Research to Better Engage HIV+ Former Prisoners in HIV Services


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The purpose of this project is to better understand the post-incarceration needs and resources of HIV+ former prisoners. This population has a poor history of remaining in medical care, resulting in increased viral load, morbidity and disease transmission risk. We have analyzed records of 363 Spectrum case management clients, developed a focus group discussion interview guide and recruitment tools, and received IRB approval to conduct focus groups.

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Research to Better Engage HIV+ Former Prisoners in HIV Services

  1. 1. Research to Better Engage HIV+Former Prisoners in HIV ServicesNina Harawa, Ph.D., Associate Professor, CDU College of MedicineCharles Hilliard, Ph.D., Clinical Director, SPECTRUM ClinicPilot funds provided by NIH/NCATS/UCLA CTSI Grant # UL1TR000124
  2. 2. Background• Prisoners are the only group in the U.S. with a constitutional right to health care.• This does not guarantee that they will continue to receive health care upon release—in fact, because of their frequent unstable status, low health literacy, and competing priorities, the incarcerated individual’s engagement in medical care often ends at release -- even when community options for free or low-cost care exist, as they do for HIV (Baillargeon JG, et al., 2010; Baillargeon J, et al., 2009).• A number of studies have shown low levels of entry into and engagement in care among former HIV+ prisoners.
  3. 3. History• We were partners in a recent effort, funded by AIDS United’s Access to Care (A2C) initiative, that sought to facilitate linkage to and retention in care for HIV-positive persons leaving California prisons.• Called the Positive Parolee Network (PPN), this project ended prematurely in March 2012.• PPN Components • intensive case management, including reentry support • peer support, and • linkage-to-care services.
  4. 4. PPN• During the PPN’s five-month implementation period, we enrolled 24 people who had been released from prison in the prior 12 months.• Although we successfully linked 79% of these clients to HIV medical care within 30 days, we encountered challenges in working with them to meet their other case management goals.• These issues contributed to frequent recidivism and inconsistent participation. Mental illness, addiction and difficulties securing stable, appropriate housing for clients were major issues.• Approximately 30% of SPECTRUM’s routine case management clients report having been incarcerated in the prior 24 months.
  5. 5. CERP• This CERP funded research project allows us to • continue the momentum of this work, • build on lessons learned, • gather data that will allow us to • improve our intervention for HIV+ former prisoners • prepare for potential funding opportunities from AU and others.
  6. 6. Research Questions• What are the most commonly experienced needs and barriers to medical care among recently incarcerated HIV-positive former prisoners compared to other clients?• What are the key differences in background characteristics between those former prisoners who are and are not retained in HIV medical care?• What are the key motivators and other factors that promote linkage to and retention in HIV medical care among former prisoners?
  7. 7. MethodsSecondary analysis of SPECTRUM data :• Case Management clients served between 2007 & 2012.• Compare • recently incarcerated SPECTRUM clients who were and were not retained in HIV medical care in the 12 months following their release from prison. • retained in care defined as two or more medical visits in a HIV care setting at least two months apart per measurement year (HRSA 2008).• Goal • assess the key predictors of successful or poor engagement in HIV care in this group
  8. 8. MethodsQualitative• Conduct focus groups with HIV positive former prisoners • four two-hour focus group discussions with • a total of 20 HIV-positive individuals • incarcerated in a California state prison within the prior twelve months• Form a Community Advisory Board (CAB) and meet with them 3 times to obtain input on: • the focus group discussion interview guide, • Interpreting the data • recruitment, • service provision
  9. 9. Outcomes• Improve parolee linkage to care: Apply health services research methods to routinely collected client data in order to improve ongoing service provision at SPECTRUM. Further, we intend to use the collected quantitative and qualitative study data to refine the intervention approach for future grant applications in order to improve outcomes for HIV+ positive parolees returning to South Los Angeles (and other communities across the country).• Improved utilization of existing client data: Develop a series of automated reports that SPECTRUM staff will be able to use going forward to periodically evaluate their client data.
  10. 10. CERP Aims AddressedCERP Aim 1 discusses promoting and sustaining bidirectionalknowledge sharing between community and academia.• This research project enables SPECTRUM and its staff to work directly with an academic researcher to apply health services research methods to analyzing its client data and to gather and examine additional data on a population it serves but whose retention-in-care needs have not been fully addressed by the traditional case management.• In turn, SPECTRUM and the community advisory board will share with the researcher the expertise it has gained from years of serving HIV-positive, low-income individuals, including many with incarceration histories.
  11. 11. CERP Aims AddressedCERP Aim 2 discusses strengthening community infrastructurefor sustainable partnered research.• Although SPECTRUM is able to obtain limited, aggregate client data from preformatted reports provided through the County’s Casewatch client data system, it lacks the capacity to look at its data in more detail or over time.• Through this research, we will identify variables, cross- tabulations, and trends that would be beneficial for SPECTRUM to examine on an ongoing basis in order to guide planning for all of its client populations.• We will use this information to develop a series of automated reports and train SPECTRUM staff to periodically recreate these reports with updated client data.
  12. 12. Timeline-deliverablesAugust 2012 Sept – Oct Nov – Dec January 2013 FebruaryIRB Approval for Obtain IRB approval for Transcribe, review, Review all focusQuantitative Qualitative Phase and code Focus group transcriptsprotocol quantitative Group #1 data Draft qualitative CAB Meetings Conduct Focus Final codebook focus group #2 & 3 Groups 2-4 discussion interview guide Preliminary crude Finalize qualitative Develop initial Quantitative date distributions for focus group code book report key predictors of discussion guide interest CAB Meeting #1 Finalize Transcribe Focus Develop outline distributions for all Groups 2-4 for one mixed- predictors of methods interest manuscript combining data from Conduct Focus Distribute Group #1 quantitative date reports
  13. 13. Added-value from CTSIFundingCTSI funding provides the resources to research an issue that has ahuge impact on the local community, the stability of HIV-positiveformer prisoners returning to South Los Angeles and the County atlarge. Existing linkage to care services are inadequate and in need ofimproved evidence-driven improvements.• This research has the potential of improving engagement and retention in HIV care for a very vulnerable population.• Improved engagement and retention of HIV positive parolees has the potential of improving parolee health, increasing parolee stability in the community, reducing further HIV transmissions, and reducing the need for parolees to access more expensive health care services and other public resources.
  14. 14. Next Steps Submit findings (manuscript) for publication. Share findings with SPECTRUM clients, DHSP, HIV medical providers within the prisons and other local provider groups serving parolees. Submit new application(s) for funding for improved case management services for parolees. Ongoing: Utilize data from quantitative analysis to improve SPECTRUM services to recently incarcerated clients; utilize data tables for ongoing evaluation of client data.