START Together: HIV Testing and Treatment in and after Jail

National Development And Research Institutes, Inc., New York NY

Investigators

Linked publications & trials

Abstract

DESCRIPTION (provided by applicant): This study views the criminal justice system as a strategic target for combating the HIV epidemic in the US. Proportionately few jail inmates consent to (and receive) a test for HIV, and inmates who are HIV+, once released, tend not to adhere to Highly Active Anti-Retroviral Therapy (HAART) as prescribed. This project will deliver and test "START Together," a comprehensive intervention to reduce both of these problems in one of the country's largest criminal justice complexes, the Rikers Island correctional facilities in New York City. START Together has 3 components: (1) Project START (an HIV reentry program), the only HIV intervention for incarcerated populations that the Centers for Disease Control considers to be effective;(2) Computer Assessment and Risk-Reduction Education, an adherence-promoting intervention, which has shown positive outcomes for HIV viral load suppression;and (3) Peer Health Navigators, who deliver the interventions and link inmates to post-release HIV medical care and other related services, and who have been successful when used in other health areas (e.g., cancer) and, more recently, with HIV+ minority group males. The project contains two associated studies;Study 1, Seek &Test, and Study 2, Treat &Sustain, both including male and female, mainly minority, inmates. The primary aim of Study 1 is to test (employing a randomized design, n=264) the hypothesis that, compared to the control condition, START Together will result in a significantly higher proportion of inmates who receive HIV testing at Rikers Island facilities. Conducted among HIV+ inmates who are recruited from Rikers Island facilities, but occurring primarily after their release, Study 2 has a primary aim to test (employing a randomized design;n=520) the hypothesis that, compared to the control condition, START Together will result in a significantly higher proportion of individuals with an undetectable HIV viral load nine months after their release from Rikers Island facilities. The application is innovative as a refinement, new application and integration of interventions with demonstrated effectiveness for HIV or other medical problems, and in its use of new statistical methods (Instrumental Variable Regression and Complier Average Causal Effect Estimation) to evaluate the impact of intervention "dosage" and compliance on the primary outcomes. If the START Together interventions are successful, the health of numerous individuals will be improved subsequent to their release from one of the nation's largest jails, and the overall transmission threat that HIV poses to public health in the New York City area will be reduced. PUBLIC HEALTH RELEVANCE: The study is significant in testing a comprehensive, multicomponent, psychosocial intervention that addresses the full Seek, Test, Treat model. It has the potential to achieve a dramatic impact on public health, since a large proportion of the city's HIV population enter and leave Rikers Island facilities each year, with far more doing so over a multi-year period. If effective, the project's intervention should generalize to criminal justice systems in other states.