Incarcerated populations are disproportionately burdened by higher rates of HIV infection compared to those in the community and are often provided with medical care during their incarceration. Interruptions in care are common following release from incarceration and may lead to worse clinical outcomes and increases in high risk behaviors for HIV transmission. Support of linkage to care is a critical component of developing programs to seek and treat persons with HIV involved in corrections. This innovative proposal seeks to improve linkage to HIV care after release from incarceration through the following Specific Aims: 1. To design and implement a monitoring strategy for evaluating follow-up HIV medical care in the community after release from incarceration. 2. To test the clinical and epidemiological utility of the monitoring strategy in 2a) distinguishing areas with high success in linkage to care from those with low success, 2b) identifying correlates of earlier and later enrollment in care post release from incarceration, and 2c) assessing whether existing policies and programs promote greater linkage to care and better HIV clinical outcomes. 3. To qualitatively explore and investigate the individual, community, institutional and political factors influencing linkage to HIV medical care during the pre- and post-release periods. To accomplish these Aims, this innovative interdisciplinary multi-site project will first develop and validate an indicator of the adequacy of linkage to care for HIV infected persons undergoing reentry by linking the new Ryan White HIV/AIDS Program client level dataset to corrections release data. This linkage process will then be applied across multiple states, correctional jurisdictions, and care environments to assess HIV treatment-relevant linkage outcomes. Locations with the highest and lowest linkage will provide an opportunity to evaluate best practices and correlates of linkage success. We will use quantitative methods and in-depth qualitative interviews with patients, providers, criminal justice staff, and policy makers, to gain a better understanding of the elements influencing an inmate's linkage to HIV care throughout reentry. This comprehensive approach will permit differentiation of the structural, community, and individual level factors affecting linkage to HIV care and will help target improvements and future interventions. The availability of client level data through Ryan White reporting represents an unprecedented opportunity to better understand this pressing public health problem. This research will inform the development of metrics for ongoing quality initiatives to track the quality of care for people with HIV on reentry and will provide critically important data to support improved systems of linkage of care throughout the nation.
This innovative proposal will address the significant challenge of improving linkage to HIV care in the community after release from incarceration. It will capitalize on detailed client level clinical data derived from reporting required for all Ryan White HIV/AIDS program grantees, which will be linked to correctional databases to create an easily replicable monitoring strategy. The accompanying quantitative and qualitative evaluations will enhance understanding of the correlates of enhanced linkage and will help to ultimately inform the design of best practice models for the support of linkages to care following release from corrections.
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