The proposed study has two research objectives: (1) to expand access and options for HIV testing with individuals in the criminal justice system, by focusing on high-risk, drug-using probationers and parolees in community settings; and (2) to improve access and maintenance of highly active antiretroviral treatment (HAART) among HIV-positive persons in this population, by implementing a promising intervention focused on continuity of HIV care, and evaluating it using a rigorous experimental design. This proposal is responsive to RFA-DA-10-017, Seek, Test and Treat: Addressing HIV in the Criminal Justice System, in its innovative and comprehensive application of the seek, test and treat paradigm. By focusing on community-based testing and treatment support for drug-using probationers and parolees, we intend to address the specific needs of a portion of the criminal-justice-involved population that is hard to reach through more traditional systems-based methods. The proposed study will be based in Oakland, California, a community with a large number of probationers and parolees, over 70% of whom are African American or Latino.
The Specific Aims are:
Aim 1 : To design and implement a targeted, community-based strategy to identify, recruit, and provide rapid HIV testing and counseling to 2,250 crack cocaine and injection drug users on probation or parole;
and Aim 2 : To conduct a randomized controlled trial (RCT) of HIV-positive participants to assess the efficacy of Project Bridge compared with a usual care arm.
In Aim 1, modified targeted sampling techniques will be used to seek eligible individuals from community settings, focusing on the neighborhoods of Oakland with the highest density of probationers and parolees. We will provide rapid HIV testing and counseling at easily accessible community locales. Outcomes of interest will be the proportion of eligible individuals who are identified and recruited, accept HIV testing, have not been HIV tested in the previous 6 months, and report recent HIV risk behavior. We will also assess factors associated with these outcomes, the analyses of which will be guided by the Behavioral Model for Vulnerable Populations.
In Aim 2, HIV-positive participants not in HIV care (n=202) will be enrolled in the RCT and followed quarterly for 24 months. The intervention (Project Bridge) is designed to engage and maintain HIV-positive ex-offenders in medical care, and has shown great promise, but has not yet been rigorously evaluated. It will be delivered at a community public health clinic. We will compare viral load, HIV care, and HAART among intervention participants, compared to a group that gets standard referral to HIV care. The proposed study will contribute innovative methods for reaching high- risk probationers and parolees for HIV testing, consistent with priorities identified by the National Institutes of Health. In addition, it will contribute to the development of evidence-based interventions to promote uninterrupted, therapeutically effective HIV care among criminal-justice-involved populations.
In response to RFA-DA-10-017 (Seek, Test, and Treat: Addressing HIV in the Criminal Justice System), we propose to develop and implement innovative community-based strategies to find and recruit high-risk drug users on probation or parole, screen them for HIV, and link those who are HIV-positive to treatment. Should the proposed study be successful, it will (1) identify an innovative way of reaching large numbers of high-risk probationers and parolees for HIV testing, and (2) provide an evidence-based evaluation of a promising model to ensure continuity of HIV care and HIV treatment as probationers and parolees move between community and correctional settings.
