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Enhancing HIV Care Continuum in Prison Release Programs: Challenges and Solutions

Explore the complexities of HIV care in pre-release programs, understand the differences between prisons and jails, and the crucial role of collaboration in providing effective care and prevention strategies for HIV-infected inmates transitioning back to their communities. Discover the impact of socioeconomic factors, stigma, and disparities in healthcare access on HIV prevalence among incarcerated populations. Gain insights into the initiatives such as the Pre-Release Planning Program (PRPP) and Jail Linkage Program (JLP) that facilitate HIV testing, treatment linkage, and prevention education. Evaluate the effectiveness of Peer Education Training Programs (PET) and Community Linkage Coordinators in improving health outcomes for HIV-positive inmates. Learn about the challenges and future strategies in managing HIV/AIDS in correctional facilities.

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Enhancing HIV Care Continuum in Prison Release Programs: Challenges and Solutions

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  1. Florida Department of Health: Corrections Programs Prison Pre-Release Planning and Jail Linkage Division of Disease Control and Health Protection

  2. Introduction • HIV Care Continuum • Prisons vs Jails • Counseling and Testing • Prevention and Linkage • Collaboration and Challenges Division of Disease Control and Health Protection

  3. HIV Care Continuum Cascade cascade source: www.aids.gov Division of Disease Control and Health Protection

  4. Socioeconomic Factors and HIV • Poverty • Discrimination, stigma • HIV Prevalence • Undiagnosed/untreated STDs • Language barriers • Incarceration Division of Disease Control and Health Protection

  5. Differences: Prisons vs Jails • Prisons • Funded/operated by state • Length of stay between 3 - 5 years • Level of care similar to community standards Division of Disease Control and Health Protection

  6. HIV-infected Inmates • HIV/AIDS rates in corrections settings are 3 - 5 times higher than general population • Over 95% of inmates will return to their communities • Appx 100,000 inmates in FL prison system ... about 3,000 have HIV/AIDS • Appx 100 HIV-infected inmates leave prison each month Division of Disease Control and Health Protection

  7. Pre-Release Planning Program (PRPP) • DOC mandated to test for HIV within 60 days of inmate's release • DOH contracts with DOC to provide PRPP services to HIV-infected inmates • Contract totals $450,000 • PRPP includes all DOC institutions and some transitional programs • Funded by Ryan White Part B Division of Disease Control and Health Protection

  8. Pre-Release Planning Program (PRPP) • Five PRPP planners employed by DOC - divided among 5 regions • Planner coordinates with CBO or medical providers to link inmate to care • Inmates given copies of med record if requested and 30-day supply of meds Division of Disease Control and Health Protection

  9. PRPP Inmates Served CY 2012-13 (n=1,618 thru Oct 2013) Division of Disease Control and Health Protection

  10. PRP Map Division of Disease Control and Health Protection

  11. Community Linkage Coordinators (CLC) • More intensive services in Broward, Miami-Dade and Orange counties • PRPP and CLC coordinate inmate appointments upon release from prison • Medical appointment within one week of release • Linkages to medical, SAMH, ADAP, case mgmt, housing, transportation, etc • Up to six-month follow up with inmate after release Division of Disease Control and Health Protection

  12. CLC Inmates Served CY 2012-13 (n=315 thru Oct 2013) Division of Disease Control and Health Protection

  13. Peer Education Training Program (PET) • DOC program located at Central Florida Reception Center (CFRC) • Provide peer education train-the-trainer sessions • Education and prevention information • Trainer supervises inmate peer educators as they conduct sessions Division of Disease Control and Health Protection

  14. Peer Education Training Program (PET) • 2012: • 2 train-the trainer classes held • 8 inmate peer educators trained • 57 orientation sessions held • 4,176 inmates attended sessions • 2,977 (71.3%) requested HIV test after sessions Division of Disease Control and Health Protection

  15. Differences: Prisons vs Jails • Jails • Funded/operated by local govt • Length of stay between 23 - 46 days, not more than 1 year • Appx 50% released within 48 hours Division of Disease Control and Health Protection

  16. Jail Linkage Program (JLP) • Counties submitted proposals to provide services • JLPs operate through CHD with no contracts • Instead use MOAs • JLP located in 16 jails • Funding appx $1.2 million Division of Disease Control and Health Protection

  17. JLP Inmates Tested CY 2012-13 (n=47,762 thru Sept 2013) 0.5% Positive 0.8% Positive 0.6% Overall Positive Rate Division of Disease Control and Health Protection

  18. JLP Linkages CY 2012-13 (n=3,959 thru Sept 2013) Division of Disease Control and Health Protection

  19. JLP Annual Comparison Testing, Linkages, Positives 2008-2013 (thru Sept 2013) Division of Disease Control and Health Protection

  20. Jail Linkage Program (JLP) • Bureau of Communicable Diseases • Florida Department of Health • JLP in 16 Counties: • 15 Counties funded by DOH • 1 County unfunded (Monroe) Division of Disease Control and Health Protection

  21. Corrections Infections Workgroup HIV/AIDS Epidemiology Hepatitis Education STD and TB Substance Abuse/Mental Health Corrections Correctional Medical Authority Juvenile Justice Division of Disease Control and Health Protection

  22. Challenges: The Future • Funding • Sequestration Round 1 - 2013 • Sequestration Round 2 - 2014 • Program evaluations/reviews • "High-impact" prevention Division of Disease Control and Health Protection

  23. www.floridahealth.gov Division of Disease Control and Health Protection

  24. HIV Care Continuum Cascade + Literacy Overall: HIV+ more common with < HS education Almost half FL HIV+ inmates < HS education cascade source: www.aids.gov Division of Disease Control and Health Protection

  25. HIV Care Continuum Cascade + Unemployed Overall: 45% are unemployed 88% FL HIV+ inmates with min-mod skills cascade source: www.aids.gov Division of Disease Control and Health Protection

  26. HIV Care Continuum Cascade + Depression Overall: 33% to 60% affected by depression cascade source: www.aids.gov Division of Disease Control and Health Protection

  27. HIV Care Continuum Cascade + Alcohol and Other Drugs Overall: 53% alcohol use in past month 33% FL HIV+ inmates poly-drug users Overall: 50% drug use in past year 15% FL HIV+ inmates IDU Overall: 15% considered heavy drinkers cascade source: www.aids.gov Division of Disease Control and Health Protection

  28. HIV Care + Combination Prevention Combination Prevention: Services Integration cascade source: www.aids.gov Division of Disease Control and Health Protection

  29. VANCE BURNS CORRECTIONS SPECIALIST HIV/AIDS AND HEPATITIS SECTION BUREAU OF COMMUNICABLE DISEASES (850) 245-4424, EXT 2565 vance.burns@flhealth.gov Division of Disease Control and Health Protection

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