Individuals motivated to participate in adherence, care and treatment (imPACT): development of a multi-component intervention to help HIV-infected recently incarcerated individuals link and adhere to HIV care

Abstract

BackgroundPolicy-makers promote a seek, test, treat and retain (STTR) strategy to expand HIV testing, support linkage and engagement in care, and enhance the continuous use of antiretroviral therapy for those HIV-infected. This HIV prevention strategy is particularly appropriate in correctional settings where HIV screening and treatment are routinely available yet many HIV-infected individuals have difficulty sustaining sufficient linkage and engagement in care, disease management, and viral suppression after prison release.Methods/designOur research team developed Project imPACT (individuals motivated to Participate in Adherence, Care and Treatment), a multi-component approach for HIV-Infected recently incarcerated individuals that specifically targets their care linkage, retention, and medication adherence by addressing multiple barriers to care engagement after release. The ultimate goals of this intervention are to improve the health of HIV-infected individuals recently released from prison and reduce HIV transmission to their communities by maintaining viral suppression. This paper describes the intervention and technology development processes, based on best practices for intervention development and process evaluation. These processes included: 1) identifying the target population; 2) clarifying the theoretical basis for intervention design; 3) describing features of its foundational interventions; 4) conducting formative qualitative research; 5) integrating and adapting foundational interventions to create and refine intervention content based on target audience feedback. These stages along with the final intervention product are described in detail. The intervention is currently being evaluation and a two arm randomized, controlled trial in two US state prison systems.DiscussionBased on a literature review, qualitative research, integration of proven interventions and behavioral theory, the final imPACT intervention focused on the transition period two to three months before and three months after prison release. It emphasized pre-release readiness, pre- and post-release supportive non-judgmental counseling, linking individuals to a HIV care clinic and technological supports through videos and text messages. This article provides a useful model for how researchers can develop, test, and refine multi-component interventions to address HIV care linkage, retention and adherence.Clinical trial registrationNCT01629316, first registered 6-4-2012; last updated 6-9-2015.

Randomized Controlled Trial of an Intervention to Maintain Suppression of HIV Viremia After Prison Release: The imPACT Trial

“…Details regarding the basis and development of the imPACT intervention have been described elsewhere (20). Briefly, the imPACT intervention adapted and combined existing theoretically-rooted interventions (21-23) to be influential at the individual, clinic/institutional, and community levels in accordance with the Social Ecological Framework (24, 25).…”

“…Given the limitations of the research published to date and the importance to successful HIV prevention of developing interventions that effectively support the continuity of HIV care and maintenance of ART through the transition from imprisonment to community re-entry, we developed a multi-dimensional intervention rooted in the STTR approach, called imPACT (Individuals Motivated to Participate in Adherence, Care and Treatment) (20). Designed to promote engagement in HIV care after release for HIV-infected prisoners, imPACT consisted of three main components: motivational interviewing before and after release, pre-release needs assessment and community medical care link coordination, and cell phone provision with texted reminders prior to each antiretroviral medication dose.…”

Observational study of continuity of HIV care following release from correctional facilities in South Africa

“…Compared to some of these prior studies, our observed self-reported linkage to care was higher. Specifically, the proportion of ex-inmates linking to care in studies from the United States ranges from 28 to 95%; a median of 36% was calculated in a metaanalysis [10][11][12][13][14][15][21][22][23][24][25][26]. There are several possible reasons for the potentially higher linkage to care that we observed.…”

Developing interventions to improve health: a systematic mapping review of international practice between 2015 and 2016

“…Other developers sometimes drew on wider research designs rather than intervention development approaches to offer a set of steps for their approach to intervention development because this offered a systematic and transparent description of their approach. For example, Golin et al [41] cited Linnan and Steckler's [42] work on process evaluation as a source of best practice for intervention development and then presented a diagram of three phases and steps they took. Most developers identified the target population in the introduction section of their articles.…”