The University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC 27599, USA.
AIDS Behav. 2011 Feb;15(2):356-64. doi: 10.1007/s10461-010-9843-4.
Imprisonment provides opportunities for the diagnosis and successful treatment of HIV, however, the benefits of antiretroviral therapy are frequently lost following release due to suboptimal access and utilization of health care and services. In response, some have advocated for development of intensive case-management interventions spanning incarceration and release to support treatment adherence and community re-entry for HIV-infected releasees. We conducted a randomized controlled trial of a motivational Strengths Model bridging case management intervention (BCM) beginning approximately 3 months prior to and continuing 6 months after release versus a standard of care prison-administered discharge planning program (SOC) for HIV-infected state prison inmates. The primary outcome variable was self-reported access to post-release medical care. Of the 104 inmates enrolled, 89 had at least 1 post-release study visit. Of these, 65.1% of BCM and 54.4% of SOC assigned participants attended a routine medical appointment within 4 weeks of release (P > 0.3). By week 12 post-release, 88.4% of the BCM arm and 78.3% of the SOC arm had at attended at least one medical appointment (P = 0.2), increasing in both arms at week 24-90.7% with BCM and 89.1% with SOC (P > 0.5). No participant without a routine medical visit by week 24 attended an appointment from weeks 24 to 48. The mean number of clinic visits during the 48 weeks post release was 5.23 (SD = 3.14) for BCM and 4.07 (SD = 3.20) for SOC (P > 0.5). There were no significant differences between arms in social service utilization and re-incarceration rates were also similar. We found that a case management intervention bridging incarceration and release was no more effective than a less intensive pre-release discharge planning program in supporting health and social service utilization for HIV-infected individuals released from prison.
监禁为 HIV 的诊断和成功治疗提供了机会，然而，由于获得和利用医疗保健和服务的机会不理想，许多人在释放后经常失去抗逆转录病毒治疗的效果。因此，一些人主张制定强化病例管理干预措施，跨越监禁和释放阶段，以支持感染 HIV 的释放者坚持治疗并重新融入社区。我们对一种动机力量模型衔接病例管理干预措施（BCM）进行了一项随机对照试验，该干预措施大约在释放前 3 个月开始，并持续到释放后 6 个月，与感染 HIV 的州监狱囚犯接受的标准监狱管理出院计划（SOC）进行比较。主要结局变量是自我报告的获得释放后的医疗保健机会。在纳入的 104 名囚犯中，有 89 名至少进行了 1 次释放后研究访视。在这些参与者中，BCM 组有 65.1%，SOC 组有 54.4%在释放后 4 周内预约了常规医疗预约（P>0.3）。在释放后第 12 周，BCM 组有 88.4%的参与者和 SOC 组有 78.3%的参与者至少预约了一次医疗预约（P=0.2），在第 24 周到 48 周期间，两组的预约率都有所增加，BCM 组为 90.7%，SOC 组为 89.1%（P>0.5）。在第 24 周没有进行常规医疗访问的任何参与者都没有在第 24 周到 48 周期间预约。在释放后 48 周内，BCM 组的平均就诊次数为 5.23（SD=3.14），SOC 组为 4.07（SD=3.20）（P>0.5）。两组在社会服务利用方面没有显著差异，再入狱率也相似。我们发现，衔接监禁和释放阶段的病例管理干预措施在支持感染 HIV 的人释放后的健康和社会服务利用方面并不比强度较低的释放前出院计划更有效。
