A Randomized Controlled Trial of HIV Testing and Linkage to Care at Community Corrections

• HIV testing [ Time Frame: Baseline ] [ Designated as safety issue: No ]

  Aim 1: To determine the willingness of the community corrections population to undergo HIV testing (Seek).

  Aim 1a: To compare a strategy of rapid HIV testing on site in community corrections (probation and parole offices) to referral to an off site community HIV testing location with a randomized control study (Test).

  
  

• 1) engagement in care [ Time Frame: 12-months ] [ Designated as safety issue: No ]
  To determine whether people with HIV (both known and newly diagnosed) can be identified in community corrections. To determine if a promising, theory driven, case management based strategy (Project Bridge), will be utilized by individuals with HIV recruited through community corrections.To determine the impact of PB versus TAU on individuals with HIV recruited through community corrections on: 1) engagement in care; 2) retention in care; and 3) proportion of those prescribed Highly Active Antiretroviral Therapy (HAART) who are undetectable at 6/12 months using a pre-post analysis (Treat).
  
  
• retention in care [ Time Frame: 18 months ] [ Designated as safety issue: No ]
  To determine the impact of Project Bridge (PB) versus Treatment as Usual (TAU) on individuals with HIV recruited through community corrections
  
  
• proportion of those prescribed Highly Active Antiretroviral Therapy (HAART) who are undetectable [ Time Frame: 6,12,18-months ] [ Designated as safety issue: No ]
  To determine if a promising, theory driven, case management based strategy (Project Bridge), will be utilized by individuals with HIV recruited through community corrections.
  
  

The first study is a two-group randomized controlled trial in which 6,000 male and female probationers and parolees in Baltimore City, Maryland and Providence, Rhode Island will be randomly assigned to one of two treatment conditions: 1) On-site rapid testing conducted by research staff co-located for the purposes of this study at the probation/parole office; or 2) Off-site referral for rapid HIV testing at a community health center or HIV testing clinic. Inclusion criteria will be: 1) Adult probationer/parolee; 2) not known to be HIV positive, and 3) resident of greater Baltimore or Providence throughout the study period. Exclusion criteria will be: 1) unable to give informed consent. The second study is a randomized trial, whereby all individuals identified at community corrections with HIV will be offered enrollment in a one-year intervention study to examine the ability to improve linkage into HIV care. Participants will be randomized to receive one of two conditions: 1) Project Bridge for one year, or 2) Treatment as Usual-referral to standard level of care. Moreover, those randomized to TAU will be given an opportunity to "crossover" to PB if they have failed to engage in treatment during the first three months. The rationale for choosing the two cities of Baltimore, MD and Providence, RI is due to the historically high rates of heroin addiction that is associated with multiple HIV-related risk behaviors in these two cities and a high likelihood of being on probation and/or parole. Furthermore, Maryland ranks 10th and Rhode Island ranks 4th in the nation in the number of probationers per 100,000 adult residents.