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HRSA Initiative on Enhancing Linkages to HIV Primary Care In Jail Settings

Presentation Objectives. To describe the HRSA EnhanceLink in Jails InitiativeTen demonstration sites funded for 4 yearsEach with innovative methods for managing HIV positive individuals leaving jail settingsTo review preliminary findings of studyTo solicit advice about best means of disseminating data and coordinating Federal initiatives.

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HRSA Initiative on Enhancing Linkages to HIV Primary Care In Jail Settings

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    1. HRSA Initiative on Enhancing Linkages to HIV Primary Care In Jail Settings HRSA: Adan Cajina, MS Melinda Tinsley, MA Evaluation and Support Center Emory University RSPH: Anne C. Spaulding, MD, MPH Kimberly Jacob Arriola, PhD, MPH Shalonda Freeman, PhD Abt Associates Inc: Lisa LeRoy, PhD, MBA Cristina Booker, MPH Rebecca Sweetland Contact Information: 1518 Clifton Road NE Room 472, Atlanta GA 30322 Tel 404.727.3369 Fax 404.727.8737 aspauld@emory.edu Website: EnhanceLink.org

    2. Presentation Objectives To describe the HRSA EnhanceLink in Jails Initiative Ten demonstration sites funded for 4 years Each with innovative methods for managing HIV positive individuals leaving jail settings To review preliminary findings of study To solicit advice about best means of disseminating data and coordinating Federal initiatives

    3. HIV in Correctional Settings The rate of confirmed AIDS in state and federal prisoners was more than 2½ times higher than in the U.S. population at the end of 2006.1 About 14% of persons with HIV in the US pass through a correctional facility annually. 2 Nearly 5% of state inmate deaths were attributable to AIDS in 2006. 1 Gender & regional differences are great: HIV+ inmates1 Northeast: 3.4% males and 6.4% females Midwest: 0.8% males and 1.4% females South: 2.1% males and 3.0% females West: 0.7% males and 0.8% females Sources: 1. BJS - HIV in Prisons, 2006; 2. Spaulding CROI 2009

    4. HIV in Jails High concentration of cases: E.g., a third of all HIV+ tests in RI found in RI jail screening1 Jails a High admissions, high turnover Local jails had 13 million admissions in 2007. 2 Half of all admissions leave within 48 hours. If HIV screening among detainees, need to screen rapidly.

    5. HRSA EnhanceLink Funded by HRSA HIV/AIDS Bureau, Special Projects of National Significance (SPNS) Evaluation and Support Center in 9/2006 Ten demonstration sites in 9/2007 Major activities HIV screening & diagnosis; e.g. show feasibility of rapid testing Continuity of care programs Develop discharge plans and provide post-release case management. Clients have option to enroll in evaluation Collection of aggregate and client-level data to inform policy lacking in regards to jails and HIV Programmatic and evaluation TA

    8. Multi-Site Evaluation: Research Questions to Address Gaps in Knowledge Aggregate Data: Data collection methods: Administrative data (jail and medical) Example: What fraction of the population eligible for the interventions was served? Client Data: Data collection methods: Longitudinal individual interviews with clients / medical chart and lab data review Example: How many linkages were maintained and for how long? What characteristics were associated with successful linkages? Cost Data: What resources were required to deliver the interventions?

    9. Preliminary Data SPNS demonstration projects: Doing a large volume of HIV testing : 1,535 tested with SPNS-funding 4,264 total tested Protocols are very much in line with the spirit of the 2006 CDC recommendations for HIV testing Programs are new, but: Reasonably high acceptance rates High rates of testing & returning results Client-level data will tell us much more: 65 clients have completed the baseline interview 51 clients in the process of completing the baseline interview More work is needed to know what testing protocols, case management protocols are most effective

    10. Dissemination (in addition to website) Descriptive papers: Rapid HIV Testing in Rapidly Released Detainees: Next Steps' STD 2009 34(11):S34-6 Enhancing Linkages to HIV Primary Care in Jail Settings: Report on a Consultant's Meeting. J Correctional Healthcare 2007 http://enhancelink.org/sites/hivjailstudy/Gallery/Emory_Jail.pdf Presentations: NCCHC ACHSA Regional and National Conferences UMass Correctional Health Conference Ryan White Conference …and HIV Prevention Conference 2009 How do we reach a wider audience and increase the impact? How can Federal initiatives be coordinated? How can initiatives be sustained?

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