Successful linkage of medical care and community services for HIV-positive offenders being released from prison

Abstract

Human immunodeficiency virus (HIV) infection is more prevalent among the incarcerated than the general population. For many offenders, incarceration is the only time that they may access primary care. Project Bridge is a federally funded demonstration project that provides intensive case management for HIV-positive ex-offenders being released from the Rhode Island state prison to the community. The program is based on collaboration between colocated medical and social work staff. The primary goal of the program is to increase continuity of medical care through social stabilization; it follows a harm reduction philosophy in addressing substance use. Program participants are provided with assistance in accessing a variety of medical and social services. The treatment plan may include the following: mental illness triage and referral, substance abuse assessment and treatment, appointments for HIV and other medical conditions, and referral for assistance to community programs that address basic survival needs. In the first 3 years of this program, 97 offenders were enrolled. Injection drug use was reported by 80% of those enrolled. There were 90% followed for 18 months, 7% moved out of state or died, and 3% were lost to follow-up. Reincarceration happened to 48% at least once. Of those expressing a need, 75% were linked with specialty medical care in the community, and 100% received HIV-related medical services. Of those expressing a need for substance abuse treatment, 67% were successful in keeping appointments for substance abuse treatment within the community. Project Bridge has demonstrated that it is possible to maintain HIV-positive ex-offenders in medical care through the provision of ongoing case management services following prison release. Ex-offenders will access HIV-related health care after release when given adequate support.

From Corrections to Communities as an HIV Priority

“…[71][72][73][74][75] Recent randomized controlled interventions with populations re-entering the community are an advance over much of the previous literature and demonstrate that it is possible to have a positive impact on risk behavior in this population. 76,77 These programs are reflections of concern not just about individual barriers to community reintegration, but also realization that concern about HIV and other infectious diseases in the correctional setting cannot be limited to consideration of risk of transmission between inmates within jail or prison.…”

Transitions to Care in the Community for Prison Releasees with HIV: a Qualitative Study of Facilitators and Challenges in Two States

“…Also important to this system are two cross-cutting elements: (1) inter-agency collaboration [10][11][12][13] and (2) government and private sector policies and programs regarding entitlements, employment, and housing. 14 The transitional care systems developed for prisoners with HIV in Rhode Island 15 and North Carolina 16 have received attention in the literature and offer good examples incorporating the key elements identified by Springer 5 and the CDC. 9 This paper presents the findings from a qualitative analysis of interviews with providers and stakeholders in these two state systems to identify the facilitators of and challenges to effective in-prison care, transitional interventions, and access to and continuity of care in the community.…”

Highly Effective Birth Control Use Before and After Women's Incarceration

“…[12][13][14] Although several programs have reported connecting incarcerated women to health care services for HIV, drug use, and mental health problems, 15,16 only one researcher to our knowledge has connected incarcerated women to sexual and reproductive health services that address unintended-pregnancy prevention upon release from jail. 17,18 Little is known about the factors associated with effective birth control use among women with criminal justice involvement: in particular, immediately upon their release from jail into the community.…”