Responses to highly active antiretroviral therapy (HAART) in correctional settings and their sustained benefit in prisoners after release are currently not known. To examine the human immunodeficiency virus type 1 (HIV-1) RNA level (VL) and CD4 lymphocyte response to HAART during incarceration and upon reentry to the correctional system, we conducted a retrospective cohort study of longitudinally linked demographic, pharmacy, and laboratory data from the Connecticut prison system. During incarceration, the mean CD4 lymphocyte count increased by 74 lymphocytes/ mu L, and the mean VL decreased by 0.93 log10 copies/mL (P<.0001). Fifty-nine percent of the subjects achieved a VL of <400 copies/mL at the end of each incarceration period. For the 27% of subjects who were reincarcerated, the mean CD4 lymphocyte count decreased by 80 lymphocytes/ mu L, and the mean VL increased by 1.14 log10 (P<.0001). Although HAART use resulted in impressive VL and CD4 lymphocyte outcomes during the period of incarceration, recidivism to prison was high and was associated with a poor outcome. More effective community-release programs are needed for incarcerated patients with HIV disease.

Directly administered antiretroviral therapy (DAART) is one approach to improving adherence to among human immunodeficiency virus (HIV)-infected drug users. We evaluated the essential features of a community-based DAART intervention in a randomized, controlled trial of DAART versus self-administered therapy. Of the initial 72 subjects, 78% were racial minorities, and 32% were women. Social and medical comorbidities among subjects included homelessness (35% of subjects), lack of interpersonal support (86%), major depression (57%), and alcoholism (36%). At baseline, the median CD4+ cell count was 403 cells/mL and the median HIV-1 RNA load was 146,333 copies/mL (log10 5.31 copies/mL). During the prior 6 months, 33% of subjects had missed a medical appointment, and 47% had visited an emergency department. Although most subjects (67%) preferred to take their own medications, 76% would accept DAART if it were made compulsory. A methadone clinic was the DAART venue acceptable to the fewest subjects (36%), and a mobile syringe-exchange program was acceptable to the most subjects (83%). Adherence was higher for supervised than for unsupervised medication administration (P<.0001), a finding that supports use of daily supervision of once-daily regimens. Moreover, DAART should incorporate enhanced elements such as convenience, flexibility, confidentiality, cues and reminders, responsive pharmacy and medical services, and specialized training for staff.

Community mental health agencies (CMHAs) and consumer-run agencies (CRAs) both provide critically important services to persons with severe psychiatric disabilities. Emerging research has begun to support the effectiveness of the CRA approach, a newer service delivery mechanism. However, collaboration between the two service systems, when it occurs, is often problematic. This article briefly identifies the core features of CRAs, discusses their potential for collaboration with CMHAs, and suggests ways to promote healthy organizational partnerships between the two based upon the model proposed by Gidron and Hasenfeld [(1994) Nonprofit Management & Leadership, 5(2), 159-172]. Salient collaboration theories are reviewed and barriers to collaboration are discussed. Finally, implications for mental health practice and future research directions are identified.

This study tested the hypothesis that users of mental health self-help services would be more satisfied with professional mental health services than clients who did not use self-help services. A survey was administered to 311 clients of professional mental health services, 151 (49 percent) of whom were users of self-help services. A multiple regression model showed that the use of self-help services was associated with greater satisfaction with professional mental health services. This finding provides support for the idea that the use of self-help services encourages appropriate use of professional services. The study provided evidence that self-help and traditional mental health services can function complementarily rather than in competition with one another.

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