Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA.
J Urban Health. 2010 Dec;87(6):954-68. doi: 10.1007/s11524-010-9496-7.
Approximately 17% of individuals living with HIV/AIDS pass through the correctional system each year. Jails provide a unique opportunity to diagnose and treat HIV infection among high-risk, transient populations with limited access to medical services. In 2007, the US Health Resources and Services Administration funded a multi-site demonstration project entitled Enhancing Linkages to HIV Primary Care in Jail Settings that aims to improve diagnosis and treatment services for HIV-positive jail detainees and link them to community-based medical care and social services upon release. We performed an evaluation of the Rhode Island demonstration site entitled Community Partnerships and Supportive Services for HIV-Infected People Leaving Jail (COMPASS). Through in-depth qualitative interviews among 20 HIV-positive COMPASS participants in Rhode Island, we assessed how COMPASS impacted access to health care and social services utilization. Most individuals were receiving HIV treatment and care services upon enrollment, but COMPASS enhanced linkage to medical care and follow-up visits for HIV and other co-morbidities for most participants. Several participants were successfully linked to new medical services as a result of COMPASS, including one individual newly diagnosed with HIV and another who had been living with HIV for many years and was able to commence highly active antiretroviral therapy (HAART). While many individuals reported that COMPASS support prevented substance abuse relapse, ongoing substance abuse nevertheless remained a challenge for several participants. Most participants enrolled in one or more new social services as a result of COMPASS, including Medicaid, Supplemental Security Income, food assistance, and housing programs. The primary unmet needs of COMPASS participants were access to mental health services and stable housing. Intensive case management of HIV-positive jail detainees enhances access to medical and social support services and helps prevent relapse to substance abuse. Expanding intensive case management programs, public housing, and mental health services for recently released HIV-positive detainees should be public health priorities.
每年约有 17%的艾滋病毒/艾滋病感染者会进入监狱系统。监狱为在医疗服务有限的情况下，对高危、流动人群中的艾滋病毒感染进行诊断和治疗提供了一个独特的机会。2007 年，美国卫生资源和服务管理局为一个名为“加强监狱环境中艾滋病毒初级保健联系”的多地点示范项目提供了资金，该项目旨在改善艾滋病毒阳性监狱被拘留者的诊断和治疗服务，并在他们获释后将他们与社区医疗和社会服务联系起来。我们对罗得岛的示范点进行了评估，该点名为“艾滋病毒感染者离开监狱后的社区伙伴关系和支持服务”（COMPASS）。通过对罗得岛 20 名 COMPASS 参与者进行深入的定性访谈，我们评估了 COMPASS 如何影响获得医疗保健和社会服务的机会。大多数参与者在入组时已经在接受艾滋病毒治疗和护理服务，但 COMPASS 增强了大多数参与者与医疗保健的联系，并促进了艾滋病毒和其他合并症的后续就诊。由于 COMPASS 的作用，一些参与者成功地获得了新的医疗服务，包括一名新诊断出艾滋病毒的个体和另一名多年来一直患有艾滋病毒并能够开始接受高效抗逆转录病毒治疗（HAART）的个体。虽然许多参与者报告说，COMPASS 的支持防止了药物滥用的复发，但对一些参与者来说，药物滥用问题仍然是一个挑战。大多数参与者由于 COMPASS 的参与，注册了一项或多项新的社会服务，包括医疗补助、补充保障收入、食品援助和住房计划。COMPASS 参与者的主要未满足需求是获得心理健康服务和稳定的住房。对艾滋病毒阳性监狱被拘留者进行强化个案管理，可增强获得医疗和社会支持服务的机会，并有助于防止药物滥用的复发。扩大针对最近释放的艾滋病毒阳性被拘留者的强化个案管理项目、公共住房和心理健康服务，应成为公共卫生的重点。
