Cohort profile: seek, test, treat and retain United States criminal justice cohort

Abstract

BackgroundThe STTR treatment cascade provides a framework for research aimed at improving the delivery of services, care and outcomes of PLWH. The development of effective approaches to increase HIV diagnoses and engage PLWH in subsequent steps of the treatment cascade could lead to earlier and sustained ART treatment resulting in viral suppression. There is an unmet need for research applying the treatment cascade to improve outcomes for those with criminal justice involvement.MethodsThe Seek, Test, Treat, and Retain (STTR) criminal justice (CJ) cohort combines data from 11 studies across the HIV treatment cascade that focused on persons involved in the criminal justice system, often but not exclusively for reasons related to substance use. The studies were conducted in a variety of CJ settings and collected information across 11 pre-selected domains: demographic characteristics, CJ involvement, HIV risk behaviors, HIV and/or Hepatitis C infections, laboratory measures of CD4 T-cell count (CD4) and HIV RNA viral load (VL), mental illness, health related quality of life (QoL), socioeconomic status, health care access, substance use, and social support.ResultsThe STTR CJ cohort includes data on 11,070 individuals with and without HIV infection who range in age from 18 to 77 years, with a median age at baseline of 37 years. The cohort reflects racial, ethnic and gender distributions in the U.S. CJ system, and 64% of participants are African-American, 12% are Hispanic and 83% are men. Cohort members reported a wide range of HIV risk behaviors including history of injection drug use and, among those who reported on pre-incarceration sexual behaviors, the prevalence of unprotected sexual intercourse ranged across studies from 4% to 79%. Across all studies, 53% percent of the STTR CJ cohort reported recent polysubstance use.ConclusionsThe STTR CJ cohort is comprised of participants from a wide range of CJ settings including jail, prison, and community supervision who report considerable diversity in their characteristics and behavioral practices. We have developed harmonized measures, where feasible, to improve the integration of these studies together to answer questions that cannot otherwise be addressed.

Approaches for creating comparable measures of alcohol use symptoms: Harmonization with eight studies of criminal justice populations

“…Cut-off scores also included drinking frequency and quantity (following established guidelines) though MNLFA and traditional CFA scores did not. Thus, as the STTR collaboration recognizes the need to consider multiple approaches to data harmonization within the rapidly developing field (see Chandler et al, 2017 for a discussion of item response theory co-calibration), we suggest that MNLFA may be a useful tool in conducting analytic harmonization analysis in future data pooling efforts.…”

“…The product of the STTR Data Collection and Harmonization Initiative developed by the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute on Drug Abuse (NIDA), the National Institute of Mental Health (NIMH), and the Office of AIDS Research (OAR), the STTR CJ cohort emerged through a collaboration with researchers who harmonized and pooled data from 12 independent studies funded to evaluate the STTR treatment cascade for CJ involved individuals (Chandler et al, 2017). Participants for the current analysis come from eight CJ study sites that administered the AUDIT at baseline.…”

“…For the current analyses, we examined only data collected at baseline in each sample. (More information available at Chandler et al, 2017, 2015).…”

“… 1 Information in this column taken from Table 2 in Chandler et al, 2017. N/A denotes AUDIT was administered without any changes from the original instrument. …”

Individual and Poly-Substance use and Condomless Sex Among HIV-Uninfected Adults Reporting Heterosexual Sex in a Multi-Site Cohort

“…(11,23) To better understand the relationship between SU and CS, we analyzed CS among heterosexual individuals in the context of SU, derived from the harmonized dataset of the National Institute of Drug Abuse (NIDA) Seek, Test, Treat, and Retain (STTR) HIV-prevention and treatment research initiative. (30) We describe the association between substance-related, person/partner related, and context-related factors and condom use. In the process we identify the combinations of factors that indicate the highest risk of CS, and hence potential for STI transmission.…”