Abstract
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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References
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.
Boutwell A, Rich JD. HIV infection behind bars. Clin Infect Dis. 2004; 38(12): 1761–1763.
Springer SA, Pesanti E, Hodges J, Macura T, Doros G, Altice FL. Effectiveness of antiretroviral therapy among HIV-infected prisoners: reincarceration and the lack of sustained benefit after release to the community. Clin Infect Dis. 2004; 38(12): 1754–1760.
Stephenson BL, Wohl DA, Golin CE, Tien HC, Stewart P, Kaplan AH. Effect of release from prison and re-incarceration on the viral loads of HIV-infected individuals. Public Health Rep. 2005; 120(1): 84–88.
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): 469–479.
Althoff AL, Zelenev A, Meyer JP, Fu J, Brown SE, Vagenas P, et al. Correlates of retention in HIV care after release from jail: results from a multi-site study. AIDS Behav. 2013; 17(Suppl 2): S156–S170. doi:10.1007/s10461-012-0372-1.
Luther JB, Reichert ES, Holloway ED, Roth AM, Aalsma MC. An exploration of community reentry needs and services for prisoners: a focus on care to limit return to high-risk behavior. AIDS Patient Care STDS. 2011; 25(8): 475–481. doi:10.1089/apc.2010.0372. Epub 2011 Jun 11.
Solomon L, Montague BT, Beckwith CG, Baillargeon J, Costa M, Dumont D, et al. Survey finds that many prisons and jails have room to improve HIV testing and coordination of postrelease treatment. Health Aff. 2014; 33(3): 434–442. doi:10.1377/hlthaff.2013.1115.
Centers for Disease Control and Prevention. HIV testing implementation guidance for correctional settings. Available at http://www.cdc.gov/hiv/pdf/risk_Correctional_Settings_Guidelines.pdf. Accessed November 15, 2014.
Ruiz M. Issue Brief: HIV in Correctional Settings: Implications for Prevention and Treatment Policy. New York, NY: American Foundation for AIDS Research; 2008. Accessed December 15, 2014 at http://amfar.org/on-the-hill/events/congressional-briefing--hiv-in-correctional-settings--implications-for-prevention-and-treatment-policy/.
Hammett TM. Public health/corrections collaborations: prevention and treatment of HIV/AIDS, STDs and TB. Research in brief: National Institute of Justice and Centers for Disease Control and Prevention; 1998
Wilson AB, Draine J. Collaborations between criminal justice and mental health systems for prisoner reentry. Psychiatr Serv. 2006; 57: 875–878.
Robillard AG, Gallito-Zaparaniuk P, Arriola KJ, Kennedy S, Hammett T, Braithwaite RL. Partners and processes in HIV services for inmates and ex-offenders. Eval Rev. 2003; 27: 535–562. doi:10.1177/0193841X03255631.
Travis J. But They All Come Back: Facing the Challenges of Prisoner Re-entry. Washington, D.C.: Urban Institute Press; 2005.
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): 279–289.
Wohl DA, Scheyett A, Golin CE, White B, Matuszewski J, Bowling M, et al. Intensive case management before and after prison release is no more effective than comprehensive pre-release discharge planning in linking HIV-infected prisoners to care: a randomized trial. AIDS Behav. 2010. doi:10.1007/s10461-010-9843-4.
Montague B, Costa M. Linkage to HIV care on release from incarceration: data from the LINCS project 2010–2012 in RI and NC. Presented at Academic & Health Policy Conference on Correctional Health, Houston, Texas; 2014
Haley D, Scheyett A, Golin C et al. Perceptions of release among incarcerated HIV-infected persons and implications for practice: the UNC Bridges to Good Health and Treatment (BRIGHT) project qualitative substudy. Abstract THPE0717. 16th International AIDS Conference, Toronto http://www.iasociety.org/Default.aspx?pageId=11&abstractId=2198904. Accessed 13–18 August 2006.
Nunn A, Cornwall A, Fu J, Bazerman L, Loewenthal H, Beckwith C. Linking HIV-positive jail inmates to treatment, care, and social services after release: results from a qualitative assessment of the COMPASS Program. J Urban Health. 2010; 87(6): 954–968.
Acknowledgments
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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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). https://doi.org/10.1007/s11524-015-9968-x
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DOI: https://doi.org/10.1007/s11524-015-9968-x