of the Project (Abstract)Inmates in South African correctional facilities have a high prevalence of HIV and TB and a highdegree of mobility between facility and community. Within correctional facilities, inmatesreceive TB and HIV care; however, on release, they are not systematically linked to communitycare programmes. As a result, the majority of released inmates may have interruptions in eitherHIV or TB treatment. The net result is poorer short and long term health outcomes for thereleased individuals and a higher risk of transmission of acquired drug resistant HIV or TBwithin the community.We propose a community-based case management approach to improve linkage into carefollowing release from correctional facilities. This operational evaluation will use a system tolocate released inmates and determine clinic attendance status. The case management systemwill include with strengths based counselling to engender health self-efficacy. Two specificareas of focus will be skills-building to develop positive interactions with the health care system.We anticipate that through this programme we will markedly increase linkage to community-based care. This will have profound implications for the health of the reduced inmate andreduced risk of developing drug resistant HIV or TB and transmitting HIV or TB to partners orcommunity members.

Public Health Relevance

The proposed operational research addresses a vital aspect of combating HIV in South Africa: engaging and retaining men in HIV care. Men are less likely to present for HIV testing, and among those tested, less likely to enter HIV care and less likely to remain in HIV care. In South Africa, only 30-35% of adults in HIV care are male and men enter care with more advanced HIV than women. Therefore, the correctional system can play a vital role in diagnosing HIV and starting appropriate treatment. Approximately 300,000 men pass through the correctional system in South Africa annually of whom around 20% are HIV-infected. Operational research conducted by the Aurum Institute in South African prisons has demonstrated (1) that high quality HIV care can be provided and (2) inmates testing for HIV and entering HIV care have higher CD4 counts and less advanced clinical disease stage than men in the community. However, although half of the prison population returning to the community annually, there is no system to link inmates into HIV care following release. A system is urgently needed to link released inmates into care is an important public health priority and a valuable service for both the health of the released inmate and the community. The proposed operational research provides an innovation in HIV treatment retention by implementing and evaluating a case management system to link released inmates into care after prison release. As a first step, current linkage to care following prison release will be determined. This will be followed by implementation of a community-based case management system with evaluation of the change in proportion linking to care.

National Institute of Health (NIH)
Coordinating Office of Global Health (COGH)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZGH1-SRC (99))
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Aurum Institute for Health Research
South Africa
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