Urban Health Study II

• Engagement in HIV Care [ Time Frame: Every 3 months for 2 years ] [ Designated as safety issue: No ]
  The proportion of participants entering HIV care will be compared between the standard referral and Project Bridge groups
• Initiation of Highly Active Antiretroviral Therapy (HAART) [ Time Frame: Every 3 months for 2 years ] [ Designated as safety issue: No ]
  The proportion of participants initiating HAART will be compared between the standard referral and Project Bridge groups

The study will test an intervention to help HIV-positive people achieve consistency of HIV care while transitioning in and out of jail.

The study has two research objectives: (1) to expand access and options for HIV testing with individuals in the criminal justice system, by focusing on high-risk intravenous drug users (IDUs) and crack cocaine smokers in community settings; and (2) to improve access and maintenance of highly active antiretroviral treatment (HAART) among HIV-positive persons in this population, by implementing a promising intervention focused on continuity of HIV care, and evaluating it using a rigorous experimental design.

HIV-positive persons will be identified through the testing activities described in Objective 1. They will then be offered enrollment in a randomized controlled trial (RCT) of an intervention designed to engage and maintain HIV-positive people with criminal justice involvement in medical care. The intervention, Project Bridge, has shown great promise but has not yet been rigorously evaluated. The RCT will assess the efficacy of Project Bridge compared with a Usual Care arm. Our hypotheses are that, at quarterly data collection visits: (1) Intervention participants will have lower HIV viral load than usual care participants 2b: (2) Intervention participants will be more likely to be in HIV care than usual care participants (3) Intervention participants will be more likely to be on HAART than usual care participants.

The study design was changed from a randomized controlled trial to a quasi-experimental comparison group design. This change was approved by the NIMH Program Officer and the RTI IRB in June, 2012.

• Behavioral: Standard Referral
  Participants randomized to this arm will be referred to local HIV care resources
• Behavioral: Project Bridge
  Arm 2

• Active Comparator: Standard Referral
  Participants randomized to this arm will be referred to local HIV care resources
  Intervention: Behavioral: Standard Referral
• Experimental: Project Bridge
  Participants randomized to this arm will be given the Project Bridge intervention
  Intervention: Behavioral: Project Bridge

Inclusion Criteria:

• Age 18 or older
• HIV antibody positive
• not currently receiving HIV care

Exclusion Criteria:

• already in care
• unable to provide informed consent