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CJDATS HIV SERVICES AND TREATMENT IMPLEMENTATION IN CORRECTIONS. Barry Zack and Katie Kramer The Bridging Group. Goal of Training. To provide a baseline level of knowledge on HIV prevention programs and testing within correctional settings and linkages to care upon community release.

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cjdats hiv services and treatment implementation in corrections

CJDATS HIV SERVICES AND TREATMENT IMPLEMENTATION IN CORRECTIONS

Barry Zack and Katie Kramer

The Bridging Group

goal of training
Goal of Training
  • To provide a baseline level of knowledge on HIV prevention programs and testing within correctional settings and linkages to care upon community release.
training objectives
Training Objectives
  • Present an overview of best practices in HIV prevention programs and testing within correctional settings and linkages to care upon community reentry.
  • Provide an in-depth review on HIV linkages to care policies and practices within correctional settings.
  • Highlight the important role of prisons and jails in HIV linkages to care policies and practices.
participant introductions
Participant Introductions
  • Your Name
  • Agency and Position in Agency
  • Years Working in or with a Correctional Agency
  • Experience with HIV/AIDS
    • Testing, prevention, linkages to care
  • Expectations from Training
  • First Musical Concert and/or Event
what is hiv and aids
What is HIV and AIDS?

H = Human Virus

I = Immunodeficiency

V = Virus

A = Acquired

I = Immune

D = Deficiency

S = Syndrome

united states incarceration rates
United States Incarceration Rates

More than 1 in 100 American adults were incarcerated at the start of 2008.

One in every 31 American adults, or 7.3 million Americans, are in prison, on parole or probation.

US has over 25% of all people incarcerated worldwide.

Approximately one in every 18 men in the US is behind bars or being monitored.

US Dept of Justice, Bureau of Justice Statistics. Prisoners in 2006. NCJ publication 219416.

slide14

14

Dual Epidemics

health and incarceration
Health and Incarceration
  • HIV/AIDS - 2 ½ times the national rate
  • STIs, Hepatitis, TB - significantly higher
  • Mental Health - 45-64%
    • 10-17% SMI
  • Substance Use – 43-69%
    • 30% have co-occurring SMI
  • Chronic Conditions - significantly higher
    • Hypertension
    • Diabetes
top 10 hiv rates among incarcerated populations
Top 10 HIV Rates Among Incarcerated Populations

US Dept of Justice, Bureau of Justice Statistics. HIV in Prisons, 2005; Appendix Tables 1 and 2. NCJ publication 218915. http://www.ojp.gov/bjs/pub/pdf/hivp05.pdf. Published Sept. 2007. Accessed Jan 9, 2008.

hiv transmission in correctional settings
HIV Transmission in Correctional Settings
  • Majority of HIV-positive people are infected before they enter prison1
  • HIV risk behaviors often continue inside the institution and include injecting drug use, tattooing, body piercing, and consensual, nonconsensual, and survival sexual activities2
  • Scarcity of sterile drug paraphernalia leads to needle sharing in prison3
  • Needle sharing among soon-to-be released individuals is high4
  • Among IDUs in New Mexico, 37.6% of those with tattoos received them in jail or prison5

1. CDC. MMWR. 2006;55(15):421-426. 4. Stephens TT et al. Am J Health Stud. 2005.

2. Hammett TM. Am J Pub Health. 2006;96(6):974-978. 5. Samuel MC et al. Epidemiol Infect. 2001;127:475-484

3. Davies R. Lancet. 2004:364:317-318.

hiv prevalence among those released from prison jail in 2006
HIV Prevalence Among Those Released From Prison/Jail in 2006
  • Estimate of proportion of HIV+ persons in US who passed through a jail or prison in 2006
  • 1 of 7 (14.1%) of all HIV+ in US were released from incarceration in 2006
    • At least 22% of all HIV+ black men in US passed through a correctional facility during 2006

14.1

85.9

Incarcerated/released

Not incarcerated

Total US HIV population ~ 1.1 million

Spaulding A, et al. PLoS One. 2010.

hcv hiv co infection in correctional systems
HCV/HIV Co-infection in Correctional Systems
  • Maryland Division of Correction and Baltimore City Detention Center (January-March 2002)[1]
    • 29.7% HCV+
    • 6.6% HIV+
    • 4% HCV/HIV co-infected
  • CDC Prison Study[2]
    • 8.2% of HCV+ inmates had HIV
    • 70% of HIV+ inmates had HCV
  • Entrants to 3 large city jails (Detroit, Chicago, San Francisco)[2]
    • 9.2% to 15.7% HCV+
    • 1.8% to 2.6% HIV+
    • ~ 1% HCV/HIV co-infected

1. Solomon L, et al. J Urban Health. 2004;81:25-37. 2. Weinbaum C, et al. AIDS 2005, 19 (suppl 3):S41–S46 .3. Weinberg C, et al. APHA Annual Meeting 2003. Abstract 5097.0.

drug abuse or dependence and mental health disorders state prison

21

Drug Abuse or Dependence and Mental Health Disorders – State Prison

Belen, S.,  (2011). Treatment needs and treatment options for drug-involved inmates: Opportunities and challenges.  Yale University Law School Sentencing Workshop.

behavioral health disorders by offense type
Behavioral Health Disorders by Offense Type

22

*p <. 001

Belen, S.,  (2011). Treatment needs and treatment options for drug-involved inmates: Opportunities and challenges.  Yale University Law School Sentencing Workshop.

22

cycle of incarceration
Cycle of Incarceration

Court

Community

Jail

Prison

slide25

25

When Prison Enters the Picture

slide26

26

Concurrent Relationships in the Community

focus past and present

27

Focus: Past and Present
  • History of HIV Prevention in Correctional Settings
    • Testing in late 80’s/early 90’s to isolate
    • Move away from testing in mid 90’s – “have to treat”
    • Mid 2000’s – up swing in testing as treatment became cheaper and more available
  • Current Research Projects
    • NIDA: CJ-DATS * NIDA/NIMH: Seek, Test and Treat
    • CDC: Proof of Concept * SAMHSA: Criminal Justice Initiative
  • Recent US Supreme Court Decision
    • Overcrowding results in unconstitutional level of healthcare/140% of capacity
a community at risk
A Community at Risk
  • Reality Check:
    • It is estimated that each year, 14 - 25% of all HIV positive persons in the US spend time in prison or jail.
  • People come into facility with higher rates of infectious diseases
  • Most people (over 90%) in correctional facility will return to the community
  • Incarcerated does not occur in a vacuum. People move in and out of prisons and jails and likewise move in and out of communities and relationships.
  • Correctional medical care and health programs represent an opportunity to improve community health
a unique opportunity
A Unique Opportunity
  • High turnover of people in prisons and jails creates a flow of individuals who may have access to health care only when incarcerated.
  • The correctional setting may be the only place where people get care, treatment and support.
issues to consider
Issues to Consider
  • Disconnect between Corrections and Public Health
  • Different Cultural Identities
  • Security= Safety First
  • Operational Policies, Procedures and Relationships
  • Confidentiality
  • Ethical Considerations
the disconnect
The Disconnect

Public Health

Corrections

  • Mission = Public Health
  • Orientation toward Change
  • Humanitarian
  • Dress code is Informal
  • Prevention/Care/Dx
  • Client-Centered
  • Flexibility
  • Creative
  • Mission = Public Safety
  • Orientation toward Order
  • Para-Military
  • Dress code is Uniform
  • Punishment
  • Institution-Centered
  • Rules
  • Standard Operating Procedures
addressing hiv supports the mission of corrections

32

Addressing HIV Supports the Mission of Corrections
  • Safety and security is the number one priority of every correctional facility.
  • Effective HIV testing, prevention and linkages to care programs can contribute to the safety and security mission of a correctional facility.

“People, who are actively working to better themselves, are less likely to get into trouble on the inside. Thus, more programs make my prison safer.”

- Former Warden, San Quentin State Prison

hiv services continuum
HIV Services Continuum

Prevention

Testing

Linkages to Care

hiv prevention
HIV Prevention
  • Provide HIV information, education and/or skills building about preventing the spread of HIV
  • Different types of programs include workshops, peer education programs, one-on-one outreach, health fairs, educational brochures, etc.
  • Models
    • Peer based
    • Educational Services
    • Medical services
hiv testing
HIV Testing
  • HIV and other disease screening
  • Confirmatory test
  • Models
    • Mandatory vs. voluntary
    • Timing (entry, during incarceration, at release)
    • Pre/post counseling
    • Tied in to other HIV prevention programs
hiv linkages to care
HIV Linkages to Care
  • Linkages to HIV treatment providers in the community after release
  • Seamless medical care
  • Additional support services
    • case managers, benefits counselors
  • Access to other treatment providers
    • substance treatment, mental health, etc.
hiv linkages to care1
HIV Linkages to Care
  • Discharge planning
    • medications, benefits paperwork, medical records
  • Linkages to HIV treatment providers in the community after release
    • seamless medical care
  • Additional support services
    • case managers, benefits counselors
  • Access to other treatment providers
    • substance treatment, mental health, etc.
the linkage challenge
The Linkage Challenge

Freedom

Incarceration

What are we doing?

  • Screening
  • Diagnosis
    • Infectious diseases (HIV, STI, TB, HCV, HBV)
    • Mental illness
    • Substance abuse
  • Treatment
  • Pre-release planning

Making the transition work!

  • Linkage to care and services
  • Treatment
    • ID (HIV, HCV, STIs, HBV, etc.)
    • Chronic (hypertension, diabetes)
    • Substance Use & Mental Health
  • Adequate community resources
  • Addressing life’s competing priorities

Reincarceration

How to break the cycle?

  • Societal challenge (poverty, discrimination, etc.)
  • Policy (Sentencing, Drugs, Housing, Sex Offenders)
linkages to care spectrum

42

Linkages to Care Spectrum
  • Inside Only Model
    • Planning begins near release with continuation of case management until release
  • Released Focused Model
    • Brief planning happens near release with continuation of case management after release
  • Inside/Out Model
    • Ongoing planning and case management occur inside and continues in the community after release
ncchc position statement on hiv discharge planning in correctional facilities

43

NCCHC Position Statement on HIV Discharge Planning in Correctional Facilities
  • HIV-positive individuals need to receive prevention, education, and treatment that continues upon release.
  • It can be difficult for HIV-positive individuals to find health care services outside a correctional environment.
  • Individuals on treatment inside need to have continuity of care upon discharge from jail or prison.
  • Give sufficient supplies of medications at release (14-30 days).
  • Provide instruction on the importance of medication adherence.
what s happening out there 4 models of linkages to care

45

What’s happening out there: 4 Models of Linkages to Care
  • California DOC Transitional Case Management Program (TCMP)
  • NYC Enhancing Linkages Program
  • CDC Project START (HIV-positive adaption)
  • Hampden County Public Health Model of Care in Correctional Facilities
tcmp activities pre release

47

TCMP Activities: Pre-Release
  • In-depth interview 90 days prior to release
    • Build relationship and confidence with client
    • Act as liaison between prison medical staff, community service providers, and parole officers
    • Conduct psychosocial needs assessment (immediate needs, id, housing, ADAP, SSI/medi-cal, substance abuse)
    • Develop care plan based on individual’s needs upon release
  • Care planning 60 days to release
    • Match needs with long-term community service provider
    • Meet with individual to discuss options from care plan
    • Provide individual with information and referrals
tcmp activities post release

48

TCMP Activities: Post-Release
  • Post-Release support/follow-up for 60 to 90 day
    • Meet with client within first 48 hours of release
    • Provide client with Parole Packet - i.e. condom, prevention telephone card, toiletry items, resource information
    • Encourage client to keep planned appointments
    • Encourage client to participate in community peer support group
  • Help client identify risky behaviors
  • Empower participant to begin to make choices
  • Discuss prison vs. free world obstacles
slide50

50

Jail Discharges to NYC Communities

by Zip Code and

Socioeconomic Status

2004

nyc enhancing linkages service components
NYC Enhancing Linkages Service Components

Identify population & engage client

use electronic health records

Court advocacy

Conduct assessment

Screen for benefits

Arrange 7 day supply of discharge medications

51

nyc enhancing linkages service components cont

52

NYC Enhancing Linkages Service Components (cont.)
  • Facilitate continuity of care
    • Aftercare letters / transfer medical information
    • Make appointments / walk-in arrangements
    • Arrange transportation / accompaniment
  • Coordinate post-release plan/community case management
    • Housing
    • Substance abuse/Mental health treatment
    • Social services
connection to care results

Nearly 80% of clients in who receive a discharge plan were connected to care, post-release. Along with primary medical care, clients were also connected to:

  • Medical case management (53%)
  • Substance abuse treatment (52%)
  • Housing services (29%)
  • Court advocacy (18%)

Approximately 65% of clients accept the offer of accompaniment and / or transport to their medical appointment.

The THCC home visit team has been able to locate 90% of people referred to it, finding that approximately one-third of those referred have been re-incarcerated.

53

Connection to Care Results
the first 33

54

The First 33

Clinical indicator changes from jail (JCR) to 6 months post release (FCR) for the first 33 participants with complete clinical data:

  • 25 (76%) had a decreased viral load
  • 94% showed a stable or improved cd4 count
    • 2 had a meaningful drop in cd4 count.
  • Statistically significant changes to both average CD4 and viral load
    • cd4 up by 50 (from 372 to 422)
    • vl load down by ~42,000 copies (from 55,795 to 13,852)
  • 9 patients were not on ART on admit; 2 not at release
    • 25/29 on ART at release received walking meds and 21d Rx
  • 2 patients were reported as not on ART at the 6-month follow-up.
    • 1 not on ART at release and one other; both had undetectable VL at f/u
project start
Project START

An HIV/STI/hepatitis risk reduction program

for people returning to the community

after incarceration

a bridge to success
A Bridge to Success
  • Is a short-term individual level program = 5 months
    • 2 months pre-release
    • 3 months post-release
    • Begins before release & continues in the community after release
  • Helps clients to “bridge” from the “inside” to community-based services on the “outside” that support their HIV/STI/hepatitis risk reduction and transitional goals
  • Does not replace longer term comprehensive systems of care
basic structure of project start
Basic Structure of Project START
  • Enrollment plus six one-on-one sessions:
    • Two sessions completed before release
    • Four sessions completed after release
  • Other sessions as needed.
  • Required tasks per session.
    • Risk assessment, ▫ Goal setting
    • Transitional needs ▫ Strengthening motivation
    • Facilitated referrals ▫ Providing condoms
  • Supplemental exercises as needed.
sessions 1 2 overview pre release
Sessions 1-2 Overview: Pre-Release
  • Assess HIV/STIs/hepatitis knowledge
  • Provide information on transmission & risk of HIV/STIs/Hepatitis
  • Discuss personal risk behaviors
  • Develop individual risk reduction and transitional plans
  • Facilitate behavioral skills practice (communication, problem solving, goal setting, & condom use)
  • Facilitate post-release service referrals for housing, employment, substance abuse treatment, etc.
sessions 3 6 overview post release
Sessions 3-6 Overview: Post-Release
  • Provide ongoing risk behavior & goal assessment/ revision
  • Provide ongoing transitional goal assessment/revision
  • Problem solve to overcome barriers and capitalize on facilitators
  • Provide ongoing availability of resource materials including condoms and lubricants
  • Acknowledge & support accomplishments
  • Facilitate service referrals to ongoing community services as needed
adaptation for hiv linkages to care
Adaptation for HIV+ Linkages to Care
  • Additional Session Inside
    • Discharge planning (medication supply, medical records, prescription, adherence)
    • Benefits/ADAP
    • Linkage to community medical provider
    • Disclosure and living with HIV in the community
  • Post Release Follow-up
    • Review discharge plan along with risk reduction plan (secondary prevention)
  • Pilot with MA Department of Public Health
    • 71% of participants attended first medical appt after release (N=33)
hampden county public health model for correctional facilities
Hampden County Public Health Model for Correctional Facilities
  • Community Health Clinics provide medical care inside the correctional facilities
    • Providers are linked to clients by zip code
    • Medical providers inside are the same medical providers in the community
  • One electronic medical record system
    • Medical providers have access to system while inside
  • One medical appointment system
hampden county linkages program service components
Hampden County Linkages Program Service Components
  • Assessment
  • Development of discharge plan
  • Linkage to care with same community provider seen inside
  • Preparation for initial health care appointment once released
  • Referrals to appropriate community resources
    • Housing, vocational, financial, legal
  • Advocacy
hampden county linkages program key activities pre sentence
Hampden County Linkages ProgramKey Activities: Pre-Sentence
  • Planning begins at time of intake into the correctional facility
  • Key activities- Pre-sentence
    • Track court dates (to determine release)
    • Establish plan of care to present to court (pre-sentencing)
    • Accompany individual to transitional program if released by courts
hampden county linkages program key activities post sentence
Hampden County Linkages ProgramKey Activities: Post-Sentence
  • Identify individual receiving health care in the facility 4-6 weeks prior to release
  • Start application for Medicaid/ADAP
  • Assure individuals on regimens leave with 5 day supply and prescription refill
  • Individuals leave with appointment for medical services in the community
critical issues for a successful linkages program
Critical Issues for a Successful Linkages Program
  • Collaboration with the right community partners
    • Network of community providers for medical & life needs
    • Organizational capacity to work with population and/or in a correctional facility.
    • Good access and location
  • Strong recruitment and referral systems
    • Obtain accurate information on release date
  • Successful staffing pattern
    • Hire the right staff and support them/limit staff turnover
    • Same staff work with the client both before and post release
critical issues cont
Critical Issues, cont.
  • Effective program design
    • Conduct face-to-face meetings before and after release
    • Have an immediate release plan for the first 24-48 hours
    • Make specific medical, treatment and social service appts
    • First post release session within 24-48 hours/meet at gate
    • Confirm housing upon release
    • Escort individuals to initial appointments
  • Comprehensive planning
    • ADAP application
    • Release of information; HIPAA
    • Treatment: HIV, substance use, mental health
    • Competing priorities: housing, income, family/social
    • Be aware of the conditions of parole and/or probation
critical issues cont1
Critical Issues, cont.

Prioritize staff safety

Crisis protocols

Safety plan for field work

Active retention strategies

Comprehensive locator information

Use of incentives

Outreach and/or field locations

Address reincarceration

Continue services as able

hiv prevention in correctional settings
HIV Prevention in Correctional Settings
  • Inside Correctional Facilities
  • In Preparation for Release
  • Post Release Programs
hiv prevention on the inside why is it important
HIV Prevention on the Inside: Why is it Important?
  • Risks outside coming in
  • Risk inside going out
  • Prevalence rates
  • “A Unique Opportunity”
hiv prevention on the inside
HIV Prevention on the Inside
  • Who
    • Peer Educators
    • Medical Staff
    • Education Staff
    • Community Providers
hiv prevention on the inside1
HIV Prevention on the Inside
  • What
    • Distribution of educational materials (brochures, posters, etc. at intake, in waiting rooms, and other locations)
    • Single session workshops to multi-session workshops
    • Health fairs
    • Evidence-based interventions
hiv prevention on the inside2
HIV Prevention on the Inside
  • When
    • Upon Entry
    • During Existing Programs (education, vocation, etc.)
    • Pre-release Programs
    • Upon Release
organizational readiness
Organizational Readiness:
  • Correctional Readiness:
    • your agency’s ability to identify, approach, and work effectively with a correctional facility.
  • HIV, Sexually Transmitted Infection and Hepatitis Prevention Education Readiness:
    • your agency’s ability to provide HIV, sexually transmitted infection and hepatitis prevention programs, and to identify additional resources as needed.
  • Agency Readiness:
    • your agency’s ability to find the necessary funding and support to sustain the program within your existing organizational structure.
  • Community Readiness:
    • your agency’s ability to identify, approach, and work effectively with community partners to provide a network of support and services for clients after release.
cdc compendium
CDC Compendium
  • Currently identify 69 evidence-based interventions for different populations, and risk behavior categories
  • Now in electronic version: www.cdc.gov/hiv/topics/research/prs/evidence-based-interventions.htm
slide78

DHAP’s Research to Practice Model

Diffusion of

Evidence-Based

Interventions

DEBI: Diffusion of Evidence-Based Interventions

debi website for hiv prevention resources
DEBI Website for HIV Prevention Resources

www.effectiveinterventions.org

  • Sample budgets
  • Fact sheets and Readiness scales
  • Logic models
  • Implementation planning tools
  • Monitoring and fidelity tools and more
debi website resources
DEBI Website - Resources

www.effectiveinterventions.org

current debi interventions for correctional settings
Current DEBI Interventions for Correctional Settings

HIV 101

IDU

  • RESPECT
  • SISTA
  • VOICES/VOCES
  • Healthy Relationships
  • WILLOW
  • Safety Counts
  • Modelo Intervencio Psicomedica (MIP)
  • SHEILD
  • Holistic Health Recovery Program (HHRP)
  • CLEAR
  • Project START

Prevention for Positives

Reentry/Risk Reduction

sista sisters informing sisters on topics about aids
SISTASisters Informing Sisters on Topics about AIDS
  • A group level intervention
  • Designed for heterosexual African American women, ages of 18-29
  • Gender and culturally specific
  • Sessions focus on ethnic and gender pride, HIV knowledge, and skills training around sexual risk reduction behaviors, communication, and decision making.
healthy relationships
Healthy Relationships
  • A small-group level intervention
  • Targets men and women living with HIV/AIDS
  • Involves defining stress and reinforce coping skills with HIV-infected people across three life areas:
    • Disclosing to family and friends
    • Disclosing to sexual partners
    • Building healthier and safer relationships
  • Designed to reduce sexual risk behaviors and improve condom negotiation skills
holistic health recovery program hhrp
Holistic Health Recovery Program (HHRP)
  • A 12 session, manual-guided group level intervention
  • Designed for HIV-positive and HIV-negative injection drug users
  • Harm reduction approach aimed at reducing both high-risk drug use and sexual behaviors and improving medical, psychological, and social functioning
  • Skills-based including negotiation, decision-making, problem solving, goal setting, and stress management.
project start1
Project START
  • An individual level intervention for incarcerated individuals
  • Sessions are delivered to individuals prior to release and then sessions delivered after the individual has been released back to the community
  • Agencies with a history of working in prisons/jails and also have a history of working with previously incarcerated individuals have the capacity to implement Project START
hiv testing in correctional settings
HIV Testing in Correctional Settings
  • Current Practices
  • CDC Guidance & Other Standards
  • Testing Options
  • Testing Methods
  • Providing Results and Support
  • Privacy and Confidentiality
why test in the correctional setting
Why Test in the Correctional Setting?
  • A public health opportunity to reach “the hard to reach”
  • If HIV negative, education to stay negative
  • If HIV positive:
    • Clinical monitoring
    • Access to treatment inside
    • Linkages to care upon release
hiv testing policies hiv aids in us prisons at year end 2006
HIV Testing Policies & HIV AIDS in US Prisons at Year End 2006
  • All state prison systems offer HIV testing at some point (admission, in custody or upon release), but gaps exist
  • Only 22 states test all individuals at admission
  • CDC-recommended HIV pre-discharge testing in high-prevalence states not widely followed: only 6 states test at discharge

(Maruschak, 2009)

hiv testing policies by state
HIV Testing Policies by State

No testing required

On entry

On release

On entry and

in custody

On entry and

on release

In custody and

on release

On entry,

in custody, and

on release

Not reported

All states test upon inmate requestexcept NH, IA, AL, KY, UT, and NV

US Dept of Justice, Bureau of Justice Statistics. HIV in Prisons, 2005; Appendix, Table 5. NCJ publication 218915. http://www.ojp.usdoj.gov/bjs/pub/pdf/p05.pdf. Published Sept. 2007. Accessed Jan 9, 2008.

cdc hiv testing for correctional settings
CDC HIV Testing for Correctional Settings
  • Background on HIV/AIDS & Corrections
  • Opt-out Testing
    • Benefits, tips, alternative options
  • Privacy and Confidentiality
  • HIV Testing Procedures
    • Conventional, rapid, result notification, counseling
  • Linkages to Services
  • Challenges and Solutions
  • HIV/AIDS Reporting
ncchc position statement on hiv testing in correctional facilities
NCCHC Position Statement on HIV Testing in Correctional Facilities
  • Include HIV testing, when indicated, as part of routine medical care
  • Provide on a voluntary basis
  • Encouraged testing with high-risk individuals
  • Make HIV education for women a priority, encourage them to test for HIV if pregnant.
  • However, HIV testing should not be performed without specific patient informed consent
testing options
Testing Options

Voluntary vs.

Opt-out vs.

Default is to test

Test performed unless individual actively declines

Permission is inferred

Mandatory

Opt-in

  • Default is to not test
  • Test can be routinely offered but not performed unless individual actively accepts
benefits opt out hiv screening
Benefits Opt-out HIV Screening
  • Increases diagnosis of HIV infection;
  • Preserves staff resources by streamlining the process;
  • Reduces stigma associated with testing;
  • Potentially diagnoses HIV infection earlier for the individual; and
  • Improves access to HIV clinical care and prevention services.
opt out approaches to hiv testing in correctional settings
Opt-out Approaches to HIV Testing in Correctional Settings
  • Targeted testing

Repeat testing

Multiple time point testing

targeted testing
Targeted Testing
  • Risk-based screenings
    • IDU, MSM, sex worker
  • Clinical indication
    • pregnant, history of STD, symptoms of HIV infection
  • Client demographic
    • income level, age, gender identity
  • Criminal behavior
    • multiple incarcerations, type of crime
repeat testing
Repeat Testing
  • Routinely offering HIV testing annually to persons known to be at high risk for HIV infection
    • IDU’s
    • MSM
    • Persons who have engaged in drug use or sexual activity while incarcerated.
  • May be a more viable option in prison settings vs. jail settings
multiple time point testing
Multiple Time Point Testing
  • Upon entry
  • Routinely throughout incarceration
  • Prior to release
considerations for testing in a correctional setting
Considerations for Testing in a Correctional Setting
  • Method and Risk
    • Blood/needles vs. swab
  • Results Turnaround
    • Especially relevant to jail facilities
  • Staffing Required
    • Phlebotomist for taking blood

And the science continues to evolve….

general recommendations for providing hiv test results
General Recommendations for Providing HIV Test Results
  • Provide HIV test results in a confidential and timely manner.
  • Communicate results in a manner similar to other serious diagnostic/screening tests.
  • Clearly explain test results to the individual.
  • Individuals with a negative result may receive information in person or through confidential written notification.
special considerations when providing positive hiv test results
Special Considerations when Providing Positive HIV Test Results
  • Individuals with positive results should be notified only in person in a private setting.
  • Allow time for the individual to understand the meaning of the positive test result.
  • Determine the next steps for his or her clinical management.
  • Provide immediate mental health or social services support as needed.
  • Follow all applicable state and local laws and regulations related to reporting of HIV/AIDS cases.
recommendations for ensuring privacy and confidentiality
Recommendations for Ensuring Privacy and Confidentiality
  • Challenge to protect privacy and confidentiality while maintaining security of correctional facility.
  • Confidentiality measures should be incorporated into all health-care services for individuals, including HIV prevention services.
confidentiality and privacy cont
Confidentiality and Privacy (cont.)
  • Secure health-care information
    • Keep medical records inaccessible to non-health-care personnel including on computer screens, desk counter tops, or logbooks.
  • Avoid identification of HIV-related clinic visits.
  • Ensure privacy for prescribed HIV medications.
  • Use professional interpreters as needed.
    • Have a signed confidentiality agreement on file.
correctional resources
Correctional Resources
  • CDC Correctional Health Website
    • www.cdc.gov/correctionalhealth/
  • American Correctional Association (ACA)
    • www.aca.org/
  • National Commission on Correctional Health Care (NCCHC)
    • www.ncchc.org/
  • Bureau of Justice Statistics
    • www.ojp.usdoj.gov/bjs/
review training objectives
Review Training Objectives
  • Present an overview of best practices in prevention, testing and linkages to care.
  • Provide an in-depth review on HIV linkages to care policies and practices.
  • Highlight the important role of prisons and jails in HIV linkages to care policies and practices.
acknowledgements
Acknowledgements
  • John Miles
  • Thomas Coyne
  • David Wohl
  • Curt Beckwith
  • Ted Hammitt
  • Jody Rich
  • Tim Flanigan
  • Laurie Reid
  • Rick Altice
  • Ann Spaulding
  • Alison Jordan
  • Steve Belen
  • Dan O’Connell
  • Jacques Baillargeon
  • Mick Gardner
  • Robin Macgowan
  • Andrew Margolis
  • David Paar
  • Marc Stern
  • Individuals serving time on the Inside
  • DPH (CDC, State and Local)
  • DOC, Sheriff’s and Jail personnel
  • And so many others….
training wrap up
Training Wrap-Up
  • Next Steps
  • Training Evaluation
  • Good Luck!
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