Linkage to HIV Care for Jail Detainees: Findings From Detention to the First 30 Days After Release

Abstract

Of people living with HIV in the US, ~16 % or over 150,000 individuals passed through a correctional facility in 2006. Given the enormous impact of HIV within incarcerated populations, facilitating continuity of care from jails to the community is particularly important in reducing morbidity and mortality for releasees. Grantees participating in the Enhancing Linkages to HIV Primary Care in Jail Settings Initiative developed models for identifying HIV-positive detainees during incarceration and linking them to care following release. In this sample of 1,021 HIV-infected releasees, 79 % received clinical services and 74 % received additional community services within 30 days post-release. Our analysis found several significant factors associated with linkage including: receipt of HIV or medication education in jail, having a completed discharge plan at release, staff awareness of clients' release date, and stable housing on the 30th day post-release. In addition, a subset of participants who had both jail and community viral load assessments showed a statistically significant increase in suppressed viral load. EnhanceLink data suggest that jails may be effective settings to engage individuals in care.

Location of HIV Diagnosis Impacts Linkage to Medical Care

“…Exclusion of laboratory tests collected outside these sites may explain why our linkage rates (particularly for those diagnosed in prison) were lower than reported elsewhere. 15,17 Third, we were unable to distinguish laboratory tests conducted in the ED from those conducted on hospital wards. Given the high patient volume and turnover in EDs, 34 additional studies evaluating the HIV testing and linkage processes in these settings are necessary.…”

Provider Perspectives Regarding the Health Care Needs of a Key Population: HIV-infected Prisoners After Incarceration

“…The interview guide was developed based on the Socio-Ecological Framework (SEF; Sallis, Owen, & Fisher, 2008) and a literature review of what was known about barriers to and facilitators of accessing care post-release for incarcerated individuals living with HIV (Althoff et al, 2013; Booker et al, 2013; Haley et al, 2006). The SEF maintains that multiple levels of influence guide health behaviors including intra-individual, inter-individual, community, and organization level factors.…”

“…The research showed that, during in-depth interviews conducted with former prisoners living with HIV, many perceived the infection to be manageable and a secondary priority to other basic needs, such as housing, family reconciliation, and avoidance of substance abuse relapse (Haley, Scheyett, Golin, Kaplan, & Parker, 2006). While HIV-infected released prisoners encountered numerous competing demands and other barriers to care, several factors have also been identified that can facilitate successful engagement in HIV care, such as receiving education courses during incarceration, arranging care coordination between correctional facilities and community care providers (Booker et al, 2013), and providing transportation assistance (Althoff et al, 2013). …”

A Review of Opportunities to Improve the Health of People Involved in the Criminal Justice System in the United States

“…These studies found that having discharge planning and disease management sessions in jail and staff knowledge of release data; postrelease needs assessment, HIV education, and transportation assistance; stable housing at 30 days postrelease; and a designated HIV provider were significantly associated with sustained retention in care, defined as having a clinic visit in each quarter in the first 6 months out of jail. A subset of participants with pre-and post-jail viral load testing showed an increase in suppressed viral load (15,106). In these studies, men with HIV had better postrelease outcomes than did women, leading to a recommendation for gender-specific care in these programs (76).…”

“…Several of the HIV studies were supported by the Enhancing Linkages to HIV Primary Care Services Initiative, a project that assessed jail-release interventions at ten largely urban US sites (4,15,76). These studies found that having discharge planning and disease management sessions in jail and staff knowledge of release data; postrelease needs assessment, HIV education, and transportation assistance; stable housing at 30 days postrelease; and a designated HIV provider were significantly associated with sustained retention in care, defined as having a clinic visit in each quarter in the first 6 months out of jail.…”