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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 multi-site demonstration and evaluation of HIV service delivery interventions coordinated by Emory University School of Public Health, the Evaluation and Support Center (ESC) for this initiative. This initiative funded  10 demonstration sites for five years to design, implement and evaluate innovative methods for linking persons living with HIV/AIDS who are in jail settings or have been recently released from local jail facilities to primary medical care and ancillary services. Interventions included flexible and suitable case management strategies that promoted durable linkages and follow up as people moved between jail and the community. The study design assessed the effectiveness of the selected model(s) in providing linkages to HIV primary care services for jail releasees and integrating services for releases 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 could be improved through greater collaboration among correctional facilities, public health agencies, and community-based organizations. Ideally, proven interventions would be initiated with inmates and coordinated upon their release.



Grants for this initiative were awarded to the applicants listed below. The abstracts provide both contact information and a brief description of their project. These grantees were funded from 2007-2011.


AID Atlanta, Inc. 

Enhanced Care for HIV+ Jail Releases

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. Started in November 2007, 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 are 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 while also providing 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, providing intensive support and guidance to assist clients in leading healthier lives and making healthier choices, and providing necessary life coaching, prevention education, self esteem building and empowerment opportunities to affect behavioral change.



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

Care Alliance sought to 1) identify HIV-infected individuals in the County and City jails through pre-release testing, counseling and case management; 2) provide health care services to those already diagnosed with HIV and in the jail system; 3) ensure linkages to care following release from jail; and 4) provide support services upon release from the correctional facilities and entrance back into the community. Care Alliance targeted inmates that are known to be HIV-positive and testes those pre-release inmates who were within the two jails at the Cuyahoga County Corrections Center. The targeted populations included substance abusers, commercial sex workers, and other individuals being held and/or pre-released from County and City jails.



AIDS Care Group
Demonstration Model of Innovations in Prisoner Release 

The AIDS Care Group initiated its Demonstration Model of Innovations in Prisoner Release, which utilized deployed case management, outreach, transportation, food, shelter, phone cards, and clothing to insure for each targeted client appropriate and timely linkages into clinical care and social services; seamless reintegration into the community; adherence to HIV medical care; and commitment to risk and harm reduction behaviors. Staff with considerable experience in prison systems, HIV medical care, case management, psychiatry, psychosocial services, and HIV education, counseling and testing coordinated services with five Pennsylvania county jails to reach prisoners before discharge and planned and carried out comprehensive discharge and reintegration activities.  The demonstration model addressed all current barriers to clinical and social services for incarcerated and newly discharged HIV positive adults.



Yale University AIDS Program

Transitions is a novel demonstration program for managing HIV+ clients as they transition from the jail to the community setting. Rapid HIV testing was enhanced within this setting to improve diagnostic screening for HIV. The Transitions intervention is based on three evidence-based components that were adapted for jail-released settings: 1) buprenorphine maintenance therapy (BMT) for opioid dependence; 2) intensive case management (ICM) with elements of assertive community treatment; and 3) money management (MM) that utilizes an assigned payee to manage financial resources to reduce social instability, homelessness, substance abuse and mental illness. A randomized controlled trial of MM will be conducted to determine if this added contribution may lead to previously unattained outcomes.



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, emphasizing the building of effective community linkages specific to the needs of women. The intervention targeted incarcerated women in Cook County Jail. To enhance continuity of quality care and services for incarcerated women with HIV, 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. 



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 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 those HIV-infected individuals with co-occurring disorders, posttraumatic stress disorder, and HIV-infected women inmates and releasees.



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 (ASGDC) which served as the intake center for un-sentenced misdemeanor and/or felony detainees/inmates and as an incarceration facility for sentenced offenders.



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 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; 5) a 5 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.



NYC Department of Health and Mental Hygiene
Special Projects of National Significance (SPNS) Planned Reintegration Opportunities to Gain Release & 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 needs of people living with HIV/AIDS by providing linkages to care for people released from city jails within 7 days or providing linkages to Alternative to Incarceration (ATI) programs for those potentially facing sentences longer than one year. This SPNS 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.



Miriam Hospital
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.



Emory University's Rollins School of Public Health
Evaluation And Support Center For Models Of Identifying HIV Infected Persons In Jail Settings And 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

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

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, December 6, 2012 [Epublished ahead of print]. 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, November 18, 2012 [Epublished ahead of print]. PubMed Abstract

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, November 16, 2012 [Epublished ahead of print].  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, November 11, 2012 [Epublished ahead of print]. 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, November 9, 2012 [Epublished ahead of print]. 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, November 6, 2012 [Epublished ahead of print]. 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 27, 2012 [Epublished ahead of print]. 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 20, 2012 [Epublished ahead of print]. 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 18, 2012. [Epublished ahead of print]. 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, September 28, 2012 [Epublished ahead of print]. 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, November 8, 2011. [Epublished ahead of print]. 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 Fulltext Exit Disclaimer


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