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Shaping HIV & Correctional Health Care: Research Questions Moving Forward

Shaping HIV & Correctional Health Care: Research Questions Moving Forward. Redonna K. Chandler, Ph.D. Division of Epidemiology, Services, and Prevention Research National Institute on Drug Abuse July 22, 2012.

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Shaping HIV & Correctional Health Care: Research Questions Moving Forward

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  1. Shaping HIV & Correctional Health Care: Research Questions Moving Forward Redonna K. Chandler, Ph.D. Division of Epidemiology, Services, and Prevention Research National Institute on Drug Abuse July 22, 2012

  2. U.S. imprisons more people per capita than any other country in the world, with 239% growth in 1990s Source: International Centre for Prison Studies, www.prisonstudies.org

  3. U.S. Adult Offender Population: Since 2005, combined federal, state, local adult correctional population has been over 7 million. Source: Bureau of Justice Statistics, 2009

  4. Prevalence of Health Screening & Services in Adult CJ % Facilities Providing Service Source: CJ-DATS National Criminal Justice Treatment Practices Survey, NIDA

  5. IDU HIV+ Are Much Less Likely to Receive HAART Percentage Of Providers Who Would Defer ART By CD4+ Count and Injection Drug Use Status Westergaard RP et al., J Int AIDS Soc 2012; 15:10.

  6. Unanswered Research Questions • How can HIV services be integrated across the criminal justice system? • What is the resistance? • What organizational change is needed? • What workforce is needed? • What implementation strategies work? • What will it cost and is it cost-effective? • What interventions are needed to reduce stigma associated with drug use, HIV, criminal justice involvement?

  7. HAART as HIV Prevention Montaner et al., Lancet 2008 GD Kirk, et al., 2001, Poster presented at the 18th Conference on Retroviruses and Opportunistic Infections , Boston MA, February 27-March 3, 2011.

  8. Treatment planning for drug abusing offenders should include strategies for chronic medical conditions (e.g. HIV/AIDS, Hep B/C, & TB) In a Given Year . . . About 14% of all people in the US with HIV, & 33% of those with HCV, & 40% of those with TB -- will pass through a correctional facility. Source: Spaulding et al. (2009); Hammett, Harmon, & Rhodes (2002).  AJPH, 92 (11), 1789-1794.

  9. Where and How do you Implement STTR in the Criminal Justice System? ENTRY (Arrest) PROSECUTION (Court, Pre-Trial Release, Jail) ADJUDICATION (Trial) SENTENCING (Fines, Community Supervision, Incarceration) CORRECTIONS (Probation, Jail, Prison) COMMUNITY REENTRY (Probation, Parole, Release) Key Players Crime victim Police FBI Crime victim Police FBI Judge Prosecutor Defense Attorney Defendant Jury Judge Judge Jury Probation Officers Correctional Personnel Probation/ Parole Officers Family Community-based providers Intervention Opportunities Drug treatment Aftercare Housing Employment Mental Health Half-way House TASC Screening/ Referral Diversion Programs Drug Courts Community Treatment TASC N/A Drug Court Terms of Incarceration Release Conditions Drug Treatment Seek Test Treat Retain

  10. Seek, Test, & Treat: Addressing HIVin the Criminal Justice System ``` Vietnam State Receiving Funding NIDA funded PI single award NIDA + NIAID funded PI NIMH funded PI Jail/Prison Location Puerto Rico

  11. How do we Implement Effective Interventions? • What is the cost of STTR? Is it cost-effective? • What assessment tools can communities use to determine which evidence-based STTR components to implement? • What are the structural/organizational requirements for different evidence-based STTR interventions? • What implementation strategies facilitate uptake?

  12. Percentage of Inmates Who Filled an ART Prescription Within 60 Days of Release 100 Only a small percentage of Texas prison inmates receiving ART while incarcerated filled an initial ART prescription within 60 days of release 80 60 Percent 30% 40 17.7% 20 5.4% 0 Had prescription filled within: 10days 30 days 60 days Baillargeon J et al., JAMA 301(8):848-857, 2009.

  13. How do we Promote Patient Sustained Adherence to HAART? • What is the role of addiction treatment (including medication) in HAART adherence? • What individual barriers impede HAART adherence? • What structural and cj system barriers impede HAART adherence? • What role can technology play in HAART adherence?

  14. How Do We Leverage Our Scientific Investment? Data Harmonization

  15. Economy, Power, Answer New Questions Increase cross-study comparability, collaboration, scientific yield Multi-site pooling for integrative data analyses Cross-site replication/comparisons Meta analyses Secondary data analyses Maximizes gain while minimizing cost, risk, and time to payoff Promotes construct quantification through integrative data analysis Why Harmonize?

  16. VAS, HAART ACTG Questionnaire, ART Pill Count, Chart Review Construct Level Measure Level Item Level The Cores Core Domains Central core measures are used in every study, forming a pool of common items Specialty core measures may be asked based on specific interests of a sub-set of studies Example: Cost/Cost Effectiveness, Climate/Culture of Jails Regarding HIV Intervention, etc.

  17. Thank YouQuestions www.drugabuse.gov/aids

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