Incarceration represents an important opportunity to provide testing and treatment for HIV and other infectious diseases and to deliver prevention education to persons at increased risk of infection or transmission. Incarcerated populations are disproportionately affected by HIV and viral hepatitis, and many inmates may be marginalized from healthcare resources in their communities. Given the short length of jail incarceration, screening and intervention delivery need to be conducted efficiently and cost-effectively. This research will adapt and evaluate information and communication technology-(ICT) based tools used for HIV testing and for improving adherence to HIV treatment, adding rapid hepatitis C virus (HCV) testing and prevention to the delivery of HIV services for jailed populations. These tools will facilitate: 1) HIV and HCV risk assessment, testing, and prevention counseling;2) linkage to community-based care for HIV-infected jail detainees;and 3) viral suppression for jail detainees on antiretrovirals being released to the community. Specifically, this project will adapt CARE (Computer Assessment and Risk-Reduction Education), an HIV prevention counseling and rapid HIV testing developed for use in clinical and community settings, and CARE+, a version of CARE for HIV-infected persons, for use among jailed populations. The new tools, CARE Corrections and CARE+ Corrections, will have content relevant and specific to incarcerated populations including HCV infection, substance use behaviors, and maintenance of HIV treatment with linkage to community care following jail release. This also will include new functionality that will allow for automated text messaging to support linkage to community HIV (CARE+ Corrections 'Call'system). In a two-site randomized controlled trial conducted within the Rhode Island Department of Corrections jail and the Washington DC jail system, we will evaluate: 1) whether CARE Corrections delivered counseling is more effective than staff delivered counseling in decreasing HIV and HCV transmission behaviors among n=840 HIV-negative persons released from jail;2) whether CARE+ Corrections Call is more effective than standard jail discharge planning services with respect to linking n=320 HIV-infected jail detainees to community based HIV care and achieving or maintaining HIV viral suppression following community re-entry;and 3) the cost-effectiveness of using CARE and CARE + Corrections Call within jail facilities compared to traditional services. This innovative approach will expand testing, prevention, and treatment in jails and address the essential components of the Seek, Test, and Treat strategy. In addition, this research will complement a major initiative underway in Washington DC (HPTN 065 Testing and Linkage to Care-Plus) by focusing on the jail system. This project has the potential to result in the creation of effective ICT tools that can be easily disseminated to a broad array of correctional facilities in order to facilitate the implementation of the Seek, Test, and Treat strategy in the incarcerated setting.
This research will adapt and evaluate technology-based tools to facilitate rapid HIV and hepatitis C testing, primary and secondary prevention counseling, and adherence to HIV treatment for jailed populations in Providence RI and Washington DC. This innovative research will use computerized counseling and tailored text messaging to expand testing, prevention, and treatment in both low- and high-HIV prevalence jail settings, addressing essential components of the Seek, Test, and Treat strategy among criminal justice populations. This research has the potential to result in the creation of effective technology-based tools that can be readily disseminated to a broad array of correctional facilities across the U.S in order to facilitate efficient identification, treatment, and linkage to care for HIV-infected persons.
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