Project START — an HIV, sexually transmitted infection and hepatitis risk-prevention program for people returning to the community from incarceration — has become a national model for community-based providers. The principal investigators for the project's Rhode Island branch were two faculty members affiliated with Miriam Hospital — Timothy Flanigan, professor of medicine, and Kathleen Morrow, associate professor of psychiatry and human behavior.
Project START began in 1997 as a research project in four states funded by a grant from the Centers for Disease Control. In the original research project, 522 young men ages 18–29 leaving prison were the subjects, as STI rates among men entering jail are as high as 35 percent, according to a CDC report. The research found that an enhanced six-session intervention program significantly reduced sexual risk behavior among these men, compared to a standard single-session program, according to a 2006 paper.
"Our theoretical orientation was that we work with these guys to be part of their transition from the incarcerated setting to their community," Morrow said. "It wasn't just about using a condom when you have sex, it was about helping them to meet their other life needs."
Morrow said the researchers took on a client-centered approach in the intervention, helping the men meet other basic life needs, such as education or job searching, so they would then be able to "think about their health." In Project START's enhanced six-session program, two intervention sessions were held for the men while in prison and four sessions were held one, three, six and 12 weeks after release.
"It took many years, but we got positive outcomes," said Barry Zack, a co-principal investigator for the Project START research in California. "The intervention worked. Then the CDC came to us and said, ‘Can you package this; can you translate it for national rollout?' So then we took the research protocols and we translated them."
The Bridging Group, a consulting group in Oakland, Calif., translated Project START with the help of the original researchers to apply to all people leaving any incarcerated setting, not just young men leaving prison, said Zack, who now works as principal consultant for the Bridging Group. Zack said Morrow represented Brown in the translation, and the translated Project START was then piloted in community-based organizations.
Groups around the nation have already implemented Project START, but based on the pilot's success, starting July 1, the program will be implemented around the country with CDC funding for the next five years, Zack said.
"The week of (April) 19 we're training trainers so they can train people around the country about how to do it," Zack said.
Project START has already been implemented to varying degrees internationally in Kazakhstan, Russia, Ukraine, Taiwan, Vietnam, and Thailand, Zack said.
"Even though this was a U.S. study, dare I say, people around the world are not waiting as long as the U.S. did," Zack said.
