HIV+ incarcerated individuals frequently face a host of challenges following release including substance abuse, securing subsistence needs such as housing and nutrition, physical and mental illness and re-establishing interpersonal relationships. These challenges often act as impediments to accessing health care and medications. Evidence suggests, that despite in-prison discharge planning, HIV+ releasees have difficulty accessing HIV-related health care and services and have high rates of recidivism. We will attempt to modify the challenges faced by HIV+ releasees as they seek care by developing and implementing a theory based 'bridging' case management (BCM) intervention spanning the periods prior to and following release. Sustained access to medical care will be compared between releasees receiving BCM or standard discharge planning. Further, recognizing the potential role HIV+ releasees play in the spread of the epidemic we will describe the intimate and unsafe drug using behaviors of study participants and the effect of a Strengths model of BCM on these behaviors. Data gathered will inform development of a subsequent risk behavior intervention for this population. We will enroll 250 HIV+ inmates who are about to be released from prison in a randomized, controlled trial.
Our aim i s to evaluate BCM and devise a manual-based training program in collaboration with staff members of the NCDOC and the NC state AIDS Care Branch. Specifically, we will: I. Develop, implement and evaluate a BCM intervention designed to improve HIV care access. Hypotheses: 1. Releasees receiving B CM will have a greater increase in health care utilization during the year following release compared with those receiving standard of care (where health care utilization is defined as the number of clinic visits over the 12 months following release (CD4 <350: at least 1 clinic visit every 4 months, CD4>350: at least I clinic visit every 6 months). 2. Releasees receiving BCM will have lower levels of plasma HIV RNA and higher CD4+ cell counts than those receiving standard of care during the year following release. II. Evaluate the impact of BCM on unmet needs, health-related quality of life, and re-incarceration. Hypotheses: 1. Releasees receiving BCM will have more of their needs met (subsistence needs, substance abuse treatment, mental health care and transportation) than releasees receiving standard of care discharge planning during the year following release. 2. Releasees receiving BCM will experience more improvement in health-related quality of life than will those receiving standard of care during the year following release. 3 Releasees receiving BCM will have a lower rate of prison/jail re-incarceration during the year following release than those receiving standard of care. 4. Releasees receiving BCM will experience less depression than will those receiving standard of care during the year following release. III. Describe the intimate and unsafe drug using behaviors of a group of H/V-infected former inmates. Hypotheses: 1. Following release, a significant proportion of HIV+ former inmates engage in behaviors that risk transmission of HIV. 2. BCM will reduce intimate and drug related HIV transmission risk behaviors during the year following prison release.
| Wohl, David A; Scheyett, Anna; Golin, Carol E et al. (2011) Intensive case management before and after prison release is no more effective than comprehensive pre-release discharge planning in linking HIV-infected prisoners to care: a randomized trial. AIDS Behav 15:356-64 |
| Scheyett, Anna; Parker, Sharon; Golin, Carol et al. (2010) HIV-infected prison inmates: depression and implications for release back to communities. AIDS Behav 14:300-7 |
