Many people are first diagnosed with HIV or begin HIV medical care when they enter a correctional facility. Moreover, most patients treated with antiretroviral medications in prison are released back into the community. History of incarceration has been linked to greater risk of antiretroviral adherence problems in community studies. Lapses in adherence to antiretroviral regimens can quickly lead to the development of drug-resistant viral strains, thereby increasing the likelihood of a poor treatment response and raising the possibility of drug-resistant HIV strains being transmitted to others. Enhancing treatment adherence among HIV+ persons released from prison therefore carries important health and public health benefits. This application requests three years of support to conduct developmental research to design and pilot test a nurse-delivered telephone intervention to improve antiretroviral adherence among incarcerated HIV+ persons during the transitional period from prison to community re-entry. We are proposing a sequence of intervention development activities that will include: (1) adapting telephone intervention manuals from an ongoing RCT conducted in a prison setting to include more targeted post-prison release content, (2) developing and refining study protocols for tracking and retaining study participants as they re-enter the community, (3) refining assessment measures, (4) conducting a randomized pilot test of a motivational and cognitive-behavioral skills based adherence intervention during the transitional period prior to and after release from prison, and (5) evaluating the feasibility and acceptability of delivering telephone intervention sessions that bridge state prison and community settings. The intervention developed in the proposed pilot study will build on our formative work with HIV-positive men and women in prison and community settings. Guided by motivational interviewing and cognitive-behavioral approaches to behavior change, the proposed community transition intervention will provide telephone support to promote medication adherence and use of community HIV care services among patients leaving prison. The proposed project constitutes the next phase of study necessary to address the important public health issue of sustaining treatment adherence in persons who re-enter the community after receiving HIV care in correctional facilities. ? ? ?
