Belenko Steven, Visher Christy, Copenhaver Michael, Hiller Matthew, Melnick Gerald, O'Connell Daniel, Pearson Frank, Fletcher Bennett
Temple University, Philadelphia, USA.
University of Delaware, Newark, USA.
Health Justice. 2013 Dec;1(1):8. doi: 10.1186/2194-7899-1-8.
Persons held in correctional facilities are at high risk for HIV infection and their prevalence of HIV is substantially higher than in the general population. Thus, the need for proper surveillance and care of this high risk population is a paramount public health issue. This study aims to evaluate an organization-level intervention strategy for improving HIV services for persons in prison or jail.
METHODS/DESIGN: HIV Services and Treatment Implementation in Corrections (HIV-STIC) is using a cluster randomized trial design to test an organization-level intervention designed to implement improvements in preventing, detecting, and treating HIV for persons under correctional supervision. Matched pairs of prison or jail facilities were randomized using a SAS algorithm. Facility staff members in both Experimental and Control conditions involved in HIV service delivery are recruited to receive training on HIV infection, the HIV services continuum, and relevant web-based resources. Staff members in both conditions are tasked to implement improvements in HIV prevention, testing, or treatment in their facility. In the Control condition facilities, staff participants use existing techniques for implementing improvement in a selected area of HIV services. In contrast, the Experimental condition staff participants work as a Local Change Team (LCT) with external coaching and use a structured process improvement approach to improve a selected part of the HIV services continuum. The intervention period is 10 months during which data are obtained using survey instruments administered to staff members and aggregate services delivery data. The study is being implemented in 13 pairs of correctional facilities across nine states in the US. Experimental sites are hypothesized to show improvements in both staff attitudes toward HIV services and the number and quality of HIV services provided for inmates.
The current study examines a range of process and outcome data relevant to the implementation of a Change Team approach across diverse correctional settings in the United States. This initial study represents an important step toward a national best practices approach to implementing change in U.S. correctional settings and could serve as an exemplar for designing similar implementation studies.
被关押在惩教机构的人员感染艾滋病毒的风险很高，其艾滋病毒感染率大大高于普通人群。因此，对这一高危人群进行适当监测和护理的需求是一个至关重要的公共卫生问题。本研究旨在评估一项组织层面的干预策略，以改善监狱或看守所中人员的艾滋病毒服务。
方法/设计：惩教机构中的艾滋病毒服务与治疗实施（HIV-STIC）正在采用整群随机试验设计，以测试一项组织层面的干预措施，该措施旨在改善对受惩教监管人员的艾滋病毒预防、检测和治疗。使用SAS算法对监狱或看守所设施的配对进行随机分组。招募参与艾滋病毒服务提供的实验组和对照组设施的工作人员，接受关于艾滋病毒感染、艾滋病毒服务连续体以及相关网络资源的培训。两组工作人员的任务都是在其设施中实施艾滋病毒预防、检测或治疗方面的改进。在对照组设施中，工作人员参与者使用现有技术在艾滋病毒服务的选定领域实施改进。相比之下，实验组工作人员参与者作为地方变革团队（LCT）在外部指导下工作，并使用结构化的过程改进方法来改善艾滋病毒服务连续体的选定部分。干预期为10个月，在此期间，使用对工作人员进行管理的调查工具以及汇总的服务提供数据来获取数据。该研究正在美国九个州的13对惩教机构中实施。假设实验地点在工作人员对艾滋病毒服务的态度以及为囚犯提供的艾滋病毒服务的数量和质量方面都有所改善。
当前研究考察了一系列与在美国不同惩教环境中实施变革团队方法相关的过程和结果数据。这项初步研究是朝着在美国惩教环境中实施变革的全国最佳实践方法迈出的重要一步，并且可以作为设计类似实施研究的范例。
