AIDS and Behavior

, Volume 17, Supplement 2, pp 100–107 | Cite as

Jails, HIV Testing, and Linkage to Care Services: An Overview of the EnhanceLink Initiative

  • Anne C. Spaulding
  • Cristina A. Booker
  • Shalonda H. Freeman
  • Sarah W. Ball
  • Matthew S. Stein
  • Alison O. Jordan
  • Divya Ahuja
  • Liza Solomon
  • Paula M. Frew
Original Paper


Over 9 million persons in the United States (US) are admitted each year to jails. HIV prevalence among detainees is higher than the general population, which creates a public health need for linking HIV-infected detainees to services during jail and after release. The EnhanceLink initiative was funded as demonstration projects in 10 communities at 20 separate jails across the US. Grantees implemented and evaluated innovative models of HIV testing in jails and linkage of HIV-infected individuals to community services post release. In this paper, we describe services delivered with the EnhanceLink initiative. During 877,119 admission events, 210,267 inmates agreed to HIV testing and 822 new diagnoses of HIV were made. The majority of persons served with transitional services were previously diagnosed before the current incarceration. Cumulatively, 9,837 HIV+ persons were offered linkage and transitional services and 8,056 (82 %) accepted the offer. EnhanceLink demonstrated the feasibility of HIV testing in jail settings and provision of linkage services to enhance continuity of HIV care post-release.


HIV/AIDS HIV testing Incarceration Inmate Jail 

Supplementary material

10461_2012_339_MOESM1_ESM.docx (149 kb)
Supplementary material 1 (DOCX 149 kb)


  1. 1.
    Grinstead OA, Zack B, Faigeles B, Grossman N, Blea L. Reducing postrelease HIV risk among male prison inmates: a peer-led intervention. Crim Justice Behav. 1999;26(4):453–65.CrossRefGoogle Scholar
  2. 2.
    Hammett TM, Gaiter JL, Crawford C. Reaching seriously at-risk populations: health interventions in criminal justice settings. Health Educ Behav. 1998;25(1):99–120.PubMedCrossRefGoogle Scholar
  3. 3.
    Spaulding A, Stephenson B, Macalino G, Ruby W, Clarke JG, Flanigan TP. Human immunodeficiency virus in correctional facilities: a review. Clin Infect Dis. 2002;35(3):305–12.PubMedCrossRefGoogle Scholar
  4. 4.
    Glaser JB, Greifinger RB. Correctional health care: a public health opportunity. Ann Intern Med. 1993;118(2):139–45.PubMedCrossRefGoogle Scholar
  5. 5.
    Hammett TM. Making the case for health interventions in correctional facilities. J Urban Health. 2001;78(2):236–40.PubMedCrossRefGoogle Scholar
  6. 6.
    Farley JL, Mitty JA, Lally MA, et al. Comprehensive medical care among HIV-positive incarcerated women: the Rhode Island experience. J Womens Health Gend-Based Med. 2000;9(1):51–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Flanigan TP, Rich JD, Spaulding A. HIV care among incarcerated persons: a missed opportunity [comment]. AIDS. 1999;13(17):2475–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Draine J, Ahuja D, Altice FL, et al. Strategies to enhance linkages between care for HIV/AIDS in jail and community settings. AIDS Care. 2011;23(3):366–77.PubMedCrossRefGoogle Scholar
  9. 9.
    Flanigan TP, Zaller N, Beckwith CG, et al. Testing for HIV, sexually transmitted infections, and viral hepatitis in jails: still a missed opportunity for public health and HIV prevention. J Acquir Immune Defic Syndr. 2010;55(Suppl 2):S78–83.Google Scholar
  10. 10.
    Spaulding AC, Seals RM, Page MJ, Brzozowski AK, Rhodes W, Hammett TM. HIV/AIDS among inmates of and releasees from US correctional facilities, 2006: declining share of epidemic but persistent public health opportunity. PLoS ONE. 2009;4(11):e7558.PubMedCrossRefGoogle Scholar
  11. 11.
    Westergaard RP, Kirk GD, Richesson DR, Galai N, Mehta SH. Incarceration predicts virologic failure for HIV-infected injection drug users receiving antiretroviral therapy. Clin Infect Dis. 2011;53(7):725–31.PubMedCrossRefGoogle Scholar
  12. 12.
    Springer SA, Spaulding AC, Meyer JP, Altice FL. Public health implications for adequate transitional care for HIV-infected prisoners: five essential components. Clin Infect Dis. 2011;53(5):469–79.PubMedCrossRefGoogle Scholar
  13. 13.
    Sperling C, Pierce A, Hall T, Tomlin J, Williams S. Intervening with substance using men newly released from jail challenges and strategies. In: National STD conference 2004.Google Scholar
  14. 14.
    Zaller ND, Holmes L, Dyl AC, et al. Linkage to treatment and supportive services among HIV-positive ex-offenders in Project Bridge. J Health Care Poor Underserved. 2008;19(2):522–31.PubMedCrossRefGoogle Scholar
  15. 15.
    Rich JD, Holmes L, Salas C, et al. Successful linkage of medical care and community services for HIV-positive offenders being released from prison. J Urban Health. 2001;78(2):279–89.PubMedCrossRefGoogle Scholar
  16. 16.
    Centers for Disease Control and Prevention. Framework for Program Evaluation in Public Health. MMWR 1999;48(No. RR-11).Google Scholar
  17. 17.
    HRSA, HIV/AIDS Bureau. Opening doors. The HRSA-CDC Corrections Demonstration Project for People Living with HIV/AIDS. December 2007. Accessed 23 Feb 2008.
  18. 18.
    Robillard A, Garner J, Laufer F. CDC/HRSA HIV/AIDS intervention, prevention, and continuity of care demonstration project for incarcerated individuals within correctional settings and the community: part I, a description of correctional demonstration project activities. J Correct Health Care. 2003;9:453–86.CrossRefGoogle Scholar
  19. 19.
    CDC. Assessment of sexually transmitted diseases services in city and county jails—United States, 1997. Morb Mortal Wkly Rep. 1998;47(21):429–31.Google Scholar
  20. 20.
    Spaulding AC, Perez SD, Seals RM, Kavasery R, Hallman M, Weiss P. The diversity of release patterns for jail detainees: implications for public health interventions. Am J Public Health. 2011;101:S347–52. doi:10.2105/AJPH.2010.300004.PubMedCrossRefGoogle Scholar
  21. 21.
    de Voux A, Spaulding AC, Beckwith C, et al. Early identification of HIV: empirical support for jail-based screening. PLoS ONE. 2012;7(5):e37603.Google Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Anne C. Spaulding
    • 1
    • 2
  • Cristina A. Booker
    • 3
  • Shalonda H. Freeman
    • 2
  • Sarah W. Ball
    • 3
  • Matthew S. Stein
    • 2
  • Alison O. Jordan
    • 5
  • Divya Ahuja
    • 6
  • Liza Solomon
    • 3
  • Paula M. Frew
    • 1
    • 4
  1. 1.Division of Infectious Diseases, Department of MedicineEmory University School of MedicineAtlantaUSA
  2. 2.Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaUSA
  3. 3.Abt Associates Inc.CambridgeUSA
  4. 4.Department of Behavioral Sciences and Health Education, Rollins School of Public HealthEmory UniversityAtlantaUSA
  5. 5.New York City Department of Health and Mental Hygiene Transitional Health Care CoordinationNew YorkUSA
  6. 6.University of South Carolina Research FoundationColumbiaUSA

Personalised recommendations