Montefiore Medical Center
One out of six people with HIV (PWH) in the U.S. are incarcerated annually; two-thirds of individuals who are incarcerated meet criteria for substance use disorder (SUD) and many more in carceral settings have risk factors for HIV. Ending the U.S. HIV epidemic hinges on linking and engaging people with criminal legal system involvement (PCLSI) with HIV or related risk factors, especially those with SUDs, to optimize antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) uptake and adherence. In this study, the investigator team will pursue Aim 1 (R33): Test the DEST2nation model in a multisite randomized control trial; and Aim 2 (R33): Estimate the cost of implementing and sustaining a decentralized, status neutral model and estimate its economic value from healthcare sector, state-policymaker, and societal perspectives.
The goal of this proposal is to test the DEST2nation model (an effective, person-centered, low-barrier, comprehensive model of post-incarceration medical care) with people with criminal legal system involvement (PCLSI) living with HIV or related risk factors. Peer navigation interventions, while an evidence-based strategy for HIV care engagement post-incarceration, have only been moderately effective. Additionally, strengths-based case management and motivational enhancement counseling plus text message adherence reminders also did not improve viral suppression over standard care. A common lim…
Inclusion Criteria: * Fortune or FIGHT client * Greater than or equal to 18 years old at time of informed consent * Living with HIV, or HIV-negative with risk factors for HIV and/or requests for PrEP * Current or history of substance use disorder * Fluent in English or Spanish * Resident of New York City (NYC) or Philadelphia County * Released from jail or prison system within the past 12 months Exclusion Criteria: * Unable to provide informed consent * Unable to complete study visits over 12 months * Does not plan to live in NYC or Philadelphia County for the next 12 months * Current suici…
A decentralized, status-neutral post-incarceration model delivered entirely through community-based organizations that serve people with criminal legal system involvement, so that people living with HIV and HIV-negative people with risk factors receive the same model. CHAs are certified through the New York State Peer Worker Certification Program and trained in HIV and substance use education, harm reduction, PrEP, and point-of-care HIV testing. CHAs, CBO project managers, and the research team hold regular case huddles to coordinate care. The model was co-developed with a community advisory board and piloted and refined before this trial.
Referral to community care delivered by a study project manager rather than a CHA. The clinic is chosen for convenience and participant preference, and the project manager does not offer navigation, accompaniment, or HIV testing.