Effectiveness of Peer Navigation to Link Released HIV+ Jail Inmates to HIV Care

The proposed study has two Primary Specific Aims:

• To examine individual-level and structural-level barriers to HIV care after release from jail, using formative semi-structured interviews with ex-inmates, case managers, and HIV care providers; and to use the information we obtain to inform the adaptation and tailoring of an intervention designed to improve linkage with and retention to HIV care for HIV+ ex-inmates (Complete);
• Using a two-group experimental RCT design, to test the adapted peer navigation intervention condition for HIV+ inmates upon release from jail compared to a usual care condition, and to evaluate the intervention's effectiveness at improving linkage with and retention in HIV care, self-reported ART adherence, and HIV RNA viral load suppression;

The intervention is hypothesized to result in greater linkage to care, a greater proportion completing at least three HIV care visits per year, increased self-reported ART adherence, and decreased levels of HIV RNA viral load compared to the usual care control group.

Secondary Aims of the study include assessing the potential moderating effects of substance abuse, the potential mediating effects of substance abuse treatment, and the program's effects on recidivism, and costs.

Active substance abuse is hypothesized to moderate the effect of the intervention, such that the intervention will be less effective among participants who report substance use.

Inclusion criteria

• Age 18 or older
• Men or TGW diagnosed HIV-positive
• English or bilingual Spanish speaking
• Selected for the TCM program (control condition) prior to LINK LA enrollment
• Residing in LA County upon release
• Eligible for ART or incarcerated on ART.

Exclusion criteria

• Inability to give informed consent
• Parole hold or planned transfer to prison
• Stay in jail <5 days.