Transcript CJDATS HIV Services and Treatment Implementation in

CJDATS HIV SERVICES AND TREATMENT
IMPLEMENTATION IN CORRECTIONS
Barry Zack and Katie Kramer
The Bridging Group
2
Goal of Training
• To provide a baseline level of knowledge on HIV
prevention programs and testing within
correctional settings and linkages to care upon
community release.
3
Training Objectives
• Present an overview of best practices in HIV
prevention programs and testing within
correctional settings and linkages to care upon
community reentry.
• Provide an in-depth review on HIV linkages to care
policies and practices within correctional settings.
• Highlight the important role of prisons and jails in
HIV linkages to care policies and practices.
4
Participant Introductions
• Your Name
• Agency and Position in Agency
• Years Working in or with a Correctional Agency
• Experience with HIV/AIDS
▫ Testing, prevention, linkages to care
• Expectations from Training
• First Musical Concert and/or Event
5
6
What is HIV and AIDS?
H = Human Virus
I = Immunodeficiency
V = Virus
A
I
D
S
=
=
=
=
Acquired
Immune
Deficiency
Syndrome
7
Modes of HIV Transmission
1
2
3
•Sexual Contact
•Injection Drug Use
•Other (Mother to Child, Blood Transfusion)
9
10
11
12
United States Incarceration Rates
• More than 1 in 100 American
adults were incarcerated at the
start of 2008.
• One in every 31 American adults,
or 7.3 million Americans, are in
prison, on parole or probation.
• US has over 25% of all people
incarcerated worldwide.
• Approximately one in every 18
men in the US is behind bars or
being monitored.
US Dept of Justice, Bureau of Justice Statistics. Prisoners in 2006. NCJ publication 219416.
13
Federal & State Prison Population
1980-2005
1,400,000
1,200,000
1,000,000
800,000
Federal
600,000
State
400,000
200,000
0
1980
1985
1990
1995
2000
2005
14
Dual Epidemics
15
Health and Incarceration
• HIV/AIDS - 2 ½ times the national rate
• STIs, Hepatitis, TB - significantly higher
• Mental Health - 45-64%
▫ 10-17% SMI
• Substance Use – 43-69%
▫ 30% have co-occurring SMI
• Chronic Conditions - significantly higher
▫ Hypertension
▫ Diabetes
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Top 10 HIV Rates Among Incarcerated Populations
Overall % HIV
Seroprevalence Rate
Female
Seroprevalence Rate
Male
Seroprevalence Rate
NY
7.0%
14.1
6.7
FL
3.9%
5.7
3.8
MD
3.0%
6.9
2.8
MS
2.7%
2.5
2.7
CT
2.6%
4.0
2.5
LA
2.5%
3.2
2.5
NJ
2.3%
6.8
2.1
SC
2.2%
2.5
2.2
GA
2.1%
3.2
2.1
MA
2.1%
3.3
2.0
State
US Dept of Justice, Bureau of Justice Statistics. HIV in Prisons, 2005; Appendix Tables 1 and 2. NCJ publication 218915.
http://www.ojp.gov/bjs/pub/pdf/hivp05.pdf. Published Sept. 2007. Accessed Jan 9, 2008.
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HIV Transmission in Correctional Settings
• Majority of HIV-positive people are infected before they enter prison1
• HIV risk behaviors often continue inside the institution and include
injecting drug use, tattooing, body piercing, and consensual,
nonconsensual, and survival sexual activities2
• Scarcity of sterile drug paraphernalia leads to needle sharing in
prison3
• Needle sharing among soon-to-be released individuals is high4
• Among IDUs in New Mexico, 37.6% of those with tattoos received
them in jail or prison5
1. CDC. MMWR. 2006;55(15):421-426.
2. Hammett TM. Am J Pub Health. 2006;96(6):974-978.
3. Davies R. Lancet. 2004:364:317-318.
4. Stephens TT et al. Am J Health Stud. 2005.
5. Samuel MC et al. Epidemiol Infect. 2001;127:475-484
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HIV Prevalence Among Those Released
From Prison/Jail in 2006
14.1
85.9
Incarcerated/released
Not incarcerated
Total US HIV population ~ 1.1 million
Spaulding A, et al. PLoS One. 2010.
 Estimate of proportion of HIV+
persons in US who passed
through a jail or prison in 2006
 1 of 7 (14.1%) of all HIV+ in US
were released from
incarceration in 2006
 At least 22% of all HIV+ black
men in US passed through a
correctional facility during
2006
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HCV/HIV Co-infection in Correctional Systems
• Maryland Division of Correction and Baltimore City Detention
Center (January-March 2002)[1]
▫ 29.7% HCV+
▫ 6.6% HIV+
▫ 4% HCV/HIV co-infected
• CDC Prison Study[2]
▫ 8.2% of HCV+ inmates had HIV
▫ 70% of HIV+ inmates had HCV
• Entrants to 3 large city jails (Detroit, Chicago, San Francisco)[2]
▫ 9.2% to 15.7% HCV+
▫ 1.8% to 2.6% HIV+
▫ ~ 1% HCV/HIV co-infected
1. Solomon L, et al. J Urban Health. 2004;81:25-37. 2. Weinbaum C, et al. AIDS 2005, 19 (suppl 3):S41–S46 .
3. Weinberg C, et al. APHA Annual Meeting 2003. Abstract 5097.0.
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Syphilis Rates in Correctional Systems
Table 1: Rates of Syphilis, Selected States 2001, /100,000 Population
State
Non-Incarcerated
Incarcerated Men
Population
Incarcerated
Women
Pennsylvania
0.8
3.0
10.0
Texas
2.3
5.1
10.5
Tennessee
5.8
0.3
21.2
Alabama
5.1
3.4
9.3
Louisiana
3.9
3.4
7.1
California
1.6
2.8
4.4
Adapted from the Sexually Transmitted Disease Surveillance 2001 Supplement, Syphilis
Surveillance Report (CDC).
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Drug Abuse or Dependence and Mental
Health Disorders – State Prison
Diagnosis
Any Mental Health Problem
Percent of Inmates
56.2%
Psychotic disorder
15.4%
Mania disorder
43.2%
Major Depression
23.5%
Drug Abuse or Dependence
53.4%
Belen, S., (2011). Treatment needs and treatment options for drug-involved inmates:
Opportunities and challenges. Yale University Law School Sentencing Workshop.
21
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Behavioral Health Disorders by Offense Type
NO
PROBLEMS
DRUG
ABUSE/
DEPEND
ONLY
MENTAL
HEALTH
DISORDER
ONLY
DRUG ABUSE/
DEPENDENCE
& MENTAL
HEALTH
DISORDER
29.6%
22.0%
17.8%
30.6%
VIOLENT
32.9%
18.8%
21.0%
27.3%
DRUG
26.1%
28.5%
11.7%
33.7%
26.3%
22.9%
16.7%
34.1%
TOTAL INMATE
POPULATION
OFFENSE TYPE*
NONVIOLENT,
NON-DRUG
*p <. 001
Belen,
S., (2011). Treatment needs and treatment options for drug-involved inmates:
Opportunities and challenges. Yale University Law School Sentencing Workshop.
22
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Cycle of Incarceration
Court
Community
Jail
Prison
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Relationships in the Community
25
When Prison Enters
the Picture
26
Concurrent Relationships
in the Community
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Focus: Past and Present
• History of HIV Prevention in Correctional Settings
▫ Testing in late 80’s/early 90’s to isolate
▫ Move away from testing in mid 90’s – “have to treat”
▫ Mid 2000’s – up swing in testing as treatment became
cheaper and more available
• Current Research Projects
▫ NIDA: CJ-DATS
▫ CDC: Proof of Concept
* NIDA/NIMH: Seek, Test and Treat
* SAMHSA: Criminal Justice Initiative
• Recent US Supreme Court Decision
▫ Overcrowding results in unconstitutional level of
healthcare/140% of capacity
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A Community at Risk
• Reality Check:
▫ It is estimated that each year, 14 - 25% of all HIV
positive persons in the US spend time in prison or jail.
• People come into facility with higher rates of infectious diseases
• Most people (over 90%) in correctional facility will return to
the community
• Incarcerated does not occur in a vacuum. People move in
and out of prisons and jails and likewise move in and out of
communities and relationships.
• Correctional medical care and health programs represent an
opportunity to improve community health
29
A Unique Opportunity
• High turnover of people in prisons and jails
creates a flow of individuals who may have
access to health care only when incarcerated.
• The correctional setting may be the only place
where people get care, treatment and support.
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Issues to Consider
• Disconnect between Corrections and Public Health
• Different Cultural Identities
• Security= Safety First
• Operational Policies, Procedures and Relationships
• Confidentiality
• Ethical Considerations
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The Disconnect
Public Health
Corrections
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Mission = Public Health
Orientation toward Change
Humanitarian
Dress code is Informal
Prevention/Care/Dx
Client-Centered
Flexibility
Creative
Mission = Public Safety
Orientation toward Order
Para-Military
Dress code is Uniform
Punishment
Institution-Centered
Rules
Standard Operating
Procedures
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Addressing HIV Supports the Mission of
Corrections
• Safety and security is the number one priority of
every correctional facility.
• Effective HIV testing, prevention and linkages to care
programs can contribute to the safety and security
mission of a correctional facility.
“People, who are actively working to better themselves,
are less likely to get into trouble on the inside. Thus,
more programs make my prison safer.”
- Former Warden, San Quentin State Prison
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33
Prevention
Testing
Linkages to Care
34
HIV Prevention
• Provide HIV information, education and/or skills
building about preventing the spread of HIV
• Different types of programs include workshops,
peer education programs, one-on-one outreach,
health fairs, educational brochures, etc.
• Models
▫ Peer based
▫ Educational Services
▫ Medical services
35
HIV Testing
• HIV and other disease screening
• Confirmatory test
• Models
▫
▫
▫
▫
Mandatory vs. voluntary
Timing (entry, during incarceration, at release)
Pre/post counseling
Tied in to other HIV prevention programs
36
HIV Linkages to Care
• Linkages to HIV treatment providers in the
community after release
• Seamless medical care
• Additional support services
▫ case managers, benefits counselors
• Access to other treatment providers
▫ substance treatment, mental health, etc.
37
38
38
39
HIV Linkages to Care
• Discharge planning
▫ medications, benefits paperwork, medical records
• Linkages to HIV treatment providers in the
community after release
▫ seamless medical care
• Additional support services
▫ case managers, benefits counselors
• Access to other treatment providers
▫ substance treatment, mental health, etc.
40
41
The Linkage Challenge
Incarceration
Freedom
What are we doing?
Making the transition work!
Screening
Diagnosis
– Infectious diseases (HIV, STI, TB, HCV,
HBV)
– Mental illness
– Substance abuse
 Treatment
 Pre-release planning
 Linkage to care and services
Treatment
ID (HIV, HCV, STIs, HBV, etc.)
Chronic (hypertension, diabetes)
Substance Use & Mental Health
 Adequate community resources
Addressing life’s competing priorities
Reincarceration
How to break the cycle?
 Societal
challenge (poverty, discrimination, etc.)
 Policy (Sentencing, Drugs, Housing, Sex Offenders)
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Linkages to Care Spectrum
• Inside Only Model
▫ Planning begins near release with continuation of case
management until release
• Released Focused Model
▫ Brief planning happens near release with continuation
of case management after release
• Inside/Out Model
▫ Ongoing planning and case management occur inside
and continues in the community after release
43
NCCHC Position Statement on
HIV Discharge Planning in Correctional Facilities
• HIV-positive individuals need to receive prevention,
education, and treatment that continues upon release.
• It can be difficult for HIV-positive individuals to find health
care services outside a correctional environment.
• Individuals on treatment inside need to have continuity of
care upon discharge from jail or prison.
• Give sufficient supplies of medications at release (14-30 days).
• Provide instruction on the importance of medication
adherence.
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45
What’s happening out there:
4 Models of Linkages to Care
• California DOC Transitional Case Management
Program (TCMP)
• NYC Enhancing Linkages Program
• CDC Project START (HIV-positive adaption)
• Hampden County Public Health Model of Care
in Correctional Facilities
46
California DOC (CDCR)
Transitional Case Management Program
(TCMP)
47
TCMP Activities: Pre-Release
• In-depth interview 90 days prior to release
▫ Build relationship and confidence with client
▫ Act as liaison between prison medical staff, community
service providers, and parole officers
▫ Conduct psychosocial needs assessment (immediate needs, id,
housing, ADAP, SSI/medi-cal, substance abuse)
▫ Develop care plan based on individual’s needs upon release
• Care planning 60 days to release
▫ Match needs with long-term community service provider
▫ Meet with individual to discuss options from care plan
▫ Provide individual with information and referrals
48
TCMP Activities: Post-Release
• Post-Release support/follow-up for 60 to 90 day
▫ Meet with client within first 48 hours of release
▫ Provide client with Parole Packet - i.e. condom, prevention
telephone card, toiletry items, resource information
▫ Encourage client to keep planned appointments
▫ Encourage client to participate in community peer support
group
• Help client identify risky behaviors
• Empower participant to begin to make choices
• Discuss prison vs. free world obstacles
49
NYC Enhancing Linkages Program
50
Jail Discharges to
NYC Communities
by Zip Code and
Socioeconomic Status
2004
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NYC Enhancing Linkages
Service Components
 Identify population & engage client
 use electronic health records
 Court advocacy
 Conduct assessment
 Screen for benefits
 Arrange 7 day supply of discharge medications
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NYC Enhancing Linkages
Service Components (cont.)
• Facilitate continuity of care
 Aftercare letters / transfer medical information
 Make appointments / walk-in arrangements
 Arrange transportation / accompaniment
 Coordinate post-release plan/community case
management
 Housing
 Substance abuse/Mental health treatment
 Social services
53
Connection to Care Results
Service Connection
%
Community Medical Provider
77%
Medical Case Management
53%
Substance Abuse Treatment
52%
Housing Services
29%
Court Advocacy
18%
Accompaniment and/or transport to medical
appt
65%
54
The First 33
Clinical indicator changes from jail (JCR) to 6 months post
release (FCR) for the first 33 participants with complete
clinical data:

25 (76%) had a decreased viral load

94% showed a stable or improved cd4 count


Statistically significant changes to both average CD4 and viral load



cd4 up by 50 (from 372 to 422)
vl load down by ~42,000 copies (from 55,795 to 13,852)
9 patients were not on ART on admit; 2 not at release


2 had a meaningful drop in cd4 count.
25/29 on ART at release received walking meds and 21d Rx
2 patients were reported as not on ART at the 6-month follow-up.

1 not on ART at release and one other; both had undetectable VL at f/u
55
An HIV/STI/hepatitis risk reduction program
for people returning to the community
after incarceration
56
A Bridge to Success
• Is a short-term individual level program = 5 months
▫ 2 months pre-release
▫ 3 months post-release
▫ Begins before release & continues in the community after release
• Helps clients to “bridge” from the “inside” to communitybased services on the “outside” that support their
HIV/STI/hepatitis risk reduction and transitional goals
• Does not replace longer term comprehensive systems of
care
57
Basic Structure of Project START
•
Enrollment plus six one-on-one sessions:
•
Other sessions as needed.
•
Required tasks per session.
•
▫ Two sessions completed before release
▫ Four sessions completed after release
▫
▫
▫
Risk assessment,
Transitional needs
Facilitated referrals
▫
▫
▫
Goal setting
Strengthening motivation
Providing condoms
Supplemental exercises as needed.
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Sessions 1-2 Overview: Pre-Release
• Assess HIV/STIs/hepatitis knowledge
• Provide information on transmission & risk of
HIV/STIs/Hepatitis
• Discuss personal risk behaviors
• Develop individual risk reduction and transitional plans
• Facilitate behavioral skills practice (communication,
problem solving, goal setting, & condom use)
• Facilitate post-release service referrals for housing,
employment, substance abuse treatment, etc.
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Sessions 3-6 Overview: Post-Release
• Provide ongoing risk behavior & goal assessment/
revision
• Provide ongoing transitional goal assessment/revision
• Problem solve to overcome barriers and capitalize on
facilitators
• Provide ongoing availability of resource materials
including condoms and lubricants
• Acknowledge & support accomplishments
• Facilitate service referrals to ongoing community
services as needed
60
Adaptation for HIV+ Linkages to Care
• Additional Session Inside
▫ Discharge planning (medication supply, medical records,
prescription, adherence)
▫ Benefits/ADAP
▫ Linkage to community medical provider
▫ Disclosure and living with HIV in the community
• Post Release Follow-up
▫ Review discharge plan along with risk reduction plan
(secondary prevention)
• Pilot with MA Department of Public Health
▫ 71% of participants attended first medical appt after release
(N=33)
61
Hampden County Public Health Model
for Correctional Facilities
• Community Health Clinics provide medical care
inside the correctional facilities
▫ Providers are linked to clients by zip code
▫ Medical providers inside are the same medical
providers in the community
• One electronic medical record system
▫ Medical providers have access to system while inside
• One medical appointment system
62
Hampden County Linkages Program
Service Components
• Assessment
• Development of discharge plan
• Linkage to care with same community provider
seen inside
• Preparation for initial health care appointment
once released
• Referrals to appropriate community resources
▫ Housing, vocational, financial, legal
• Advocacy
63
Hampden County Linkages Program
Key Activities: Pre-Sentence
• Planning begins at time of intake into the
correctional facility
• Key activities- Pre-sentence
▫ Track court dates (to determine release)
▫ Establish plan of care to present to court (presentencing)
▫ Accompany individual to transitional program if
released by courts
64
Hampden County Linkages Program
Key Activities: Post-Sentence
• Identify individual receiving health care in the
facility 4-6 weeks prior to release
• Start application for Medicaid/ADAP
• Assure individuals on regimens leave with 5 day
supply and prescription refill
• Individuals leave with appointment for medical
services in the community
65
Critical Issues for a Successful
Linkages Program
• Collaboration with the right community partners
▫ Network of community providers for medical & life needs
▫ Organizational capacity to work with population and/or in a
correctional facility.
▫ Good access and location
• Strong recruitment and referral systems
▫ Obtain accurate information on release date
• Successful staffing pattern
▫ Hire the right staff and support them/limit staff turnover
▫ Same staff work with the client both before and post release
66
Critical Issues, cont.
• Effective program design
▫
▫
▫
▫
▫
▫
Conduct face-to-face meetings before and after release
Have an immediate release plan for the first 24-48 hours
Make specific medical, treatment and social service appts
First post release session within 24-48 hours/meet at gate
Confirm housing upon release
Escort individuals to initial appointments
• Comprehensive planning
▫
▫
▫
▫
▫
ADAP application
Release of information; HIPAA
Treatment: HIV, substance use, mental health
Competing priorities: housing, income, family/social
Be aware of the conditions of parole and/or probation
67
Critical Issues, cont.
• Prioritize staff safety
▫ Crisis protocols
▫ Safety plan for field work
• Active retention strategies
▫ Comprehensive locator information
▫ Use of incentives
▫ Outreach and/or field locations
• Address reincarceration
▫ Continue services as able
68
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HIV Prevention in Correctional Settings
• Inside Correctional Facilities
• In Preparation for Release
• Post Release Programs
70
HIV Prevention on the Inside:
Why is it Important?
• Risks outside coming in
• Risk inside going out
• Prevalence rates
• “A Unique Opportunity”
71
HIV Prevention on the Inside
• Who
▫ Peer Educators
▫ Medical Staff
▫ Education Staff
▫ Community Providers
72
HIV Prevention on the Inside
• What
▫ Distribution of educational materials (brochures,
posters, etc. at intake, in waiting rooms, and other
locations)
▫ Single session workshops to multi-session
workshops
▫ Health fairs
▫ Evidence-based interventions
73
HIV Prevention on the Inside
• When
▫ Upon Entry
▫ During Existing Programs (education, vocation, etc.)
▫ Pre-release Programs
▫ Upon Release
74
Organizational Review
Does our agency have the experience and ability
to deliver programs with incarcerated populations?
Does our
agency
have the
experience
and ability
to deliver
HIV, STI, &
Hepatitis
prevention
activities?
No
No
Yes
Our agency does not have the
experience or ability to provide
either correctional programs or
HIV-prevention activities.
Yes
Our agency has the experience and
ability to provide correctional
programs but does not have the
experience or ability to provide HIV
prevention activities.
Least Chance of Success
Better Chance of Success
Our agency has the experience
and ability to provide HIVprevention activities but does not
have the experience or ability to
do this for correctional
populations.
Better Chance of Success
Our agency has the experience and
ability to provide correctional
programs and also has experience
and ability to provide HIVprevention activities.
Best Chance of Success
75
Organizational Readiness:
• Correctional Readiness:
▫ your agency’s ability to identify, approach, and work
effectively with a correctional facility.
• HIV, Sexually Transmitted Infection and Hepatitis
Prevention Education Readiness:
▫ your agency’s ability to provide HIV, sexually transmitted
infection and hepatitis prevention programs, and to identify
additional resources as needed.
• Agency Readiness:
▫ your agency’s ability to find the necessary funding and
support to sustain the program within your existing
organizational structure.
• Community Readiness:
▫ your agency’s ability to identify, approach, and work
effectively with community partners to provide a network of
support and services for clients after release.
76
77
CDC Compendium
• Currently identify 69 evidencebased interventions for different
populations, and risk behavior
categories
• Now in electronic version:
www.cdc.gov/hiv/topics/research
/prs/evidence-basedinterventions.htm
78
DHAP’s Research to Practice Model
Diffusion of
Evidence-Based
Interventions
DEBI: Diffusion of Evidence-Based Interventions
79
DEBI Website for HIV Prevention Resources
www.effectiveinterventions.org
• Sample budgets
• Fact sheets and Readiness scales
• Logic models
• Implementation planning tools
• Monitoring and fidelity tools and more
80
DEBI Website - Resources
www.effectiveinterventions.org
81
Current DEBI Interventions for
Correctional Settings
HIV 101
▫ RESPECT
▫ SISTA
▫ VOICES/VOCES
Prevention for Positives
▫ Healthy Relationships
▫ WILLOW
IDU
▫ Safety Counts
▫ Modelo Intervencio
Psicomedica (MIP)
▫ SHEILD
▫ Holistic Health Recovery
Program (HHRP)
Reentry/Risk Reduction
▫ CLEAR
▫ Project START
82
SISTA
Sisters Informing Sisters on
Topics about AIDS
• A group level intervention
• Designed for heterosexual African American
women, ages of 18-29
• Gender and culturally specific
• Sessions focus on ethnic and gender pride,
HIV knowledge, and skills training around
sexual risk reduction behaviors,
communication, and decision making.
83
Healthy Relationships
• A small-group level intervention
• Targets men and women living with
HIV/AIDS
• Involves defining stress and reinforce
coping skills with HIV-infected people
across three life areas:
▫
▫
▫
Disclosing to family and friends
Disclosing to sexual partners
Building healthier and safer relationships
• Designed to reduce sexual risk behaviors
and improve condom negotiation skills
84
Holistic Health Recovery Program (HHRP)
• A 12 session, manual-guided group level intervention
• Designed for HIV-positive and HIV-negative injection
drug users
• Harm reduction approach aimed at reducing both highrisk drug use and sexual behaviors and improving
medical, psychological, and social functioning
• Skills-based including negotiation, decision-making,
problem solving, goal setting, and stress management.
85
Project START
• An individual level intervention for incarcerated
individuals
• Sessions are delivered to individuals prior to release
and then sessions delivered after the individual has
been released back to the community
• Agencies with a history of working in prisons/jails
and also have a history of working with previously
incarcerated individuals have the capacity to
implement Project START
86
HIV Testing in Correctional Settings
• Current Practices
• CDC Guidance & Other Standards
• Testing Options
• Testing Methods
• Providing Results and Support
• Privacy and Confidentiality
87
Why Test in the Correctional Setting?
• A public health opportunity to reach “the hard
to reach”
• If HIV negative, education to stay negative
• If HIV positive:
▫ Clinical monitoring
▫ Access to treatment inside
▫ Linkages to care upon release
88
HIV Testing Policies & HIV AIDS
in US Prisons at Year End 2006
• All state prison systems offer HIV testing at some
point (admission, in custody or upon release), but
gaps exist
• Only 22 states test all individuals at admission
• CDC-recommended HIV pre-discharge testing in
high-prevalence states not widely followed: only 6
states test at discharge
(Maruschak, 2009)
89
HIV Testing Policies by State
No testing
required
On entry
On release
On entry and
in custody
On entry and
on release
In custody and
on release
On entry,
in custody, and
on release
Not reported
US Dept of Justice, Bureau of Justice Statistics. HIV in Prisons, 2005; Appendix,
Table 5. NCJ publication 218915. http://www.ojp.usdoj.gov/bjs/pub/pdf/p05.pdf.
Published Sept. 2007. Accessed Jan 9, 2008.
All states test upon inmate request
except NH, IA, AL, KY, UT, and NV
90
91
CDC HIV Testing for Correctional Settings
•
Background on HIV/AIDS &
Corrections
•
Opt-out Testing
▫
Benefits, tips, alternative options
•
Privacy and Confidentiality
•
HIV Testing Procedures
▫
Conventional, rapid, result
notification, counseling
•
Linkages to Services
•
Challenges and Solutions
•
HIV/AIDS Reporting
92
NCCHC Position Statement on
HIV Testing in Correctional Facilities
• Include HIV testing, when indicated, as part of
routine medical care
• Provide on a voluntary basis
• Encouraged testing with high-risk individuals
• Make HIV education for women a priority,
encourage them to test for HIV if pregnant.
• However, HIV testing should not be
performed without specific patient
informed consent
93
Testing Options
Voluntary
vs.
Mandatory
Opt-out
vs.
Opt-in
▫ Default is to test
▫ Default is to not test
▫ Test performed unless
individual actively
declines
▫ Test can be routinely
offered but not
performed unless
individual actively
accepts
▫ Permission is inferred
94
Benefits Opt-out HIV Screening
• Increases diagnosis of HIV infection;
• Preserves staff resources by streamlining the process;
• Reduces stigma associated with testing;
• Potentially diagnoses HIV infection earlier for the
individual; and
• Improves access to HIV clinical care and prevention
services.
95
Opt-out Approaches to HIV
Testing in Correctional Settings
Targeted testing
Repeat testing
Multiple time point testing
96
Targeted Testing
• Risk-based screenings
▫ IDU, MSM, sex worker
• Clinical indication
▫ pregnant, history of STD, symptoms of HIV infection
• Client demographic
▫ income level, age, gender identity
• Criminal behavior
▫ multiple incarcerations, type of crime
97
Repeat Testing
• Routinely offering HIV testing annually to persons
known to be at high risk for HIV infection
• IDU’s
• MSM
• Persons who have engaged in drug use or sexual
activity while incarcerated.
• May be a more viable option in prison settings vs.
jail settings
98
Multiple Time Point Testing
• Upon entry
• Routinely throughout incarceration
• Prior to release
99
Considerations for Testing in a
Correctional Setting
• Method and Risk
▫ Blood/needles vs. swab
• Results Turnaround
▫ Especially relevant to jail facilities
• Staffing Required
▫ Phlebotomist for taking blood
And the science continues to evolve….
100
General Recommendations for
Providing HIV Test Results
• Provide HIV test results in a confidential and
timely manner.
• Communicate results in a manner similar to
other serious diagnostic/screening tests.
• Clearly explain test results to the individual.
• Individuals with a negative result may receive
information in person or through confidential
written notification.
101
Special Considerations when Providing
Positive HIV Test Results
• Individuals with positive results should be notified
only in person in a private setting.
• Allow time for the individual to understand the
meaning of the positive test result.
• Determine the next steps for his or her clinical
management.
• Provide immediate mental health or social services
support as needed.
• Follow all applicable state and local laws and
regulations related to reporting of HIV/AIDS cases.
102
Recommendations for Ensuring
Privacy and Confidentiality
• Challenge to protect privacy and confidentiality
while maintaining security of correctional facility.
• Confidentiality measures should be incorporated
into all health-care services for individuals,
including HIV prevention services.
103
Confidentiality and Privacy (cont.)
• Secure health-care information
• Keep medical records inaccessible to non-healthcare personnel including on computer screens,
desk counter tops, or logbooks.
• Avoid identification of HIV-related clinic visits.
• Ensure privacy for prescribed HIV medications.
• Use professional interpreters as needed.
▫ Have a signed confidentiality agreement on file.
104
105
Correctional Resources
• CDC Correctional Health Website
▫ www.cdc.gov/correctionalhealth/
• American Correctional Association (ACA)
▫ www.aca.org/
• National Commission on Correctional Health
Care (NCCHC)
▫ www.ncchc.org/
• Bureau of Justice Statistics
▫ www.ojp.usdoj.gov/bjs/
106
Review Training Objectives
• Present an overview of best practices in
prevention, testing and linkages to care.
• Provide an in-depth review on HIV linkages to
care policies and practices.
• Highlight the important role of prisons and jails
in HIV linkages to care policies and practices.
107
Acknowledgements
•
•
•
•
•
•
•
•
•
•
•
•
•
John Miles
Thomas Coyne
David Wohl
Curt Beckwith
Ted Hammitt
Jody Rich
Tim Flanigan
Laurie Reid
Rick Altice
Ann Spaulding
Alison Jordan
Steve Belen
Dan O’Connell
•
•
•
•
•
•
•
Jacques Baillargeon
Mick Gardner
Robin Macgowan
Andrew Margolis
David Paar
Marc Stern
Individuals serving time on the
Inside
• DPH (CDC, State and Local)
• DOC, Sheriff’s and Jail personnel
• And so many others….
108
Training Wrap-Up
• Next Steps
• Training Evaluation
• Good Luck!