HIV
Conditions
Keywords
HIV, detention, substance abuse
Brief summary
Each year, there are over 600 unduplicated HIV-infected persons incarcerated in the San Francisco jail. Two thirds of those released with HIV-focused discharge planning are reincarcerated within one year. More than half of HIV-infected jail inmates are diagnosed with mental health conditions severe enough to require medication and a similar proportion report substance use disorders at the time of detention. While some community-based services exist, there remains a critical need to improve linkages to care and adherence to care plans for HIV-infected adults as they move between community and jail. The Navigator Project is a five-year randomized study that will test the effectiveness of an intensive enhanced case management intervention to reduce sex and drug-related HIV transmission risk; increase HIV medication adherence; reduce drug dependence; and reduce reincarceration.
Interventions
BEHAVIORALNavigator enhanced case-management
Patient navigators are non-clinical, paraprofessional peers who are HIV-infected and have lifetime histories of detention and substance abuse. Working with the patient, they facilitate adherence to a comprehensive care plan designed to address clients' multiple risks and needs. Patients have access to Navigator services for one year after study enrollment.
BEHAVIORALForensic AIDS Project
The Forensics AIDS Project provides primary care to HIV-infected detainees, as well as up to 90 post-release case-management services which include discharge planning.
Sponsors
San Francisco Jail Health Services - HIV and Integrated Services
San Francisco Pretrial Diversion Project
University of California, San Francisco
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Detention in the San Francisco jail system * Confirmed HIV infection * Lifetime history of ever having met standardized criteria for drug or alcohol addiction * Likely release back into San Francisco without transfer to another facility * Agreement to work with Forensic AIDS Project to plan post-release care * Able and willing to provide informed consent * Not scheduled for release within 36 hours
Exclusion criteria
* Undocumented HIV status * Inability to speak English or Spanish * Unable or unwilling to provide informed consent * Not under routine level of jail security
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| substance use | 2 months, 6 months, 12 months | change from baseline in self-reported drug and alcohol use, measured by a survey tool, and actual use of five drugs (methamphetamine, cocaine, tetrahydrocannabinol, opiates, and benzodiazepines), measured by a urine screen, at three time points each |
| recidivism | 12 months | number of times re-detained during the twelve-month study period, collected from jail records |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| sexual risk behavior | 2 months, 6 months, 12 months | change from baseline in self-reported sexual risk behaviors, measured by a survey tool at three time points after the initial detention |
| adherence to HIV medications | 2 months, 6 months, 12 months | change from baseline in self-reported adherence (as a %) to antiretroviral therapy, measured by a survey tool at three time points after the initial detention |
Other
| Measure | Time frame | Description |
|---|---|---|
| medical coverage | 2 months, 6 months,12 months | change from baseline in self-reported insurance coverage, measured by a survey tool at three time points after the initial detention, and use of community health services and jail health services, measured continuously via a community database for 12 months after the initial detention |
| needle use | 2 months, 6 months, 12 months | change from baseline in self-reported needle-use and needle-sharing, measured by a survey tool at three time points after the initial detention |
| housing | 2 months, 6 months, 12 months | change from baseline in self-reported housing status, measured by a survey tool at three time points after the initial detention |
Countries
United States
Outcome results
None listed