Harzke AJ, Ross MW, Scott DP. Predictors of postrelease primary care utilization among HIV-positive prison inmates: a pilot study
ABSTRACT The primary aims of this exploratory pilot study were (1) to determine the proportion of a sample of HIV-positive inmates utilizing primary care after recent release, and (2) to identify variables associated with utilization of primary care at the time of a post-release interview. Sixty HIV-positive, male and female state prison inmates were interviewed approximately three months prior to release, and 30 were interviewed again between seven and 21 days after release. Variables associated with having utilized primary care at the time of a post-release interview (chi(2) p-values < 0.20) included: taking anti-HIV medications at the time of release, no alcohol use since release, living in the same place as before incarceration and rating of housing situation as 'comfortable' or 'very comfortable'. For exploratory purposes, these variables were entered into a logistic regression model. The model correctly classified 80% of cases overall. Future studies are required to ascertain whether these results would obtain with a statistically adequate sample size.
- SourceAvailable from: Matthew L Hiller
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- "For HIV-infected inmates leaving prison, continuity of HIV care is only part of community reentry (Rich et al., 2011). Most returning inmates face numerous reintegration challenges, including financial burdens and disorganized lifestyles , such as homelessness, poverty, mental illness, substance abuse, lack of medical coverage, unemployment, inadequate social support, and physical health issues (Baillargeon et al., 2009; Harzke, Ross, & Scott, 2006; Keuroghlian et al., 2011; Mellins, Kang, Leu, Havens, & Chesney, 2003; Springer, Azar, & Altice, 2011). These challenges often present conflicting demands, and priorities often shift depending on immediate needs. "
ABSTRACT: HIV risk is disproportionately high among incarcerated individuals. Corrections agencies have been slow to implement evidence-based guidelines and interventions for HIV prevention, testing, and treatment. The emerging field of implementation science focuses on organizational interventions to facilitate adoption and implementation of evidence-based practices. A survey of correctional agency partners from the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) revealed that HIV policies and practices in prevention, detection, and medical care varied widely, with some corrections agencies and facilities closely matching national guidelines and/or implementing evidence-based interventions. Others, principally attributed to limited resources, had numerous gaps in delivery of best HIV service practices. A brief overview is provided of a new CJ-DATS cooperative research protocol, informed by the survey findings, to test an organization-level intervention to reduce HIV service delivery gaps in corrections.Journal of Correctional Health Care 10/2013; 19(4):293-310. DOI:10.1177/1078345813499313
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- "In a smaller study of 30 HIV-infected recently released prisoners, only 18 (60%) were enrolled in HIV primary care 21 days after incarceration. Enrollment in primary care was associated with abstinence from alcohol though this association did not reach statistical significance, likely owing to the small sample size . Other published research on reduced uptake in HIV care after prison release has not assessed the important contribution of SUDs to discontinuous care [22, 23]. "
ABSTRACT: The criminal justice system bears a disproportionate burden of the HIV epidemic. Continuity of care is critical for HAART-based prevention of HIV-related morbidity and mortality. This paper describes four major challenges to successful management of HIV in the criminal justice system: relapse to substance use, homelessness, mental illness, and loss of medical and social benefits. Each of these areas constitutes a competing priority upon release that demands immediate attention and diverts time, energy, and valuable resources away from engagement in care and adherence to HAART. Numerous gaps exist in scientific knowledge about these issues and potential solutions. In illuminating these knowledge deficits, we present a contemporary research agenda for the management of HIV in correctional systems. Future empirical research should focus on these critical issues in HIV-infected prisoners and releasees while interventional research should incorporate evidence-based solutions into the criminal justice setting.AIDS research and treatment 07/2011; 2011(2090-1240):680617. DOI:10.1155/2011/680617
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- "Studies have found that 26 % of HIV-infected inmates reported unprotected sexual activity within 45 days after release (Stephenson et al., 2006). Forty percent of HIV-infected prison releasees had not accessed medical care by six weeks post-release (Harzke, Ross, and Scott, 2006) and decreased CD4 lymphocyte counts and increased plasma HIV RNA levels are common in releasees (Spring, et al., 2004; Stephenson et al., 2005). Depression has been linked to disease progression in HIV-infected individuals, probably through multiple mechanisms, including poor medication adherence and risky sexual behaviors, however depressive symptoms have been found to be linked to disease progression even after controlling for medication adherence and clinical and demographic factors (Boarts, Sledjeski, Bogart, and Delahanty, 2006; Evans et al., 2002; Ickovics et al., 2001; Lima et al., 2007; Olatunji, Mimiaga, O'Cleirigh, and Safren, 2006; Perdue, Hagan, Thiede, and Valleroy, 2003; Reynolds et al., 2004; Vanable, Carey, Blair, and Littlewood, 2006). "
ABSTRACT: High rates of both HIV and depression are seen in prison populations; depression has been linked to disease progression in HIV, risky behaviors, and medication non-adherence. Despite this, few studies have examined HIV-infected inmates with depression. We therefore conducted an exploratory study of a sample of HIV-infected inmates in North Carolina prisons (N=101) to determine what proportion of this sample screened positive for depression and whether depression was associated with different pre-incarceration characteristics or post-release needs. A high proportion of HIV infected inmates (44.5%) screened positive for depression. Depressed inmates were significantly more likely have low coping self-efficacy scores (180 vs. 214), to report having had resource needs (OR=2.91) prior to incarceration and to anticipate needing income (OR=2.81), housing (OR=4.07), transportation (OR=9.15), and assistance with adherence (OR=8.67) post-release. We conclude by discussion the implications of our findings for prison based care and effective prison release planning for HIV infected inmates.