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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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Shaping hiv correctional health care research questions moving forward
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


Shaping hiv correctional health care research questions moving forward

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


Shaping hiv correctional health care research questions moving forward

U.S. Adult Offender Population: in the world, with 239% growth in 1990s Since 2005, combined federal, state, local adult correctional population has been over 7 million.

Source: Bureau of Justice Statistics, 2009


Prevalence of health screening services in adult cj
Prevalence of Health Screening in the world, with 239% growth in 1990s & Services in Adult CJ

% Facilities Providing Service

Source: CJ-DATS National Criminal Justice Treatment Practices Survey, NIDA


Shaping hiv correctional health care research questions moving forward

IDU HIV+ Are Much Less Likely to Receive HAART in the world, with 239% growth in 1990s

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.


Unanswered research questions
Unanswered Research Questions in the world, with 239% growth in 1990s

  • How can HIV services be integrated across the criminal justice system?

  • What is the resistance?

  • What organizational change is needed?

  • What workforce is needed?

  • What implementation strategies work?

  • What will it cost and is it cost-effective?

  • What interventions are needed to reduce stigma associated with drug use, HIV, criminal justice involvement?


Shaping hiv correctional health care research questions moving forward

HAART as HIV Prevention in the world, with 239% growth in 1990s

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.


Shaping hiv correctional health care research questions moving forward

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.


Where and how do you implement sttr in the criminal justice system
Where and How do you Implement STTR in the Criminal Justice System?

ENTRY

(Arrest)

PROSECUTION

(Court, Pre-Trial Release, Jail)

ADJUDICATION

(Trial)

SENTENCING

(Fines, Community

Supervision,

Incarceration)

CORRECTIONS

(Probation, Jail, Prison)

COMMUNITY

REENTRY

(Probation, Parole, Release)

Key Players

Crime victim

Police

FBI

Crime victim

Police

FBI

Judge

Prosecutor

Defense Attorney

Defendant

Jury

Judge

Judge

Jury

Probation

Officers

Correctional

Personnel

Probation/ Parole

Officers

Family

Community-based

providers

Intervention Opportunities

Drug treatment

Aftercare

Housing

Employment

Mental Health

Half-way House

TASC

Screening/

Referral

Diversion Programs

Drug Courts

Community Treatment

TASC

N/A

Drug Court

Terms of

Incarceration

Release Conditions

Drug Treatment

Seek

Test

Treat

Retain


Seek test treat addressing hiv in the criminal justice system
Seek, Test, & Treat System?: Addressing HIVin the Criminal Justice System

```

Vietnam

State Receiving Funding

NIDA funded PI single award

NIDA + NIAID funded PI

NIMH funded PI

Jail/Prison Location

Puerto Rico


How do we implement effective interventions
How do we Implement Effective Interventions? System?

  • What is the cost of STTR? Is it cost-effective?

  • What assessment tools can communities use to determine which evidence-based STTR components to implement?

  • What are the structural/organizational requirements for different evidence-based STTR interventions?

  • What implementation strategies facilitate uptake?


Shaping hiv correctional health care research questions moving forward

Percentage of Inmates Who Filled an System?

ART Prescription Within 60 Days of Release

100

Only a small percentage of Texas prison inmates

receiving ART while incarcerated filled an initial ART prescription within 60 days of release

80

60

Percent

30%

40

17.7%

20

5.4%

0

Had prescription

filled within:

10days

30 days

60 days

Baillargeon J et al., JAMA 301(8):848-857, 2009.


How do we promote patient sustained adherence to haart
How do we Promote Patient Sustained Adherence to HAART? System?

  • What is the role of addiction treatment (including medication) in HAART adherence?

  • What individual barriers impede HAART adherence?

  • What structural and cj system barriers impede HAART adherence?

  • What role can technology play in HAART adherence?



Why harmonize

Economy, Power, Answer New Questions System?

Increase cross-study comparability, collaboration, scientific yield

Multi-site pooling for integrative data analyses

Cross-site replication/comparisons

Meta analyses

Secondary data analyses

Maximizes gain while minimizing cost, risk, and time to payoff

Promotes construct quantification through integrative data analysis

Why Harmonize?


The cores

VAS, HAART ACTG Questionnaire, ART Pill Count, Chart Review System?

Construct Level

Measure Level

Item Level

The Cores

Core Domains

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.


Thank you questions
Thank You System?Questions

www.drugabuse.gov/aids