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

针对出狱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: 9540937
• 负责人: MARVIN E BELZER
• 金额: $ 71.99万
• 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/9540937
• 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; Comorbidity; 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; contingency management; control trial; cost; 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.

项目摘要/摘要 艾滋病毒护理的连续性迫使新的重点是识别和有效服务于高需求的紧迫性， 资源不足，通常是短暂的人群，以促进他们接受必要的持续护理和 抗逆转录病毒疗法（ART）抑制HIV RNA病毒载量（VL）。改善护理的关键目标群体 沿着连续体是年轻的（16-25岁），性别和性别少数（SGM）人口被释放 从监狱设置。艾滋病毒（YLWH）的继承青年中的艾滋病毒患病率是 普通人群和所有艾滋病毒+人中的七分之一每年都会经历进化。艾滋病毒事件， 黑人和拉丁美洲人的患病率和事件率高于任何其他群体 - 这些 在青年中，差异尤为明显。此外，实际上只有6％的艾滋病毒+青年是 由于保留不力和对艺术的依从性而受到压制。现有的联系和保留服务是 不足以满足涉及刑事司法的急性需求（CJI）艾滋病毒+青年，尤其是在高需求的 从进化中释放后的时期。而且，由于缺乏经验，许多年轻人可能 努力获得所需的服务并稳定其生活条件。艾滋病毒的差异继续结果 与监禁，药物使用障碍（SUD），无家可归和心理健康无关紧要 （MH）YLWH中的问题。如果要控制艾滋病毒，并且艺术的好处很广泛，那么 CJI YLWH的问题必须以创新，青年和性别和性别少数群体（SGM）来解决 - 敏感方法。我们建议注册240 CJI YLWH，年龄16-25岁，在洛杉矶被监禁 芝加哥监狱和少年拘留所。我们将将参与者随机进行YSN干预（n = 120） 与通常的护理对照组（n = 120）。青年服务导航员（YSNS）将协助解决 立即未满足的需求，例如临床护理和持续的住房，运输和食物；将指导 干预参与者参加一系列社区服务，以支持艾滋病毒连续性的进步 关心;并将提供直接的艺术依从性支持。拟议的研究有两个主要的特定目的：1。 调整现有的同行导航干预措施，以创建青年服务导航（YSN） 对SGM文化敏感的干预措施，指导青年在艾滋病毒护理的连续性中需要服务。 这种干预措施将医疗，药物使用和心理保健与全面的重新进入相​​结合 支持CJI YLWH，从大型县监狱和少年拘留系统释放后16-25岁； 2。 使用两组RCT设计，我们将测试新的YSN，青年对SGM敏感的有效性 与对照组相比，CJI YLWH年龄在16-25岁之间的干预提供了对服务的标准推荐。我们将 评估YSN干预对审查后连接，保留，依从性和病毒的影响 抑制以及泡沫，心理健康，服务利用和满足需求。次要目的：我们 将评估YSN对累犯，成本和潜在的成本偏变/有效性的影响。