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HIV and STD Programs in Jail

HIV and STD Programs in Jail. Hampden County, Massachusetts T Lincoln March 2002. Corrections Statistics- USA. 2 million incarcerated (world ~ 8 million) Including probation and parole, 6 million persons involved with corrections- 3% of all U.S. Adults

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HIV and STD Programs in Jail

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  1. HIV and STD Programs in Jail Hampden County, Massachusetts T Lincoln March 2002

  2. Corrections Statistics- USA • 2 million incarcerated (world ~ 8 million) • Including probation and parole, 6 million persons involved with corrections- 3% of all U.S. Adults • 13% of African-American men cannot vote due to this • “Invisible population” • 25% of some neighborhoods • Incarceration rate has more than tripled since 1980 • “34th state”

  3. Percent of Total Burden of Infectious Disease Found Among People Passing Through Correctional Facilities, 1996 Hammet T, Abt Associates, Nat’l HIV Prevention Conf. Aug 1999

  4. HIV DATA 2000 • Massachusetts • annual AIDS rate = 18.9 per 100,000 • 31% IDU, 27% female • Metropolitan Springfield (population ½ million) • annual AIDS rate = 24.2 per 100,000 • 44% IDU, 37% female • Hampden County Correctional Center • 5.5% of men and 8.7% of women HIV positive on intake (1996) • usually ~75 known HIV patients at jail

  5. Community Integrated Correctional Health Care The Hampden County Public Health Model

  6. Public Health Model- Current Structure • 4 jail health teams integrated with 4 community (neighborhood) health centers • Patients assigned to health team by zip code or prior association with community health center • Dually based team members in 4 health centers and jail • Physicians and HIV case managers primarily community health center based • Nurse practitioners, primary nurses primarily jail based • Community corrections (probation/parole/DRC) component in development

  7. Public Health Model for Corrections • Education • Prevention • Early detection • Treatment • Continuity of care • Reservoir of Illness • Proactive v. Reactive • Sentinel function • Public HealthDepartment • Community-integrated model

  8. Model for Correctional Health Care: Evaluation • Support: CDC, Soros Foundation, NIJ • Various facets: Chronic conditions (medical and mental), prevention (HIV, STD, TB, viral hepatitis), HIV treatment, continuity of care • Cost: $9-10/inmate-day, 10% of $44 million budget. ACA average cost prisons 10%. MA 12%. • Economic analysis: A-team • HIV prevention- voluntary counseling & testing • Urine chlamydia screening and partner services

  9. Hampden County Correctional Center • 1800 inmates- 90% men, 10% women • Pretrial and sentenced • % released: 20% 36% 67% at: 3days 2wks 3mo • 70% street drugs- 80% past month, 11% men & 25% women shared needles • 46% in jail in past year

  10. HCCC intake population- self-report 2Q1999 • Sexual Behavior: • 49% sex within a year and never use condom, • 70% drink/use drugs during sex • 11% report prior chlamydia • HIV/AIDS: • 69% ever tested for HIV • 83% feel low/no chance of getting HIV

  11. HCCC program flow • Intake health screen- day 1 • Nurse visit- Brief history & exam includes HIV history, mental health screen • RPR, CBC, ALT, PPD planted • UA (with leukocyte esterase), pregnancy test, since 2/99 urine LCx for chlamydia & brief STD questions • Gonorrhea- Gen-Probe if symptoms, risk, LET+ • Intake Unit- day 1-3/4 • Education and orientation- includes HIV/hepatitis. Video, instructor led, peer education.

  12. HCCC program flow • History and Physical- day 3/4 • Nurse practitioner • Documentation of HIV test acceptance/refusal • HIV voluntary counseling and testing • Referral from: • Prior medical (priority fast-tracked) and education events • Ongoing education programs • Care of other medical concerns • Patient request

  13. HCCC program flow • HIV voluntary counseling and testing (cont’d) • MA Dept Public Health lab and VCT questionnaire • STD • Treatment • Partner elicitation and outreach through MA DPH STD Disease Intervention Specialist includes partners of men with chlamydia • Continuity of care • HIV: Case management is key. 90% show rate at follow-up after release

  14. Key Points • Jail is community. Almost everyone returns. Temporarily displaced. At risk. • Public health opportunity. • Triad of corrections, community and public health. • Program description- set the stage • Need for economic analysis to inform resource allocation

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