Linking HIV-positive Jail Inmates to Treatment, Care, and Social Services After Release: Results from a Qualitative Assessment of the COMPASS Program
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Approximately 17% of individuals living with HIV/AIDS pass through the correctional system each year. Jails provide a unique opportunity to diagnose and treat HIV infection among high-risk, transient populations with limited access to medical services. In 2007, the US Health Resources and Services Administration funded a multi-site demonstration project entitled Enhancing Linkages to HIV Primary Care in Jail Settings that aims to improve diagnosis and treatment services for HIV-positive jail detainees and link them to community-based medical care and social services upon release. We performed an evaluation of the Rhode Island demonstration site entitled Community Partnerships and Supportive Services for HIV-Infected People Leaving Jail (COMPASS). Through in-depth qualitative interviews among 20 HIV-positive COMPASS participants in Rhode Island, we assessed how COMPASS impacted access to health care and social services utilization. Most individuals were receiving HIV treatment and care services upon enrollment, but COMPASS enhanced linkage to medical care and follow-up visits for HIV and other co-morbidities for most participants. Several participants were successfully linked to new medical services as a result of COMPASS, including one individual newly diagnosed with HIV and another who had been living with HIV for many years and was able to commence highly active antiretroviral therapy (HAART). While many individuals reported that COMPASS support prevented substance abuse relapse, ongoing substance abuse nevertheless remained a challenge for several participants. Most participants enrolled in one or more new social services as a result of COMPASS, including Medicaid, Supplemental Security Income, food assistance, and housing programs. The primary unmet needs of COMPASS participants were access to mental health services and stable housing. Intensive case management of HIV-positive jail detainees enhances access to medical and social support services and helps prevent relapse to substance abuse. Expanding intensive case management programs, public housing, and mental health services for recently released HIV-positive detainees should be public health priorities.
KeywordsHIV/AIDS Treatment and care Substance abuse Jail Corrections Linkage
This manuscript was supported by the Special Projects of National Significance of the Health Resources and Services Administration (grant H97HA08535), and the Lifespan/Tufts/Brown Center for AIDS Research (grant P30AI42853). In addition, A. Nunn received support from the NIDA grant 5T32DA013911, NIAAA grant 1K01AA020228-01A1, and a Rhode Island Foundation Medical Research Grant. C. Beckwith received support from NIDA grant K23DA021095 and L. Bazerman received support from the Tufts Nutrition Collaborative, A Center for Drug Abuse, and AIDS Research (grant P30DA013868). None of the aforementioned agencies had any role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
- 1.Glynn M, Rhodes P. Estimated HIV prevalence in the United States at the end of 2003 [Abstract No. T1-B1101]. National HIV Prevention Conference. Atlanta, GA, June 12–15, 2005.Google Scholar
- 2.Fleming P, Byers R, Sweeney P, Karon J, Janssen RS. HIV prevalence in the United States, 2000. Programs and Abstracts of the 9th Conference on Retroviruses and Opportunistic Infections. Seattle, Washington: Abstract 11; February 24–28, 2002.Google Scholar
- 4.Maruschak L. HIV in prisons, 2006. US Department of Justice, Bureau of Justice Statistics. NCJ-222179.Google Scholar
- 5.Visher C, LaVigne N, Travis J. Returning home: understanding the challenges of prisoner reentry. Maryland Pilot Study: findings from Baltimore: Urban Institute, Justice Policy Center; January 2004. JPC Publication CPR04 0122.Google Scholar
- 18.James D. Profile of jail inmates, 2002 US Department of Justice, Office of Justice Programs. Bureau of Justice Statistics, Special Report July 2004 NCJ 201932.Google Scholar
- 23.Health Resources and Services Administration, US Department of Health and Human Services. The HIV/AIDS Bureau: Special Projects of National Significance (SPNS) Enhancing Linkages to Primary Care and Services in Jail Settings Demonstration Models. Announcement Number: HRSA-07-031. Available at https://grants.hrsa.gov/webExternal/DisplayAttachment.asp?ID=0553C8C6-91DE-4C09-9D5D-1B1BF572F8D7.
- 24.Spaulding A, Arriola K, Ramos K. Enhancelink: linking HIV infected jail detainees to care. American Correctional Health Services Association, Southeast Regional 2008 Professional Development Conference. Chattanooga, TN; September 19–21, 2008. Available at http://enhancelink.org/sites/hivjailstudy/ACHSA_fall_08_918.pdf.
- 26.Merriam SB. Qualitative research and case study applications in education. 2nd ed. San Francisco: Jossey-Bass; 1998.Google Scholar
- 27.Weiss RS. Learning from strangers: the art and method of qualitative interview studies. New York: Free Press; Toronto: Maxwell Macmillan Canada; Maxwell Macmillan International; 1994.Google Scholar
- 28.Maxwell JA. Qualitative research design: an interactive approach. 2nd ed. Thousand Oaks: Sage; 2005.Google Scholar
- 29.Seidman I. Interviewing as qualitative research: a guide for researchers in education and the social sciences. 3rd ed. New York: Teachers College Press; 2006.Google Scholar
- 32.Beckwith CG, Poshkus M, Chowdury S, et al. Routine jail-based HIV testing in Rhode Island, 2000-2007 [Presentation CCT4B-1]. 2009 National HIV Prevention Conference. Atlanta, GA, August 23-26, 2009.Google Scholar
- 33.CDC. Coinfection with HIV and hepatitis C virus. Atlanta: CDC; 2010.Google Scholar
- 40.James D, Glaze L. Mental health problems of prison and jail inmates. US Department of Justice, Bureau of Justice Statistics. September 2006:NCJ 213600. Accessed at http://bjs.ojp.usdoj.gov/content/pub/pdf/mhppji.pdf.