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yale aids program

JasminFlorian
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yale aids program

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    1. Yale AIDS ProgramYale School of MedicineYale UniversityNew Haven, CTFrederick L. Altice, MD “TRANSITIONS” Enhancing Linkages to HIV Primary Care in Jail Settings Grantee Meeting 10/25/2007 – 10/26/2007 Rockville, MD

    3. Project Goals To develop a unique jail-release model utilizing a jail-based discharge planner, community-based case managers, opiate substitution therapy and community outreach that results in improved HIV treatment, substance abuse and social stabilization outcomes To adapt and test a Money Management program for inmates being released from jail To compare the HIV, substance abuse and social stabilization outcomes for those who receive vs. not receive MM services.

    4. Enhancements to Existing Services Available for HIV+ Inmates Increased HIV screening for those at greatest risk Introduction of discharge planning for jail inmates Strengthened linkages to medical support and opiate substitution therapy upon release Availability of intensified case management Addition of rep payee and other money management services upon release

    5. Project Team and Collaborative Partners Grantee – Yale AIDS Program Project Team Frederick L. Altice, MD – Principal Investigator Mark Rosen, MD – Co- Investigator Laurie Sylla/ David Smith – Study Coordinators Shu Chen – Evaluator Mary Walton, PA-C – Community Healthcare Van Coordinator Jo Anne Mezger – Data Manager TBN – Intensive CM/MM TBN – RA

    6. Project Team and Collaborative Partners Jails – New Haven Community Correctional Center (men) and York Correctional Institution (women) DOC Administrators and Coordinators TBN Referrals Coordinator Waterbury Infectious Disease Clinic 3 Clinic ID Physicians TBN – Intensive Case Manager/Money Manager South Central Rehabilitation Services (SCRC)

    7. Target Population 5-8 per day for HIV screening 60 participants for BMT 60 participants for ICM 30 participants for MM who are also receiving ICM 70% male, 30% female 45% African American, 34% Hispanic, 20% White, 1% other Inmates released to either New Haven or Waterbury, small urban centers of poverty and crime High rates of co-occurring mental health disorders, substance abuse, HCV and chronic homelessness

    8. Local Evaluation Strategy Chart review VL and CD4 testing Standardized interviews Encounter numbers

    9. Local Data Collection(Individual) BPN (eligible subjects only) Chart Review VL and CD4 Standardized Questions Health care utilization Receipt and Adherence (visual analogue scale) to HAART Needs Assessment for Services Substance abuse treatment services Urine toxicology (more may be done by other providers) Addiction Severity Index HIV risk behaviors (ACASI, previous three months) Social entitlements (including ADAP) Social support Illegal activities Homelessness Reincarceration Screening and treatment for mental illness

    10. Local Data Collection Program/Systems Percent HIV tested Service Utilization Percent receiving BUP prior and post release Percent remaining opiate free

    11. Method of Data Collection Chart review Urine toxicology screening Clinical lab tests Counseling and case management notes Interview data Aggregate clinical data Research team minutes Client satisfaction surveys Scannable data forms

    12. Who is Collecting Local Data Research Assistants Case Managers Referrals Coordinator Data Manager

    13. Outcomes Outcomes measures for buprenorphine treatment Retention in buprenorphine treatment Percent opiate free urines Recidivism to drug use, incarceration and criminal behavior Outcomes measures for Intensive Case Management Retention in intensive case management Retention in HIV, psychiatric and medical care Use of emergency department and inpatient hospitalization Outcomes measures for Money Management Retention in money management Recidivism to homelessness Requests for withdrawal of inappropriate funds

    14. Expected Challenges & Possible Solutions High rate of turnover in jail populations Solution – Rapid linkage to the in house Referral Coordinator Poor acceptance of inmates of money management Solution - We will allow for self selection rather than randomization Transportation from jail to clinical care site Solution - Referrals coordinator to provide documents, bus token, medical information and medications on DOR if inmate will return to jail lobby after court

    15. Expected Challenges & Possible Solutions Lack of willingness for the Jail or Community HIV programs to integrate the TRANSITIONS program into routine care Solution - We have obtained support from administrative leaders and will work on a daily basis with field staff to overcome obstacles High rates of HIV testing but inability to provide post test HIV counseling Solution - Inmates who are tested will sign a release form for referral to CARE program; blood for WB confirmation will be drawn on same day

    16. Contact Information Frederick L. Altice, MD raltice@aol.com 203-737-2883 Laurie Sylla laurie.sylla@yale.edu 203-785-5538 David Smith david.smith.ds643@yale.edu 203-785-2038

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