Homeless parolees are at high risk for Hepatitis B virus (HBV), Hepatitis C virus (HCV) and HIV infection due to high rates of injection drug use and unprotected sexual activity. Although HBV is a vaccine-preventable illness, 12% to 25% of formerly incarcerated individuals are infected with HBV. Homeless parolees pose a particular challenge for successful reentry as they have underlying mental health issues combined with substance use and abuse and must contend with unstable housing situations, disorganized lives, unemployment, and limited access to health care and social services. Generally about 50% of all parolees scheduled to enroll in community-based drug treatment fail to enroll and less than 10% of enrollees actually complete treatment. Not surprisingly, about two-thirds of all individuals on parole are rearrested and return to custody within three years of release from prison. Our recent data also revealed homeless persons least likely to complete a HAV/HBV vaccine series were young (<40), and were men who had been discharged from prison. Therefore, it is critical to engage paroled adults in comprehensive intervention programs that not only protect them from HBV, but also reduce risky behavior, promote access to health care, social and employment services, and enable positive coping and communication skills. With advice from our community partners who have successfully treated parolees and our experience with hepatitis vaccination work, we propose to conduct a prospective, three-group study that randomly assigns 700 ready-for- discharge parolees, scheduled to enter a community residential drug treatment program, to enter one of three groups: 1) a PCPC (Parolee Comprehensive Care + Phone Coaching Program), which includes nurse case management and specialized hepatitis education sessions and referrals, the HAV/HBV vaccination series (to all eligible) and coach- facilitated mentoring (mostly by cell-phone);2) a Parolee Brief Hepatitis Education + HBV vaccination + Phone Coaching (PBCP) Program, which includes brief hepatitis/HIV education, the HAV/HBV vaccination and coach-facilitated mentoring;or 3) a Usual Care (UC) control program, which includes brief general health information, and the HAV/HBV vaccine. For the randomized parolees, the primary aims will be to examine: reincarceration (any vs none), number of days to first reincarceration, completion of HAV/HBV vaccination (among those HBV-negative), and completion of six months of the Amity community-based residential drug treatment program. Secondary aims are to examine program- related differences in potential mediating variables, such as reduction in drug and alcohol use and sexual risk behaviors, visit to health care or social service providers, and improved knowledge of Hepatitis/HIV and communication skills, between 6 and 12 months or over the one-year study period, depending on the measure, and to assess the relative costs of the three programs. This study will advance our knowledge about drug treatment and HBV vaccine completion and recidivism among homeless parolees. Findings from this study can inform targeted interventions and lay the groundwork for health policy decisions that may impact hepatitis and HIV risk reduction and recidivism in this group who are a reservoir for these viruses in the general population, and are returning to prison at unprecedented numbers.

Public Health Relevance

In this study, researchers from UCLA will partner with Amity Foundation and will work together in designing a program to engage soon-to-be discharged prisoners targeted to enter community-based residential drug treatment to receive a comprehensive program that not only protects them from hepatitis A and B infection by means of the hepatitis vaccination, but also reduces risky behaviors, helps them access health care, and social services, and help them to use more positive coping and communication skills. Using nurse case management strategies found successful with homeless adults, incorporating phone coaching, where a buddy who has successfully completed the drug treatment program supports the newly released parolee, we will evaluate the effectiveness of a Parolee Comprehensive Phone Coaching program compared to a less intense program or a usual care program. Findings from this study can inform targeted interventions and lay the groundwork for health policy decisions that may impact hepatitis and HIV risk reduction and rearrest and/or return to custody in this group who can spread hepatitis infection in the general population, and, are returning to prison at unprecedented numbers.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Special Emphasis Panel (ZRG1-AARR-G (50))
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Wiley, Tisha R A
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University of California Los Angeles
Schools of Nursing
Los Angeles
United States
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Nyamathi, Adeline; Salem, Benissa E; Farabee, David et al. (2017) Impact of an intervention for recently released homeless offenders on self-reported re-arrest at 6 and 12 months. J Addict Dis 36:60-71
Nyamathi, Adeline M; Zhang, Sheldon X; Wall, Sarah et al. (2016) Drug Use and Multiple Sex Partners Among Homeless Ex-Offenders: Secondary Findings From an Experimental Study. Nurs Res 65:179-90
Nyamathi, Adeline M; Zhang, Sheldon; Salem, Benissa E et al. (2016) A randomized clinical trial of tailored interventions for health promotion and recidivism reduction among homeless parolees: outcomes and cost analysis. J Exp Criminol 12:49-74
Nyamathi, Adeline; Salem, Benissa E; Zhang, Sheldon et al. (2015) Nursing case management, peer coaching, and hepatitis a and B vaccine completion among homeless men recently released on parole: randomized clinical trial. Nurs Res 64:177-89
Nyamathi, Adeline; Salem, Benissa E; Farabee, David et al. (2014) Correlates of Heroin and Methamphetamine Use among Homeless Male Ex-Jail and Prison Offenders. Addict Res Theory 22:463-473
Nyamathi, Adeline; Salem, Benissa; Farabee, David et al. (2014) Predictors of High Level of Hostility among Homeless Men on Parole. J Offender Rehabil 53:95-115
Nyamathi, Adeline; Salem, Benissa; Marshall, Lori et al. (2014) Substance use trends among younger vs. older homeless parolees. J Addict Dis 33:124-33
Nyamathi, Adeline; Salem, Benissa E; Marlow, Elizabeth et al. (2013) Understanding correlates of hepatitis C virus infection among homeless recently paroled men. J Forensic Nurs 9:161-70
Salem, Benissa E; Nyamathi, Adeline; Idemundia, Faith et al. (2013) At a crossroads: reentry challenges and healthcare needs among homeless female ex-offenders. J Forensic Nurs 9:14-22
Salem, Benissa E; Nyamathi, Adeline; Keenan, Colleen et al. (2013) Correlates of risky alcohol and methamphetamine use among currently homeless male parolees. J Addict Dis 32:365-76

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