A Systemic Approach to Seek, Test, and Treat Strategies for Correctional Populations It is estimated that 25% of all HIV-positive people in the U.S. pass through a correctional facility each year. Yet, many correctional systems and facilities do not provide a comprehensive and systemically coordinated approach to HIV testing, treatment, and transitional referral, resulting in many missed opportunities to identify previously undiagnosed cases of HIV and link individuals to treatment and prevention services. To address this gap, and in response to RFA-DA-10-017 (Seek, Test, and Treat (STT): Addressing HIV in the Criminal Justice System), we propose to: AIM1: (1) Comprehensively test a high-risk population (people in a state correctional facility being released to a major metropolitan area that accounts for nearly 60% of all state HIV cases, has experienced a recent and significant increase in the rate of HIV, and has perennially high rates of sexually transmitted infections); (2) (re)-link HIV-positive people being released from a state correctional facility to this metropolitan area into low- or no-cost treatment and case management services; and (3) seek to evaluate an innovative network method of HIV testing referral to utilize high-risk negatives in the correctional system to, upon release, encourage other high-risk individuals in their social-sexual networks who might not otherwise access testing services to get HIV tested. Aim 2. Conduct cost and cost-effectiveness analyses to assess: (1) the overall, systemic cost of the proposed STT program; (2) the cost of individual program components and cost to individual payers; (3) the comparative cost-effectiveness of testing in the state prison versus standard walk-in testing at the community treatment provider who will be lined to people testing positive in the prison, and a local county jail that was the site of a recent cost-effectiveness STT study; (4) the potential increase in economic efficiency that could be achieved through risk reduction screening prior to testing in detention facilities; and (5) the cost-effectiveness of implementing post-release partner seeking/testing services for high-risk detainees. The proposed study is highly innovative in that it (1) comprehensively addresses all 3 STT elements across all state correctional facilities who release people to a large metropolitan region with rising rates of HIV; (2) facilitates in-depth cost and cost-effectiveness analyses of this coordinated and systemic STT approach; and (3) involves a unique partnership between academic investigators, HIV treatment providers, a Department of Corrections, a state Division of AIDS/HIV, and a City Health Department. PUBLIC HEALTH RELEVANCE: A Systemic Approach to Seek, Test, and Treat Strategies for Correctional Populations We propose to (1) comprehensively test a high-risk population (people in a state correctional facility being released to a major metropolitan area that accounts for nearly 60% of all HIV cases in its state, has experienced a recent and significant increase in the rate of HIV, and has perennially high rates of sexually transmitted infections); (2) (re)-link HIV-positive people being released from a state correctional facility to this metropolitan region into low- or no-cost treatment and case management services; and (3) seek to evaluate an innovative network method of HIV testing referral to utilize high-risk negatives in the correctional system to, upon release, encourage other high-risk individuals in their social-sexual networks who might not otherwise access testing services to get HIV tested. We further will conduct extensive (4) cost and cost-effectiveness analyses to evaluate the likelihood of the proposed STT program's sustainability.