Improving HIV care continuum outcomes among formerly incarcerated individuals through critical time legal interventions

通过关键时刻的法律干预改善前被监禁者的艾滋病毒护理连续结果

• 批准号: 10819889
• 负责人: Steven A Safren
• 金额: $ 23.08万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10819889
• 关键词: Address; Advocate; Affect; Asthma; Behavioral; COVID-19; Caring; Case Management; Case Manager; Clinic; Clinical; Communication; Communities; Community Health; Conflict (Psychology); Consolidated Framework for Implementation Research; Continuity of Patient Care; Data; Development; Diabetes Mellitus; Discrimination; Domestic Violence; Emotional; Employment; Ensure; Epidemic; Evidence based intervention; Fatigue; Florida; HIV; Health; Health Services; Healthcare; Healthcare Systems; Heart Diseases; Hispanic-serving Institution; Homelessness; Housing; Hypertension; Imprisonment; Individual; Intervention; Lead; Legal; Legal Intervention; Manuals; Medical; Mental Health; Neighborhood Health Center; Nonprofit Organizations; Outcome; Pain; Patients; Perceived quality of life; Pharmaceutical Preparations; Protocols documentation; Provider; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Readiness; Recovery; Reporting; Research Personnel; Risk; Risk Factors; Safety; Services; Social Justice; Social Work; Structural Racism; Structure; Testing; Time; Training; Translations; Universities; Viral; Work; Workplace; acceptability and feasibility; barrier to care; care outcomes; clinical care; collaborative environment; court; design; enhancing factor; evidence base; experience; food security; global health; health care delivery; health equity; health inequalities; implementation framework; implementation strategy; improved; improved outcome; innovation; marginalization; medically underserved; medically underserved population; medication compliance; meetings; migration; operation; patient-clinician communication; physical conditioning; pilot test; pilot trial; prevent; primary care provider; programs; protocol development; psychosocial; research study; service providers; social; social stigma; substance use; underserved community

Project Summary. Formerly incarcerated individuals are impacted by health-harming legal needs and risks, including lack of access to HIV care, unsafe housing safety, unstable employment, and other issues that often disrupt HIV care. Providing access to legal services can address barriers to HIV care and improve HIV care continuum outcomes for formerly incarcerated individuals. The proposed study, led by the University of Central Florida (Hispanic Serving Institution), together with the University of Miami, and Hope and Help Inc., aims to pilot test a comprehensive critical-time intervention medical legal partnership (CTI-MLP) approach to optimize timely HIV linkage, retention and viral suppression among formerly incarcerated individuals. MLPs have been used by social justice-oriented medical, health, social, and legal service practices to identify and address health-harming legal needs and risks that create barriers to treatment, care, and recovery for several health conditions. MLPs offer an integrated structural intervention that could improve HIV care continuum and psychosocial outcomes among formerly incarcerated individuals. Our CTI-MLP intervention package consists of: 1) training for all MLP staff (clinical, social and behavioral services, and legal) on HIV continuum of care, health-harming legal needs and risks impacting formerly incarcerated individuals, and MLP structure and operations to ensure that an integrated and collaborative environment is established from the earliest stages of the program; 2) training for case managers and court advocate on the legal continuum of care; 3) embedding of legal expertise within regularized case management team meetings; 4) co-locating legal services in health care agencies through MLP inter-organizational partnership; and 5) tailoring and implementing organizational best-practices in communication and information-sharing protocols among providers within MLP, anchored in patient autonomy and choice. In year 1, we will engage a local community advisory board, scientific advisory board, and legal expert panel to finalize protocols and the Medical Legal Partnership Training Manual. In year 2, we will implement the training and pilot test a CTI-MLP initiative with formerly incarcerated individuals living with HIV (n=100). Over a 6-month period, the team will collect (1) patients' health and functioning, including overall physical health, mental health, social health, pain, fatigue, and overall perceived quality of life; (2) data on legal needs and risk factors; (3) patient HIV care clinical outcomes; and (4) clinic-level indicators, including provider-patient communication and readiness for continued implementation and sustainability. The study will be guided by Reach, Effectiveness, Adoption, Implementation, and Maintenance and Consolidated Framework for Implementation Research frameworks. Active engagement will ensure the effective translation and dissemination of our findings into practice. Completion this project will result in an innovative, evidence-based, community driven structural intervention to improve HIV care continuum outcomes among formerly incarcerated individuals.

项目摘要。曾被监禁的人受到损害健康的法律需求和风险的影响， 包括缺乏艾滋病毒护理、住房安全不安全、就业不稳定以及其他经常出现的问题 扰乱艾滋病毒护理。提供法律服务可以解决艾滋病毒护理的障碍并改善艾滋病毒护理 前被监禁者的连续结果。该研究由中央大学牵头 佛罗里达州（西班牙裔服务机构）与迈阿密大学和希望与帮助公司一起，旨在试点 测试全面的关键时间干预医疗法律合作伙伴关系 (CTI-MLP) 方法，以及时优化 前被监禁者之间的艾滋病毒联系、保留和病毒抑制。 MLP 已被使用 以社会正义为导向的医疗、健康、社会和法律服务实践，以识别和解决危害健康的问题 法律需求和风险对多种健康状况的治疗、护理和康复造成障碍。 MLP 提供综合的结构干预措施，可以改善艾滋病毒护理的连续性和心理社会结果 在以前被监禁的人中。我们的 CTI-MLP 干预方案包括：1) 对所有 MLP 进行培训 工作人员（临床、社会和行为服务以及法律）关于艾滋病毒连续护理、损害健康的法律需求 影响前被监禁个人的风险和风险，以及 MLP 结构和运营，以确保 从项目的最初阶段就建立了集成和协作的环境； 2）培训 案件管理者和法庭辩护人负责法律连续性护理； 3) 融入法律专业知识 定期举行案件管理团队会议； 4) 通过 MLP 在医疗保健机构中提供法律服务 组织间伙伴关系； 5) 定制和实施组织最佳实践 MLP 内提供者之间的通信和信息共享协议以患者自主权为基础 和选择。在第一年，我们将聘请当地社区顾问委员会、科学顾问委员会和法律顾问委员会 专家小组最终确定协议和医疗法律合作培训手册。在第 2 年，我们将实施 该培训和试点测试了 CTI-MLP 计划，对象是曾经被监禁的艾滋病毒感染者 (n=100)。超过 在 6 个月的时间内，该团队将收集 (1) 患者的健康状况和功能，包括整体身体健康状况， 心理健康、社会健康、疼痛、疲劳和整体感知生活质量； (2) 法律需求和风险数据 因素； (3) 患者 HIV 护理临床结果； (4) 诊所层面的指标，包括提供者-患者 沟通并为持续实施和可持续性做好准备。该研究将由 范围、有效性、采用、实施和维护以及综合框架 实施研究框架。积极参与将确保有效的翻译和 将我们的研究结果传播到实践中。该项目的完成将产生一个创新的、基于证据的、 社区驱动的结构性干预，以改善前被监禁者的艾滋病毒护理连续结果 个人。

项目成果

Cognitive Performance, as well as Depression, Alcohol Use, and Gender, predict Anti-Retroviral Therapy Adherence in a South African Cohort of People with HIV and Comorbid Major Depressive Disorder.

认知表现以及抑郁、饮酒和性别可以预测南非艾滋病毒和共病重度抑郁症患者群体的抗逆转录病毒治疗依从性。

• 发表时间: 2023-08
• 影响因子: 4.4
• 作者: Dreyer, Anna J;Nightingale, Sam;Andersen, Lena S;Lee, Jasper S;Gouse, Hetta;Safren, Steven A;O'Cleirigh, Conall;Thomas, Kevin G F;Joska, John
• 通讯作者: Joska, John

Intersecting Relationships of Psychosocial and Structural Syndemic Problems Among People with HIV in South Africa: Using Network Analysis to Identify Influential Problems.

南非艾滋病毒感染者心理社会和结构性症状问题的交叉关系：利用网络分析识别有影响的问题。

• 发表时间: 2023-06
• 影响因子: 4.4
• 作者: Lee, Jasper S;Bainter, Sierra A;Tsai, Alexander C;Andersen, Lena S;Stanton, Amelia M;Magidson, Jessica F;Kagee, Ashraf;Joska, John A;O'Cleirigh, Conall;Safren, Steven A
• 通讯作者: Safren, Steven A

Factors associated with meningitis vaccine awareness and engagement among Latino men who have sex with men in South Florida.

南佛罗里达州男男性行为拉丁裔男性脑膜炎疫苗意识和参与度的相关因素。

• 发表时间: 2024-06
• 影响因子: 3.1
• 作者: Weinstein, Elliott R;Chen, Yumei Olivia;Maya, Daniel;Saber, Rana;Harkness, Audrey
• 通讯作者: Harkness, Audrey