Assessing the HIV care cascade in a large southern prison system

评估南部大型监狱系统的艾滋病毒护理级联

• 批准号: 8847066
• 负责人: DAVID L ROSEN
• 金额: $ 38万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-18 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8847066
• 关键词: Address; Area; Caring; Characteristics; Clinical; Communities; Continuity of Patient Care; Criminal Justice; Detection; Diagnosis; Epidemic; Failure; Focus Groups; Future; General Population; Goals; HIV; HIV Seropositivity; Health; Healthcare; Human immunodeficiency virus test; Imprisonment; Individual; Infection; Intervention; Interview; Jail; Link; Literature; Measures; Metric; Modeling; North Carolina; Outcome; Patients; Pattern; Patterns of Care; Perception; Population; Populations at Risk; Prevalence; Prisoner; Prisons; Process; Provider; Qualitative Methods; Research; Risk; Staging; Statistical Models; Structure; System; Testing; Time; United States National Institutes of Health; Viral; Work; base; community setting; design; improved; insight; metropolitan; public health relevance; routine care; therapy design; transmission process

 DESCRIPTION (provided by applicant): The overlap in the dual epidemics of HIV and imprisonment in the U.S. is well-documented with a prevalence of HIV among prison populations more than three times that of the general population. Prisons are widely recognized as an important setting to address the HIV epidemic: testing and treating HIV-infected prisoners and linking those prisoners into community-based HIV care upon their release may both improve their health and reduce their risk of transmission in communities to which prisoners return. This strategy is commonly referred to as Seek, Test, Treat, and Retain (STTR). There are several NIH-sponsored ongoing and completed studies to evaluate components of the STTR strategy for criminal justice populations. Most focus on ways to increase HIV testing among inmates or improve continuity of HIV care from prisons and jails to the community. However, little research has addressed factors influencing entry into and retention in HIV care during imprisonment. This gap in the literature is significant considering that as many as 63% of known HIV-positive (HIV+) prisoners have not attained viral suppression at their time of release. Failure to attain routine HIV care in prison may portend a high likelihood of failure to enter into community HIV care at release, resulting in poor health and a heightened risk of transmission. Recently, a cascade of HIV care has been used to conceptualize HIV care across a continuum that starts with detection of infection and ends in suppression of viral replication. The strength f this popular model is that it provides a snap shot of gaps across progressive stages of HIV care; a limitation is that the cascade does not convey patients longitudinal patterns of care. This cascade has been enumerated to provide community estimates of engagement in care, but the HIV care cascade has not been applied to correctional settings, where opportunities and barriers to detect and treat HIV may be distinct from those in the community. We propose to examine the HIV care cascade and identify barriers and facilitators to entering and maintaining care and achieving viral suppression in a large southern prison system. In the process, we will evaluate the utility of the cascade outcomes in a prison setting. Specifically we plan to estimate the proportion of prisoners across each stage of the prison HIV care cascade. We will then evaluate whether the cross- sectional Cascade metrics provide a reasonable surrogate for longitudinal patterns of care, and we will identify individual- and system-level factors associated with failing to link into and retain prison HIV care. Finally, we will conduct interviews to understand barriers and facilitators to care from the perspectives of HIV+ prisoners and prison HIV care providers. These proposed activities are key steps in designing and evaluating interventions to strengthen the implementation of the STTR model, with the ultimate goal of improving the health of HIV+ prisoners and diminishing their risk of transmission in prison and in the communities to which they return.

 描述（由适用提供）：在美国的双重艾滋病毒和监禁中的重叠，有充分的记录，艾滋病毒的患病率是一般人群的三倍以上。监狱被广泛认为是解决艾滋病毒流行病的重要环境：对感染艾滋病毒的囚犯进行测试和治疗，并将这些囚犯释放后将这些囚犯联系到基于社区的艾滋病毒护理中，这既可以改善他们的健康，又可以降低他们在囚犯返回的社区中传播的风险。该策略通常称为寻求，测试，治疗和保留（STTR）。有几项NIH赞助的正在进行的研究和完成的研究，以评估刑事司法人口的STTR战略的组成部分。大多数专注于增加囚犯中艾滋病毒测试或改善从监狱和监狱到社区的艾滋病毒的连续性的方法。但是，很少的研究涉及因素影响在监禁期间进入和保留艾滋病毒护理中的因素。考虑到多达63％的已知艾滋病毒阳性（HIV+）囚犯在释放时尚未获得病毒抑制。未能在监狱中获得常规的艾滋病毒护理可能预示着很可能未能进入的可能性 释放时社区艾滋病毒护理，导致健康状况不佳和传播风险增加。最近，一系列的艾滋病毒护理已被用来概念化艾滋病毒护理，从而从感染的检测开始，并抑制病毒复制。这种流行的模型的实力是，它在艾滋病毒护理的渐进阶段提供了差距的快照。一个限制是，级联不能传达患者纵向护理模式。该级联已经列举了社区估算有关护理参与的估计，但是艾滋病毒护理级联的级联尚未应用于纠正措施，在这种情况下，发现和治疗艾滋病毒的机会和障碍可能与社区中的人不同。我们建议检查艾滋病毒护理级联，并确定障碍和促进者在大型南部监狱系统中进入，维持护理并实现病毒抑制。在此过程中，我们将评估级联成果在监狱环境中的效用。具体而言，我们计划估计监狱艾滋病毒护理级联每个阶段囚犯的比例。然后，我们将评估横截面级联指标是否为纵向护理模式提供合理的替代物，我们将确定与个人和系统级别相关的因素 由于无法链接并保留监狱艾滋病毒护理。最后，我们将进行采访以了解障碍和促进者，从艾滋病毒+囚犯和监狱艾滋病毒护理提供者的角度进行护理。这些提议的活动是设计和评估干预措施以加强STTR模型实施的关键步骤，其最终目标是改善艾滋病毒+囚犯的健康状况，并减少他们在监狱和返回社区中传播的风险。