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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 CORRECTIONS

  • 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 CORRECTIONS

  • 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 CORRECTIONS

  • 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? CORRECTIONS

H = Human Virus

I = Immunodeficiency

V = Virus

A = Acquired

I = Immune

D = Deficiency

S = Syndrome



United states incarceration rates
United States Incarceration Rates CORRECTIONS

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.



14 CORRECTIONS

Dual Epidemics


Health and incarceration
Health and Incarceration CORRECTIONS

  • 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 CORRECTIONS

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 CORRECTIONS

  • 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 CORRECTIONS

  • 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 CORRECTIONS

  • 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 CORRECTIONS

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 CORRECTIONS

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 CORRECTIONS

Court

Community

Jail

Prison



25 CORRECTIONS

When Prison Enters the Picture


26 CORRECTIONS

Concurrent Relationships in the Community


Focus past and present

27 CORRECTIONS

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 CORRECTIONS

  • 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 CORRECTIONS

  • 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 CORRECTIONS

  • Disconnect between Corrections and Public Health

  • Different Cultural Identities

  • Security= Safety First

  • Operational Policies, Procedures and Relationships

  • Confidentiality

  • Ethical Considerations


The disconnect
The Disconnect CORRECTIONS

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 CORRECTIONS

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 CORRECTIONS

Prevention

Testing

Linkages to Care


Hiv prevention
HIV Prevention CORRECTIONS

  • 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 CORRECTIONS

  • 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 CORRECTIONS

  • 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.



Linkages to hiv care in inside in the community after release

38 CORRECTIONS

Linkages to HIV Care in Inside & in the Community After Release


Hiv linkages to care1
HIV Linkages to Care CORRECTIONS

  • 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 journey home

40 CORRECTIONS

The Journey Home


The linkage challenge
The Linkage Challenge CORRECTIONS

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 CORRECTIONS

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 CORRECTIONS

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.


Current local practices in linkages to care
Current Local Practices in CORRECTIONSLinkages to Care


What s happening out there 4 models of linkages to care

45 CORRECTIONS

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


California doc cdcr transitional case management program tcmp

46 CORRECTIONS

California DOC (CDCR)Transitional Case Management Program (TCMP)


Tcmp activities pre release

47 CORRECTIONS

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 CORRECTIONS

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


Nyc enhancing linkages program

49 CORRECTIONS

NYC Enhancing Linkages Program


50 CORRECTIONS

Jail Discharges to NYC Communities

by Zip Code and

Socioeconomic Status

2004


Nyc enhancing linkages service components
NYC Enhancing Linkages Service Components CORRECTIONS

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 CORRECTIONS

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 connected to care, post-release. Along with primary medical care, clients were also connected to:

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 connected to care, post-release. Along with primary medical care, clients were also connected to:

An HIV/STI/hepatitis risk reduction program

for people returning to the community

after incarceration


A bridge to success
A Bridge to Success connected to care, post-release. Along with primary medical care, clients were also connected to:

  • 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 connected to care, post-release. Along with primary medical care, clients were also connected to:

  • 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 connected to care, post-release. Along with primary medical care, clients were also connected to:

  • 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 connected to care, post-release. Along with primary medical care, clients were also connected to:

  • 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 connected to care, post-release. Along with primary medical care, clients were also connected to:

  • 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 Facilities

  • 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 Program FacilitiesKey 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 Program FacilitiesKey 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 Facilities

  • 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. Facilities

  • 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. Facilities

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


Stranded
Stranded Facilities


Hiv prevention in correctional settings
HIV Prevention in Correctional Settings Facilities

  • Inside Correctional Facilities

  • In Preparation for Release

  • Post Release Programs


Hiv prevention on the inside why is it important
HIV Prevention on the Inside: FacilitiesWhy 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 Facilities

  • Who

    • Peer Educators

    • Medical Staff

    • Education Staff

    • Community Providers


Hiv prevention on the inside1
HIV Prevention on the Inside Facilities

  • 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 Facilities

  • When

    • Upon Entry

    • During Existing Programs (education, vocation, etc.)

    • Pre-release Programs

    • Upon Release



Organizational readiness
Organizational Readiness: Facilities

  • 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.


Current local practices in hiv prevention
Current Local Practices in FacilitiesHIV Prevention


Cdc compendium
CDC Compendium Facilities

  • 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


DHAP’s Research to Practice Model Facilities

Diffusion of

Evidence-Based

Interventions

DEBI: Diffusion of Evidence-Based Interventions


Debi website for hiv prevention resources
DEBI Website for HIV Prevention Resources Facilities

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 Facilities

www.effectiveinterventions.org


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

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
SISTA FacilitiesSisters 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 Facilities

  • 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) Facilities

  • 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 Facilities

  • 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 Facilities

  • 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? Facilities

  • 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 Facilitiesin 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 Facilities

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.


Current local practices in hiv testing
Current Local Practices in FacilitiesHIV Testing


Cdc hiv testing for correctional settings
CDC HIV Testing for Correctional Settings Facilities

  • 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 FacilitiesHIV 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 Facilities

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 Facilities

  • 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 Facilities

  • Targeted testing

Repeat testing

Multiple time point testing


Targeted testing
Targeted Testing Facilities

  • 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 Facilities

  • 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 Facilities

  • Upon entry

  • Routinely throughout incarceration

  • Prior to release


Considerations for testing in a correctional setting
Considerations for Testing in a Correctional Setting Facilities

  • 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 Facilities

  • 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 Results 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.) Results

  • 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 Results

  • 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 Results

  • 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 Results

  • 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 Results

  • Next Steps

  • Training Evaluation

  • Good Luck!


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