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Enhancing Linkages to HIV Primary Care & Services in Jail Settings

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The Special Projects of National Significance Enhancing Linkages to HIV Primary Care and Services in Jail Settings Initiative was a five year multi-site demonstration and evaluation of HIV service delivery interventions in correctional settings. This initiative funded 10 demonstration sites to design, implement and evaluate innovative methods for linking persons living with HIV/AIDS in jail settings or recently released from local jail facilities to community-based primary medical care and ancillary services. Interventions included flexible and suitable case management strategies that promoted durable linkages and appropriate follow-ups as people moved from jail to the community. Emory University School of Public Health, the Evaluation and Support Center (ESC) for this initiative, assessed the effectiveness of the interventions in providing linkages to HIV primary care services for jail releasees, and integrating services for them within the community's HIV continuum of care.

Correctional systems have an opportunity to provide coordinated prevention and treatment interventions for infectious diseases in concert with local public health officials. Many people released from jails have serious, unmanaged infectious diseases and mental illnesses. Public health and safety can be improved through greater collaboration among correctional facilities, public health agencies, and community-based organizations. Successful interventions should be initiated with inmates while in jail, and then coordinated upon their release.



Grants for this initiative were awarded to the organizations listed below. Their abstracts provide a brief description of their project.


AID Atlanta, Inc.

Enhanced Care for HIV+ Jail Releasees

The primary purpose of this Correctional Demonstration Project (CDP) was to improve the health and overall quality of life of jailed inmates prior to their release into the community. This program targeted HIV+ substance abusing men of the metro Atlanta area, and provided them with comprehensive healthcare, enhanced case management, substance abuse treatment and HIV and STD prevention education. A needs assessment revealed that HIV disproportionately affects inmates, many of whom are likely to be substance abusers, which together negatively impact their health outcomes. Services were insufficient to meet the healthcare and substance abuse treatment needs of this population.

AID Atlanta developed and implemented a project to increase the medical treatment adherence rate of HIV+ releasees by immediately linking them to primary care. The project also provided coordinated services including enhanced case management, inpatient and outpatient substance abuse treatment, housing, and other supportive services. AID Atlanta also sought to decrease the rate of inmate recidivism by addressing the underlying factors that cause individuals to be repeat offenders, including treatment of substance abuse, provision of intensive support, and guidance to assist clients in leading healthier lives and making healthier choices, with necessary life coaching, prevention education, self esteem building and empowerment opportunities to affect behavioral change.


AIDS Care Group
Demonstration Model of Innovations in Prisoner Release

AIDS Care Group utilized deployed case management, outreach, transportation, food, shelter, phone cards, and clothing to ensure appropriate and timely linkages for each targeted client into clinical care and social services. It also sought seamless reintegration into the community; improved adherence to HIV medical care; and commitment to risk and harm reduction behaviors. Project staff had considerable experience in prison systems, HIV medical care, case management, psychiatry, psychosocial services, and HIV education, counseling and testing. They coordinated services with five Pennsylvania county jails to reach prisoners before discharge and planned and carried out comprehensive discharge and reintegration activities. This demonstration project addressed all current barriers to clinical and social services for incarcerated and newly discharged HIV positive adults.


Baystate Medical Center, Inc.
The Hampden County Public Health Model of Correctional Health Care Enhancement Project

The Hampden County Correctional Center (HCCC) in Springfield Massachusetts developed a nationally recognized public health model of correctional health care. HCCC promotes continuity of care for inmates and releasees by using dually-based physicians and case managers working at both the jail and at community health centers in Hampden County. The model emphasizes five elements: early detection, effective treatment, education, prevention, and continuity of care. This project enhanced current linkages in primary care and social support services by adding dually-based mental health clinicians providing mental health assessment and treatment services in the jail and at the collaborating community health centers, including the Holyoke Health Center, the Caring Health Center, Mason Square Neighborhood Health Center, High Street Health Center, and Brightwood Health Center. Mental health services were provided by a contracted, non-profit vendor, Behavioral Health Network, which delivered on-site outpatient and inpatient services at the jail of the health services department. It also expanded services to increase continuity care through follow-up services at community health center sites that provide primary care to HIV-infected releasees. The mental health services staff included psychiatrists, social workers, clinicians, administrators, and program managers. The project also sought to increase the capacity of the collaborating health centers to provide medication-assisted treatment for opioid addiction within the HIV primary care and support service network. The project also focused on serving people living with HIV who also had co-occurring disorders and posttraumatic stress disorder, as well as HIV-infected women inmates and releasees.


Care Alliance Health Center
Enhancing Linkages to HIV Primary Care Services in Jail Settings

Care Alliance's project sought to identify HIV-infected individuals in the County and City jails through pre-release testing, counseling and case management, and then to provide health care services to those already diagnosed with HIV in the jail system. The project sought to ensure post-release linkages to care by providing support services upon release and re-entry back into the community. Care Alliance targeted inmates known to be HIV-positive and tested pre-release inmates in the two jails of the Cuyahoga County Corrections Center. The targeted populations included substance abusers, commercial sex workers, and others being held and/or pre-released from County and City jails.


Miriam Hosptial
Enhancing Linkages to HIV Primary Care and Services in Jail Settings

The goals of this demonstration project were to enhance existing HIV counseling and testing services in the jail setting, and to augment linkage to health care for HIV-positive persons in Southeastern New England transitioning to the community after release from jail. This project included linkage to HIV primary care, mental health care, substance abuse treatment, dentistry, and ophthalmology.


New York City Department of Health and Mental Hygiene
Planned Reintegration Opportunities to Gain Release and Access Medical Care

DOHMH established a Continuum of Care model for persons living with HIV/AIDS in city jails that included testing, treatment and discharge planning. For this SPNS project, DOHMH worked in collaboration with Rikers Island Transitional Consortium (RITC) to enhance the existing HIV Continuum of Care. This program provided for the unmet primary care and substance abuse treatment needs of people living with HIV/AIDS by providing linkages to care for people released from city jails within seven days, or providing linkages to Alternative to Incarceration (ATI) programs for those potentially facing sentences longer than one year. This project included identification of clients, assessment of need, discharge plans, and placement in community programs as appropriate, with follow-up to ensure ongoing participation in community health care and services.


Philadelphia FIGHT
The Healthcare Linkage Program

Philadelphia FIGHT worked in partnership with Action AIDS and the Center for Mental Health Policy and Services Research at the University of Pennsylvania. The project sought to increase capacity and enhance coordination of services for people living with HIV/AIDS within the Philadelphia Prison System and once released through its Healthcare Linkage Program. The program offered five core services: 1) in-reach within the nine local jails; 2) ex-offender case management services initiated in the jails and continued at Action AIDS; 3) in-jail discharge planning; 4) an ex-offender HIV primary care clinic at the Jonathan Lax Center; and 5) a five week patient education program housed at FIGHT. All services were coordinated through weekly partner case conferences, informed by a multi-agency task force, and refined and disseminated through data collection and evaluation results.


University of Illinois at Chicago School of Public Health
Enhancing HIV care linkages for women in jail: A gender-responsive case management approach

The University of Illinois at Chicago's project addressed primary care and service needs of women who are living with HIV in jail and upon their return to the community. The intervention targeted incarcerated women in Cook County Jail, and emphasized the building of effective community linkages specific to the needs of women. To enhance their continuity of quality care and services, the University of Illinois at Chicago planned its intervention to take place prior to release, and then worked to mitigate barriers to obtaining care and services in their communities.


University of South Carolina Research Foundation
South Carolina Linkage Program for Inmates

The goals of the South Carolina Linkage Program for Inmates (SCLPI) were to identify HIV-infected individuals in jails and promote their participation in HIV primary care and other support services as they re-entered the community. The project implemented rapid testing and a brief linkage coordination intervention that was demonstrated in clinical trials to be effective in improving linkage with HIV primary care and substance abuse treatment. The project also implemented a brief educational program provided to inmates immediately following their detention in the Alvin S. Glenn Detention Center which served as the intake center for un-sentenced misdemeanor and/or felony detainees/inmates and as an incarceration facility for sentenced offenders.


Yale University AIDS Program

Transitions was a novel demonstration program for managing HIV+ clients as they transition from the jail to the community setting. Rapid HIV testing was enhanced within jail settings to improve diagnostic screening for HIV. The intervention was based on three evidence-based components that were adapted for jail-released settings. These included buprenorphine maintenance therapy (BMT) for opioid dependence; intensive case management (ICM) with elements of assertive community treatment; and money management (MM) that utilizes an assigned payee to manage financial resources to reduce social instability, homelessness, substance abuse and mental illness.


Emory University's Rollins School of Public Health
Evaluation And Support Center for Models of Identifying HIV Infected Persons in Jail Settings snd Enhancing Linkages to HIV Primary Care

A multidisciplinary team of scientists at the Rollins School of Public Health of Emory University in Atlanta, GA and researchers from Abt Associates, Inc. in Cambridge, MA partnered to implement the activities of the Evaluation and Support Center (ESC) for this SPNS initiative. The ESC team convened an expert consultation to advise HRSA on recent advances in identifying and linking HIV-infected jail inmates with care. Based on the consultation meeting and other research, the ESC wrote a report on recent trends, possible interventions, relevant research designs, and recommended data elements for collection in a multi-site evaluation of testing and linkage models. The ESC then developed recommended methods, protocols, and procedures for such a multi-site evaluation of the demonstration projects, including quantitative and qualitative process and outcome measures. It also provided technical assistance to the demonstration sites and data management services, and lead the dissemination of results.


Journal Articles

Vagenas P, Zelenev A, Altice FL, Di Paola A, Jordan AO, Teixeira PA, Frew PM, Spaulding AC, & Springer SA.  HIV-infected men who have sex with men, before and after release from jail: the impact of age and race, results from a multi-site study.  AIDS Care, January 2016;  28 (1): 22-31.  PubMed Abstract

Arriola KJ, Spaulding AC, Booker CA, Williams C, Avery A, Porter NJ, Jordan AO, Loewenthal H, & Frew PM.  Understanding the relationship between social support and physical and mental well-being among jail detainees living with HIV. Journal of Health Psychology, January 2015; 20 (1): 3-12.  PubMed Abstract

Teixeira PA, Jordan AO, Zaller N, Shah D, & Venters H. Health Outcomes for HIV-Infected Persons Released From the New York City Jail System With a Transitional Care-Coordination Plan. American Journal of Public Health, February 2015; 105 (2): 351-357.  PubMed Abstract

Meyer JP, Zelenev A, Wickersham JA, Williams CT, Teixeira PA, and Altice FL. Gender Disparities in HIV Treatment Outcomes Following Release From Jail: Results From a Multicenter Study. American Journal of Public Health, March, 2014; 104 (3): 434-441. PubMed Abstract

Flanigan TP. Jails: the new frontier. HIV testing, treatment, and linkage to care after release. AIDS and Behavior, October 2013; 17 (Supplement 2): S83-S85. No abstract available.

Rapp RC, Ciomcia R, Zaller N, Draine J, Ferguson A, & Cagey R. The Role of Jails in Engaging PLWHA in Care: From Jail to Community. AIDS and Behavior, October 2013; 17 (Supplement 2): S89-S99 PubMed Abstract

Spaulding AC, Booker CA, Freeman SH, Ball SW, Stein MS, Jordan AO, Ahuja D, Solomon L, & Frew PM. Jails, HIV Testing, and Linkage to Care Services: An Overview of the EnhanceLink Initiative. AIDS and Behavior, October 2013; 17 (Supplement 2): S100-S107. PubMed Abstract

Stein MS, Spaulding AC, Cunningham M, Messina LC, Kim BI, Chung KW, Draine J, Jordan AO, Harrison A, Avery AK, & Flanigan TP. HIV-Positive and in Jail: Race, Risk Factors, and Prior Access to Care. AIDS and Behavior, October 2013; 17 (Supplement 2): S108-S117. PubMed Abstract

Chitsaz E, Meyer JP, Krishnan A, Springer SA, Marcus R, Zaller N, Jordan AO, Lincoln T, Flanigan TP, Porterfield J, & Altice FL. Contribution of substance use disorders on HIV treatment outcomes and antiretroviral medication adherence among HIV-infected persons entering jail. AIDS and Behavior, October 2013; 17 (Supplement 2): S118-S127. PubMed Abstract

Booker CA, Flygare CT, Solomon L, Ball SW, Pustell MR, Bazerman LB, Simon-Levine D, Teixeira PA, Cruzado-Quinones J, Kling RN, Frew PM, Spaulding AC; and The EnhanceLink Study Group. Linkage to HIV Care for Jail Detainees: Findings From Detention to the First 30 Days After Release. AIDS and Behavior, October 2013; 17 (Supplement 2): S128-S136. PubMed Abstract

Avery AK, Ciomcia RW, Lincoln T, Desbrais M, Jordan AO, Rana AI, & Machekano R. Jails as an Opportunity to Increase Engagement in HIV Care: Findings from an Observational Cross-Sectional Study. AIDS and Behavior, October 2013; 17 (Supplement 2): S137-S144. PubMed Abstract

Fu JJ, Herme M, Wickersham JA, Zelenev A, Althoff A, Zaller ND, Bazazi AR, Avery AK, Porterfield J, Jordan AO, Simon-Levine D, Lyman M, & Altice FL. Understanding the revolving door: individual and structural-level predictors of recidivism among individuals with HIV leaving jail. AIDS and Behavior, October 2013; 17 (Supplement 2): S145-S155. PubMed Abstract

Althoff AL, Zelenev A, Meyer JP, Fu J, Brown SE, Vagenas P, Avery AK, Cruzado-Quiñones J, Spaulding AC, & Altice FL. Correlates of Retention in HIV Care After Release from Jail: Results from a Multi-site Study. AIDS and Behavior, October 2013; 17 (Supplement 2): S156-S170. PubMed Abstract

Krishnan A, Wickersham JA, Chitsaz E, Springer SA, Jordan AO, Zaller N, & Altice FL. Post-Release Substance Abuse Outcomes Among HIV-Infected Jail Detainees: Results from a Multisite Study. AIDS and Behavior, October 2013; 17 (Supplement 2): S171-S180. PubMed Abstract

Zelenev A, Marcus R, Kopelev A, Cruzado-Quinones J, Spaulding A, Desabrais M, Lincoln T, & Altice FL. Patterns of homelessness and implications for HIV health after release from jail. AIDS and Behavior, October 2013; 17 (Supplement 2): S181-S194. PubMed Abstract

Williams CT, Kim S, Meyer J, Spaulding A, Teixeira P, Avery A, Moore K, Altice F, Murphy-Swallow D, Simon D, Wickersham J, Ouellet LJ. Gender differences in baseline health, needs at release, and predictors of care engagement among HIV-positive clients leaving jail. AIDS and Behavior, October 2013; 17 (Supplement 2): S195-S202. PubMed Abstract

Spaulding AC, Messina LC, Kim BI, Chung KW, Lincoln T, Teixeira P, Avery AK, Cunningham M, Stein MS, Ahuja D, & Flanigan TP. Planning for Success Predicts Virus Suppressed: Results of a Non-Controlled, Observational Study of Factors Associated with Viral Suppression Among HIV-Positive Persons Following Jail Release. AIDS and Behavior, October 2013; 17 (Supplement 2): S203-S211. PubMed Abstract

Jordan AO, Cohen LR, Harriman G, Teixeira PA, Cruzado-Quinones J, & Venters H. Transitional Care Coordination in New York City Jails: Facilitating Linkages to Care for People with HIV Returning Home from Rikers Island. AIDS and Behavior, October 2013; 17 (Supplement 2): S212-219. PubMed Abstract

Spaulding AC, Pinkerton SD, Superak H, Cunningham MJ, Resch S, Jordan AO, & Yang Z. Cost Analysis of Enhancing Linkages to HIV Care Following Jail: A Cost-Effective Intervention. AIDS and Behavior, October 2013; 17 (Supplement 2): S220-S226. PubMed Abstract

de Voux A, Spaulding AC, Beckwith C, Avery A, Williams C, Messina LC, Ball S, & Altice FL. Early Identification of HIV: Empirical Support for Jail-Based Screening. PLoS One. 2012; 7(5): e37603. Epublished May 25, 2012.  Journal Fulltext Exit Disclaimer

Chen NE, Meyer JP, Avery AK, Draine J, Flanigan TP, Lincoln T, Spaulding AC, Springer SA, & Altice FL. Adherence to HIV Treatment and Care Among Previously Homeless Jail Detainees. AIDS and Behavior, October 2013; 17(8): 2654-2666. PubMed Abstract

Draine J, Ahuja D, Altice FL, Arriola KJ, Avery AK, Beckwith CG, Booker CA, Ferguson A, Figueroa H, Lincoln T, Ouellet LJ, Porterfield J, Spaulding AC, & Tinsley MJ. Strategies to enhance linkages between care for HIV/AIDS in jail and community settings. AIDS Care, March 2011; 23 (3): 366-377. PubMed Abstract

Nunn A, Cornwall A, Fu J, Bazerman L, Loewenthal H, & Beckwith C. Linking HIV-positive Jail Inmates to Treatment, Care, and Social Services After Release: Results from a Qualitative Assessment of the COMPASS Program. Journal of Urban Health, December 2010; 87 (6): 954-968. PubMed Abstract

Spaulding AC, Arriola KJ, Hammett T, Kennedy S, & Tinsley M. Rapid HIV testing in rapidly released detainees: next steps. Sexually Transmitted Diseases, February 2009; 36 (2nd Supplement): S34-S36. Journal Fulltext Exit Disclaimer

Spaulding AC, Arriola K, Ramos KL, Hammett T, Kennedy S, Norton G, & Tinsley M. Enhancing Linkages to HIV Primary Care in Jail Settings: Report on a Consultants’ Meeting Journal of Correctional Health Care, April 2007; 13 (2): 93-128. Journal Abstract Exit Disclaimer


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