Intensive Case Management Before and After Prison Release is No More Effective Than Comprehensive Pre-Release Discharge Planning in Linking HIV-Infected Prisoners to Care: A Randomized Trial

The University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC 27599, USA.
AIDS and Behavior (Impact Factor: 3.49). 11/2010; 15(2):356-64. DOI: 10.1007/s10461-010-9843-4
Source: PubMed


Imprisonment provides opportunities for the diagnosis and successful treatment of HIV, however, the benefits of antiretroviral therapy are frequently lost following release due to suboptimal access and utilization of health care and services. In response, some have advocated for development of intensive case-management interventions spanning incarceration and release to support treatment adherence and community re-entry for HIV-infected releasees. We conducted a randomized controlled trial of a motivational Strengths Model bridging case management intervention (BCM) beginning approximately 3 months prior to and continuing 6 months after release versus a standard of care prison-administered discharge planning program (SOC) for HIV-infected state prison inmates. The primary outcome variable was self-reported access to post-release medical care. Of the 104 inmates enrolled, 89 had at least 1 post-release study visit. Of these, 65.1% of BCM and 54.4% of SOC assigned participants attended a routine medical appointment within 4 weeks of release (P > 0.3). By week 12 post-release, 88.4% of the BCM arm and 78.3% of the SOC arm had at attended at least one medical appointment (P = 0.2), increasing in both arms at week 24-90.7% with BCM and 89.1% with SOC (P > 0.5). No participant without a routine medical visit by week 24 attended an appointment from weeks 24 to 48. The mean number of clinic visits during the 48 weeks post release was 5.23 (SD = 3.14) for BCM and 4.07 (SD = 3.20) for SOC (P > 0.5). There were no significant differences between arms in social service utilization and re-incarceration rates were also similar. We found that a case management intervention bridging incarceration and release was no more effective than a less intensive pre-release discharge planning program in supporting health and social service utilization for HIV-infected individuals released from prison.

11 Reads
    • "within 10 days of release, 17.7% within 30 days, and 30% within 60 days (Baillargeon et al., 2009). In other studies, only 20% to 54% of inmates enrolled in an HIV clinic within 1 month of release (Baillargeon et al., 2010; Wohl et al., 2011). Disruptions in care and poor adherence lead to higher HIVrelated mortality, poorer HIV-related outcomes, and resistance to HIV medications in recently released individuals (Rosen, Schoenbach, & Wohl, 2008; Springer, Friedland, Doros, Pesanti, & Altice, 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Most HIV-infected inmates leave prison with a suppressed viral load; many, however, become disconnected from care and nonadherent to medications during reentry to community life. In this secondary data analysis of focus groups (n = 6) and in-depth interviews (n = 9) with 46 formerly incarcerated HIV-infected people during reentry, we used an inductive analytic approach to explore the interplay between individual, interpersonal, community, and structural factors and HIV management. Participants described barriers and facilitators to care engagement and adherence at each of these four levels, as well as a milieu of HIV and incarceration-related stigma and discrimination. The constellation of barriers and facilitators created competing demands and a sense of chaos in participants' lives, which led them to address reentry-related basic needs (e.g., housing, food) before health care needs. Interventions that simultaneously address multiple levels, including augmenting employment and housing opportunities, enhancing social support, and reducing stigma, are needed. Copyright © 2015 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
    The Journal of the Association of Nurses in AIDS Care: JANAC 06/2015; 26(5). DOI:10.1016/j.jana.2015.06.001 · 1.27 Impact Factor
  • Source
    • "Annually, one in six PLWHAs passes through the criminal justice system (CJS), with 95% of releasees coming out of jails (Spaulding et al., 2009). As a result, any period of incarceration is an important opportunity to address disease education, prevention, and treatment, including delivery of and linkage to care for HIV, mental illness, and substance use (Draine et al., 2011; Flanigan et al., 2010; McClelland et al., 2002; Spaulding et al., 2009; Springer & Altice, 2005; Springer, Azar, & Altice, 2011; Springer, Spaulding, Meyer, & Altice, 2011; Wohl et al., 2011). The trans-institutionalization (from public psychiatric hospital to jail or prison) of those with mental illness starting in the late 1960s led the CJS to be a repository of care and treatment of the mentally ill. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study evaluates the prevalence of mental/emotional distress and its specific correlates among people living with HIV/AIDS (PLWHA) in 20 jail systems across the United States. Of the 878 PLWHA jail detainees, 52% had high levels of mental/emotional distress, defined by the composite Addiction Severity Index score. High mental/emotional distress was found to be associated with the inmate living in a city with lower income inequality, lower health ranking, and higher degree of danger. Proximate variables included being female, bisexual orientation, poorer physical health, and increased severity of substance abuse. Inmates in jails with accredited health services and those satisfied with family support had lower mental/emotional distress scores. These findings indicate the need for expanded mental health assessment of PLWHAs entering jail. © The Author(s) 2015.
    Journal of Correctional Health Care 04/2015; 21(2):125-39. DOI:10.1177/1078345815574566
  • Source
    • "Our systematic literature search initially yielded 39 search results. Fourteen studies were excluded because they did not have female-only samples or report genderspecific outcomes (Alemagno, Stephens, Stephens, Shaffer-King, & White, 2009; Bauserman et al., 2003; Bryan, Robbins, Ruiz, & O'Neill, 2006; Bryan, Schmeige, & Broaddus, 2009; Hurd, Valerio, Garcia, & Scott, 2010; Lauby et al., 2010; Leukefeld et al., 2003; Mouttappa, Watson, McCuller, Reiber, & Tsai, 2009; Prendergast et al., 2011; Reznick, McCartney, Gregorich, Zack, & Feaster, 2013; Schmiege, Broaddus, Levin, & Bryan, 2009; Tolou-Shams et al., 2011; Wexler, Magura, Beardsley, & Josepher, 1994; Wohl et al., 2011). Ten studies were excluded because of selective outcome reporting bias (Cochrane Collaboration, 2013). "
    09/2014; 5(3):253-289. DOI:10.1086/677394
Show more