Youth Services Navigation Intervention for HIV+ adolescents and young adults being released from incarceration: A randomized control trial

针对从监狱释放的艾滋病毒青少年和年轻人的青年服务导航干预：一项随机对照试验

• 批准号: 9890791
• 负责人: MARVIN E BELZER
• 金额: $ 68.71万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-08 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9890791
• 关键词: Acute; Address; Adherence; Adolescent; Adolescent and Young Adult; Adult; Alcohol or Other Drugs use; Bisexual; Caring; Cellular Phone; Chicago; Community Health Services; Community Services; Continuity of Patient Care; County; Criminal Justice; Effectiveness; Enrollment; Ensure; Food; Gays; General Population; HIV; HIV diagnosis; Healthcare; Homelessness; Housing; Imprisonment; Incentives; Incidence; Intervention; Jail; Latino; Link; Los Angeles; Medical; Mental Health; Mental Health Services; Outcome; Participant; Patient Self-Report; Persons; Population; Prevalence; Probability; Problem Solving; Provider; Randomized; Randomized Controlled Trials; Reporting; Resources; Sampling; Services; Sexual and Gender Minorities; Shelter facility; Substance Use Disorder; System; Testing; Time; Training; Transportation; Viral; Viral Load result; Work; Youth; aged; antiretroviral therapy; clinical care; community reentry; comorbidity; comparison intervention; contingency management; control trial; cost; effectiveness testing; evidence base; experience; health service use; high risk; improved; innovation; intervention effect; intervention participants; men; men who have sex with men; navigator intervention; peer; public health relevance; recidivism; response; successful intervention; therapy adherence; transgender women; trial design; usual care arm; viral RNA; young men who have sex with men

Project Summary/Abstract The continuum of HIV care has forced new focus on the urgency to identify and effectively serve high-need, under-resourced, and often transient populations to facilitate their receiving the necessary ongoing care and antiretroviral therapy (ART) to suppress HIV RNA viral load (VL). Crucial target groups for improving care along the continuum are young (aged 16-25), sexual and gender minority (SGM) populations being released from jail settings. HIV prevalence among incarcerated youth living with HIV (YLWH) is three times that of the general population and one in seven of all HIV+ persons experience incarceration each year. HIV incidence, prevalence, and incarceration rates are higher for blacks and Latinos than for any other group – these disparities are especially prominent among youth. Furthermore, only an estimated 6% of HIV+ youth are virally suppressed, due to poor retention and adherence to ART. Existing linkage and retention services are insufficient to meet the acute needs of criminal justice-involved (CJI) HIV+ youth, particularly in the high-need period following release from incarceration. Moreover, because of their lack of experience, many youths may struggle to obtain needed services and stabilize their living conditions. Disparities in HIV continuum outcomes are inextricably linked to incarceration, substance use disorders (SUDs), homelessness, and mental health (MH) problems among YLWH. If HIV is to be controlled and the benefits of ART experienced broadly, the problems of CJI YLWH must be addressed with innovative, youth-, and sexual and gender minority (SGM)- sensitive approaches. We propose to enroll 240 CJI YLWH, aged 16-25, incarcerated in Los Angeles and Chicago jails and juvenile detention facilities. We will randomize participants to the YSN intervention (n=120) vs. a usual-care control group (n=120). The youth services navigators (YSNs) will assist with addressing immediate unmet needs such as housing, transportation, and food prior to clinical care and ongoing; will guide intervention participants to a range of community services to support progress along the continuum of HIV care; and will provide direct ART adherence support. The proposed study has two Primary Specific Aims: 1. Adapt an existing peer navigation intervention for adults to create a Youth Service Navigation (YSN) intervention sensitive to SGM culture that guides youth to needed services along the continuum of HIV care. This intervention combines medical, substance use and mental health care with comprehensive reentry support for CJI YLWH, aged 16-25 upon release from large county jails and juvenile detention systems; 2. Using a two-group RCT design, we will test the effectiveness of the new YSN, youth SGM-sensitive intervention among CJI YLWH aged 16-25, compared to controls offered standard referrals to services. We will evaluate the YSN Intervention's effect on post-incarceration linkage, retention, adherence, and viral suppression, as well as on SUDs, mental health, services utilization, and met needs. Secondary Aims: We will assess YSN's effects on recidivism, costs and potential cost-offset/effectiveness.

项目概要/摘要 艾滋病毒护理的连续性迫使我们重新关注确定和有效服务高需求人群的紧迫性， 资源不足且往往是流动人口，以帮助他们获得必要的持续护理和 抑制 HIV RNA 病毒载量 (VL) 的抗逆转录病毒治疗 (ART) 是改善护理的关键目标群体。 沿着连续体的是年轻人（16-25岁）、性少数群体（SGM）被释放 监狱环境中被监禁的艾滋病毒携带者 (YLWH) 的感染率是普通青少年的三倍。 每年，普通民众和七分之一的艾滋病毒感染者都经历过监禁。 黑人和拉丁裔的患病率和监禁率高于任何其他群体——这些 此外，估计只有 6% 的艾滋病病毒感染者感染艾滋病病毒。 由于现有的链接和保留服务的保留和遵守情况不佳，因此受到抑制。 不足以满足涉及刑事司法 (CJI) 的艾滋病毒阳性青年的迫切需求，特别是在高需求群体中 此外，由于缺乏经验，许多青少年可能会在刑满释放后的一段时间内。 努力获得所需的服务并稳定其生活条件的艾滋病毒连续结果的差异。 与监禁、药物滥用障碍 (SUD)、无家可归和心理健康有着千丝万缕的联系 (MH) YLWH 中的问题。如果要控制艾滋病毒并广泛体验 ART 的益处， CJI YLWH 的问题必须通过创新、青年、性和性别少数 (SGM) 来解决 - 我们建议招募 240 名 CJI YLWH，年龄 16-25 岁，被监禁在洛杉矶和 我们将随机分配 YSN 干预的参与者 (n=120) 芝加哥监狱和少年拘留所。 与常规护理对照组 (n=120) 相比，青少年服务导航员 (YSN) 将协助解决问题。 临床护理之前和持续期间未满足的直接需求（例如住房、交通和食物）将指导； 干预参与者参与一系列社区服务，以支持艾滋病毒的持续进展 护理；并将提供直接的 ART 依从性支持。拟议的研究有两个主要具体目标： 1. 调整现有的成年人同伴导航干预措施，创建青少年服务导航 (YSN) 对 SGM 文化敏感的干预措施，引导青少年在艾滋病毒护理的整个过程中获得所需的服务。 该干预措施将医疗、药物滥用和心理保健与全面重返社会结合起来 为 CJI YLWH 提供支持，年龄为 16-25 岁，从大型县监狱和少年拘留系统释放后； 采用两组RCT设计，我们将测试新的YSN、青少年SGM敏感的有效性 与提供标准转诊服务的对照相比，我们将在 16-25 岁的 CJI YLWH 中进行干预。 评估 YSN 干预对监禁后联系、保留、依从性和病毒传播的影响 抑制，以及 SUD、心理健康、服务利用和满足需求。 将评估 YSN 对累犯、成本和潜在成本抵消/有效性的影响。