Improving Linkages to Care of Recently Released HIV+ Inmates

Mary Sylla, The Center for Health Justice, Los Angeles; Trista Bingham, LA County Department of Public Health, Los Angeles
Research on Systems of Prevention and Care
Thematic Priority Area: Linkages and Intergration in Provision of Prevention and Care
Community Collaborative Research Awards

Newly diagnosed people living with HIV who have recently been released from jail have trouble accessing HIV medical care and staying in treatment consistently. Since consistent HIV medical care results in many positive effects, including improved health outcomes for the patient, reduced risk-behavior and reduced likelihood of additional transmission, programs that connect newly diagnosed HIV+ people with care are important to HIV prevention. Programs for prisoners with HIV leaving jail and prison are called transitional case management (TCM) programs and are designed to link recently released individuals to medical care and other services that support them in staying healthy. These are important because of the host of obstacles former prisoners encounter when attempting to reintegrate into society. Poor reintegration, especially for newly diagnosed HIV+ people, can result in poor health of the recently released inmates, and also threatens the health of the community to which they return. Little research has been done on TCM programs for recently released HIV+ people. This is surprising because percentage of incarcerated individuals who have HIV is five times that in the general population and an estimated 20-26% of the HIV+ people in the U.S. pass through a correctional facility at some point each year.

Improving Linkages to Care of Recently Released HIV+ Inmates is a research project designed to compare the current method of providing TCM to inmates leaving the Los Angeles Sheriff’s Department’s (LASD) jails with a new model which we call Health Justice-Linked Care (HJ-LC) that provides intensive, post-release support in linking recently released inmates to primary HIV care and other supportive services. The collaborative team of the Improving Linkages to Care Project includes a community-based organization with a history of providing services to this group, the Center for Health Justice (CHJ) and researchers from the Los Angeles County Department of Public Health who will oversee the research. Our collaborative team has the following goals:

  1. Conduct a research to determine effectiveness of the Health Justice-Linked Care (HJ-LC) intervention to link newly diagnosed HIV+ inmates to primary HIV medical care at three months post-release compared to the existing TCM system; and
  2. Estimate the time it takes newly reported HIV+ LASD inmates to get into medical care compared to the general population of persons with newly reported HIV in Los Angeles County.

We believe that the HJ-LC model, which includes intensive community-based case management services, will result in an improvement in successful linkage to primary HIV medical care at three months post-release. To see if we’re right, we propose to adapt case management model that has already had research done on it and has been shown to improve linkage to care – the Antiretroviral Treatment and Access Study (ARTAS) model – to serve newly diagnosed HIV+ individuals recently released from LAC jails. We’re also going to look at the amount of time it takes to get recently released HIV+ people into medical care; we can compare this to information we have about LAC residents as a whole to see if people with incarceration history experience more delayed entry to care generally.

This research project is unlike any that has been done before. No published studies address a similar question and while we know case management improves linkage to care generally, we do not know if it does in this vulnerable group. This project will help determine if a program like HJ-LC can overcome the many challenges HIV+ people face when they are released from jail to the community. This project will provide information for advocates to advance policy initiatives that address recently released HIV+ individuals, including hard data to support advocates in pressing policy-makers to adopt sound policies that strategically address the problem of delayed entry to HIV care.