Twelve scientific teams in more than a dozen states will receive National Institutes of Health (NIH) grants to study effective ways to prevent and treat HIV/AIDS among people in the criminal justice system. The grants, announced today, will be awarded primarily by the National Institute on Drug Abuse (NIDA), with additional support from the National Institute of Mental Health (NIMH) and the National Institute of Allergy and Infectious Diseases (NIAID), all components of NIH. The research will take place over a five-year period.
"These important and wide reaching research grants will focus on identifying individuals with HIV within the criminal justice system and linking them to highly active antiretroviral therapy (HAART) during periods of incarceration and after community re-entry," said NIDA Director Dr. Nora D. Volkow. "We hope this effort will lead to decreased HIV/AIDS-related illness and death among those in the criminal justice system, as well as decrease HIV transmission in the community at-large, making an important impact on public health."
The seek, test and treat funding opportunity follows NIH-sponsored research conducted over the last few years which has indicated that identifying and offering treatment to all medically eligible HIV-positive individuals cannot only stop progression to AIDS and AIDS-related death, but can also help to prevent HIV transmission. These new grants will apply this strategy to the criminal justice system, where there is a high prevalence of HIV/AIDS and often poor access to treatment.
The newly funded research will compare different modalities of the seek, test, and treat strategy to identify, test, engage and retain HIV-positive offenders in treatment. Some of the projects will create and compare systems to better integrate and coordinate HIV management efforts within jails, prisons, health departments, universities, and community organizations. The grants will also support randomized controlled trials among large groups of HIV-positive parolees and probationers comparing varied approaches for linking them to screening, treatment and social services in their communities.
"We are learning that treatment can be one of the most powerful forms of prevention," said NIMH Director Dr. Thomas Insel. "But treatment of HIV-infected men and women during or after incarceration is a challenge, especially when many have co-occurring mental or substance abuse disorders. We know that patients will stay connected to HIV care if their mental health improves. NIMH's project involves intensive case management for African-American and Latino parolees in Oakland, California."
The grants will support research in a diverse group of jails and prison systems, including the Los Angeles County Jail; the Cook County Jail in Chicago; the Rikers Island correctional facility in New York City; jail facilities in Washington, D.C., as well as prison systems in Illinois, North Carolina, Texas, Wisconsin and Rhode Island. One of the grants will compare levels of care and adherence to HAART treatment among HIV-positive injection-drug using detainees in Hanoi, Vietnam, a city with a high rate of HIV infection related to drug use. Two of the projects will study the effectiveness of medication used to treat heroin addiction among HIV-positive injection drug users who are transitioning to home communities.
"The strategy of providing widespread, voluntary testing for HIV infection, identifying individuals infected with the virus and better linking those patients to antiretroviral treatment and medical care is one that NIH is pursuing in a number of different populations," said NIAID Director Dr. Anthony S. Fauci. "It is a potentially viable way to reduce HIV transmission and improve the health of those infected with the virus."
Currently, an estimated 1.1 million people in the United States are infected with HIV. Since the late 1990s, the number of new HIV infections has remained relatively stable with approximately 56,000 new infections reported annually. The funding opportunity, Seek, Test, and Treat: Addressing HIV in the Criminal Justice System, represents NIH's largest research initiative to date to aggressively identify and treat HIV-positive inmates, parolees and probationers and to help them continue care when they return to their communities. Close to $50 million dollars in grants over a five-year period are expected under this research initiative.
About four of every 10 AIDS deaths are related to drug abuse. Each year, an estimated one in seven individuals infected with HIV passes through a correctional facility suggesting that a disproportionate number of people in the criminal justice system are infected with the virus.
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