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

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One in seven people living with HIV in the USA passes through a prison or jail each year, and almost all will return to the community. Discharge planning and transitional programs are critical but challenging elements in ensuring continuity of care, maintaining treatment outcomes achieved in prison, and preventing further viral transmission. This paper describes facilitators and challenges of in-prison care, transitional interventions, and access to and continuity of care in the community in Rhode Island and North Carolina based on qualitative data gathered as part of the mixed-methods Link Into Care Study of prisoners and releasees with HIV. We conducted 65 interviews with correctional and community-based providers and administrators and analyzed the transcripts using NVivo 10 to identify major themes. Facilitators of effective transitional systems in both states included the following: health providers affiliated with academic institutions or other entities independent of the corrections department; organizational philosophy emphasizing a patient-centered, personal, and holistic approach; strong leadership with effective “champions”; a team approach with coordination, collaboration and integration throughout the system, mutual respect and learning between corrections and health providers, staff dedicated to transitional services, and effective communication and information sharing among providers; comprehensive transitional activities and services including HIV, mental health and substance use services in prisons, timely and comprehensive discharge planning with specific linkages/appointments, supplies of medications on release, access to benefits and entitlements, case management and proactive follow-up on missed appointments; and releasees’ commitment to transitional plans. These elements were generally present in both study states but their absence, which also sometimes occurred, represent ongoing challenges to success. The qualitative findings on the facilitators and challenges of the transitional systems were similar in the two states despite differences in context, demographics of target population, and system organization. Recommendations for improved transitional systems follow from the analysis of the facilitators and challenges.

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The authors are grateful to the Rhode Island Department of Corrections and Department of Health, the North Carolina Department of Public Safety and Department of Health and Human Services for their collaboration and support on this study, as well as to all of the service providers and other stakeholders who participated in the interviews on which this paper is largely based. We also gratefully acknowledge the funding support of the National Institute on Drug Abuse, National Institutes of Health through grant # 1R01DA030778 Improving Linkage to HIV Care Following Release from Incarceration, awarded to Miriam Hospital with sub-grants to Abt Associates and University of North Carolina. This work was also supported by NIH grants K24DA022112 and P30AI042853. Last but not least, we are indebted to Alice Lee for her research assistance on this project.

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Correspondence to Theodore M. Hammett.

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Hammett, T.M., Donahue, S., LeRoy, L. et al. Transitions to Care in the Community for Prison Releasees with HIV: a Qualitative Study of Facilitators and Challenges in Two States. J Urban Health 92, 650–666 (2015).

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