; Injection of therapeutic agent; Major Depressive Disorder; Mental disorders; Outcome; Outpatients; Patient Care; Pharmaceutical Preparations; Pharmacy facility; Play; Policies; Population; Prisoner; Prisons; Psychotic Disorders; Public Health; Publishing; Rate; Reporting; Risk; Risk Factors; Role; Schizoaffective Disorders; Schizophrenia; Screening procedure; Source; Standards of Weights and Measures; Substance abuse problem; System; Texas; Time; Title; Treatment Protocols; Viral Load result; Viral load measurement; antiretroviral therapy; base; correctional system; data management; high risk behavior; high risk sexual behavior; offender; prescription document; prescription procedure; programs; recidivism

DESCRIPTION (provided by applicant): The US prison system has become an important front in the effort to control HIV. The increase in drug-related sentencing over the last 20 years has resulted in significantly increased concentrations of offenders with HIV and HIV-related risk factors. The US correctional system serves as the principal screening and treatment venue for millions of individuals with or at high risk for HIV infection who are out of the conventional community-based health care system's reach. Many offenders are offered HIV testing for the first time while incarcerated, and three-quarters of inmates with HIV infection initiate treatment during incarceration. The majority of incarcerated HIV-infected offenders respond well to antiretroviral therapy and demonstrate high levels of adherence to complex antiretroviral drug regimens during incarceration. Many ex-offenders, however, discontinue their treatment following release from prison. These individuals are at increased risk of developing drug-resistant disease and resuming high-risk behaviors, potentially infecting others and creating reservoirs of drug-resistant HIV in the general community. Psychiatric disorders may serve as a significant barrier to HIV- infected offenders' failure to establish and maintain clinical care following release from prison. Because the vast majority of offenders are incarcerated for less than 3 years, identifying and understanding the extent to which psychiatric disease serves as a barrier to establishing and maintaining effective HIV outpatient care planning holds far-reaching public health relevance. To date, no published information is available on this critically important issue. We propose a historical cohort study to assess the extent to which having a psychiatric disorder decreases the likelihood of establishing and maintaining outpatient care among newly released HIV-infected Texas Department of Criminal Justice (TDCJ) offenders. Our study cohort will consist of approximately 1,200 HIV-infected offenders who were released from the TDCJ between January 1, 2004 and December 31, 2006 and were referred to HIV outpatient care in Harris County, TX. This study will rely on electronic clinical, pharmacy, and demographic data from 3 sources: 1) the TDCJ electronic medical record system, 2) the Harris County Centralized Patient Care Data Management System (CPCDMS), and 3) the Texas Department of Health (TDH) Texas HIV Medication Program (THMP) database. Specifically, we will examine whether ex-offenders with psychiatric disorders are at increased risk of the following outcomes in comparison to ex-offenders without psychiatric disease: 1) poorer rates of initiating outpatient clinical care; 2) poorer overall clinical outcomes (CD4 count, virus load, AIDS-indicator diseases); 3) poorer retention in outpatient care; and 4) higher recidivism rates. Recent reports indicate that HIV-infected prison inmates adhere to antiretroviral therapy and have positive treatment results during incarceration, but these effects are not sustained following their release into the general community, indicating that a large proportion of offenders stop HIV treatment following their release from prison. Given that psychiatric disorders constitute a substantial barrier to HIV treatment adherence in nonincarcerated populations, it is likely that they also play a major role in treatment non- adherence in released offenders. Because the majority of offenders are incarcerated for less than 3 years, identifying and understanding the extent to which psychiatric disease decreases the likelihood of establishing and maintaining effective HIV outpatient care following release from prison is an important public health issue.

描述（由申请人提供）：美国监狱系统已成为控制艾滋病毒的重要方面。过去20年中，与药物相关的量刑增加导致艾滋病毒和与HIV相关危险因素的罪犯的浓度显着增加。美国惩教系统是数百万患者或高风险的人的主要筛查和治疗场所，这些患者不受传统的基于社区的医疗保健系统的影响力。在被监禁时，许多罪犯首次接受了艾滋病毒测试，而在监禁期间，患有艾滋病毒感染的四分之三会引发治疗。大多数被监禁的艾滋病毒感染者对抗逆转录病毒疗法的反应很好，并表现出对被监禁期间复杂的抗逆转录病毒药物方案的高水平。但是，许多前罪犯在监狱释放后停止了他们的待遇。这些人有增加耐药性疾病并恢复高风险行为的风险，潜在地感染他人并在普通社区创造耐药的艾滋病毒储量。精神疾病可能是艾滋病毒感染者未能在监狱释放后无法建立和维持临床护理的重大障碍。因为绝大多数罪犯被监禁了不到3年，因此确定并理解精神病的程度是建立和维持有效的HIV门诊门诊计划的障碍，这具有深远的公共健康相关性。迄今为止，尚无有关此至关重要的问题的公开信息。我们提出了一项历史人群研究，以评估患有精神障碍的程度，从而降低了新释放的HIV感染的德克萨斯州刑事司法部（TDCJ）罪犯之间建立和维持门诊护理的可能性。我们的研究队列将由2004年1月1日至2006年12月31日在TDCJ中释放的大约1,200名HIV感染的罪犯组成，并被转介到德克萨斯州哈里斯县的HIV门诊护理。这项研究将依靠3个来源的电子临床，药房和人口统计数据：1）TDCJ电子病历系统，2）哈里斯县集中的患者护理数据管理系统（CPCDMS）和3）德克萨斯州卫生部（ TDH）德克萨斯州HIV药物计划（THMP）数据库。具体而言，我们将研究患有精神疾病的前罪犯是否与没有精神病的前罪犯相比，是否有以下结果的风险增加：1）启动门诊临床护理的率较差； 2）总体临床结局较差（CD4计数，病毒负荷，艾滋病指示疾病）； 3）在门诊护理中保留较差； 4）更高的累犯率。最近的报告表明，艾滋病毒感染的监狱囚犯遵守抗逆转录病毒疗法，并在监禁期间有阳性的治疗结果，但是在释放进入一般社区后，这些影响并没有持续，表明很大一部分罪犯在监狱中释放了艾滋病毒治疗。鉴于精神疾病构成了非监禁人群中艾滋病毒治疗依从性的重大障碍，因此它们在释放罪犯的治疗非依从性中也可能发挥重要作用。由于大多数罪犯被监禁了不到3年，因此确定和理解精神病降低了从监狱释放后建立和维持有效的HIV门诊医疗的可能性的程度是一个重要的公共卫生问题。