Shaping HIV & Correctional Health Care: Research Questions Moving Forward. Redonna K. Chandler, Ph.D. Division of Epidemiology, Services, and Prevention Research National Institute on Drug Abuse July 22, 2012.
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Redonna K. Chandler, Ph.D.
Division of Epidemiology, Services, and Prevention Research
National Institute on Drug Abuse
July 22, 2012
U.S. imprisons more people per capita than any other country in the world, with 239% growth in 1990s
Source: International Centre for Prison Studies, www.prisonstudies.org
U.S. Adult Offender Population: Since 2005, combined federal, state, local adult correctional population has been over 7 million.
Source: Bureau of Justice Statistics, 2009
% Facilities Providing Service
Source: CJ-DATS National Criminal Justice Treatment Practices Survey, NIDA
IDU HIV+ Are Much Less Likely to Receive HAART
Percentage Of Providers Who Would Defer ART By CD4+ Count
and Injection Drug Use Status
Westergaard RP et al., J Int AIDS Soc 2012; 15:10.
HAART as HIV Prevention
Montaner et al., Lancet 2008
GD Kirk, et al., 2001, Poster presented at the 18th Conference on Retroviruses and Opportunistic Infections , Boston MA, February 27-March 3, 2011.
Treatment planning for drug abusing offenders should include strategies for chronic medical conditions (e.g. HIV/AIDS, Hep B/C, & TB)
In a Given Year . . .
About 14% of all people in the US with HIV,
& 33% of those with HCV,
& 40% of those with TB
-- will pass through a correctional facility.
Source: Spaulding et al. (2009); Hammett, Harmon, & Rhodes (2002). AJPH, 92 (11), 1789-1794.
(Court, Pre-Trial Release, Jail)
(Probation, Jail, Prison)
(Probation, Parole, Release)
State Receiving Funding
NIDA funded PI single award
NIDA + NIAID funded PI
NIMH funded PI
Percentage of Inmates Who Filled an
ART Prescription Within 60 Days of Release
Only a small percentage of Texas prison inmates
receiving ART while incarcerated filled an initial ART prescription within 60 days of release
Baillargeon J et al., JAMA 301(8):848-857, 2009.
Economy, Power, Answer New Questions
Increase cross-study comparability, collaboration, scientific yield
Multi-site pooling for integrative data analyses
Secondary data analyses
Maximizes gain while minimizing cost, risk, and time to payoff
Promotes construct quantification through integrative data analysis
VAS, HAART ACTG Questionnaire, ART Pill Count, Chart Review
Central core measures are used in every study, forming a pool of common items
Specialty core measures may be asked based on specific interests of a sub-set of studies
Example: Cost/Cost Effectiveness, Climate/Culture of Jails Regarding HIV Intervention, etc.