# A Decentralized, Status neutral, Stakeholder-engaged, post-incarceration intervention for people with and at risk for HIV

> **NIH NIH R61** · ALBERT EINSTEIN COLLEGE OF MEDICINE · 2024 · $963,230

## Abstract

A. Abstract
 One out of six people with HIV (PWH) in the U.S. are incarcerated annually; two-thirds of incarcerated persons meet
criteria for substance use disorder (SUD) and many more in carceral settings are at risk for HIV. Ending the U.S. HIV
epidemic hinges on linking and engaging criminal legal system-involved people with and at risk for HIV, especially those
with SUDs, to optimize ART and PrEP uptake and adherence. Carceral facilities can offer ART and PrEP access, and
increasingly SUD treatment, but in the year following release, nearly 80% of PWH lack viral suppression, and PrEP
coverage is extremely limited. Post-release disruptions in ART stem from multiple causes: health system complexity, SUD
relapse, unstable housing, medical mistrust, and stigma. PrEP outcomes are underexplored, but preliminary data suggest
similar challenges. Because HIV transmission risk is high upon community re-entry, multimodal interventions among
recently incarcerated people with and at risk for HIV are critical to ending the HIV epidemic. The goal of this phased
R61/R33 proposal is to develop a Decentralized, Status neutral, Stakeholder-engaged, post-incarceration intervention
for people with and at risk for HIV with SUD: The DEST2nation model. In addition to peer navigation, we will collaborate
with carceral-focused community-based organizations to address competing priorities, such as unstable housing, lack of
employment in culturally sensitive environments that mitigate stigma. Our specific aims are to: Aim 1 (R61 phase): Pilot
and refine a package of decentralized strategies to address barriers impacting criminal legal system-involved people with
HIV and those at risk. Aim 2: (R33 phase): Test the DEST2nation model (vs. SoC) in a multisite randomized control trial.
Aim 3 (R33): Estimate the cost of implementing and sustaining DEST2nation, and assess its economic value, relative to
SoC, from healthcare sector, state-policymaker, and societal perspectives.

## Key facts

- **NIH application ID:** 10908959
- **Project number:** 1R61DA060627-01
- **Recipient organization:** ALBERT EINSTEIN COLLEGE OF MEDICINE
- **Principal Investigator:** Matthew Akiyama
- **Activity code:** R61 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $963,230
- **Award type:** 1
- **Project period:** 2024-05-15 → 2025-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10908959

## Citation

> US National Institutes of Health, RePORTER application 10908959, A Decentralized, Status neutral, Stakeholder-engaged, post-incarceration intervention for people with and at risk for HIV (1R61DA060627-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10908959. Licensed CC0.

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