Shaping HIV & Correctional Health Care: Research Questions Moving Forward Redonna K. Chandler, Ph.D....
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![Page 1: Shaping HIV & Correctional Health Care: Research Questions Moving Forward Redonna K. Chandler, Ph.D. Division of Epidemiology, Services, and Prevention.](https://reader035.fdocuments.us/reader035/viewer/2022070400/56649e415503460f94b32ca6/html5/thumbnails/1.jpg)
Shaping HIV & Correctional Health Care: Research Questions Moving
Forward
Redonna K. Chandler, Ph.D.Division of Epidemiology, Services, and
Prevention ResearchNational Institute on Drug Abuse
July 22, 2012
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U.S. imprisons more people per capita than any other country in the world, with 239% growth in 1990s
53
100
112
116
125
139
400
628
702
91
73
85
0 100 200 300 400 500 600 700 800
Japan
Sweden
France
Germany
Italy
Australia
Canada
Spain
England and Wales
South Africa
Russian Federation
United States
Inmates per 100K CitizensSource: International Centre for Prison Studies, www.prisonstudies.org
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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
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Prevalence of Health Screening
& Services in Adult CJ% Facilities Providing Service
Source: CJ-DATS National Criminal Justice Treatment Practices Survey, NIDA
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Westergaard RP et al., J Int AIDS Soc 2012; 15:10.
IDU HIV+ Are Much Less Likely to Receive HAART
Percentage Of Providers Who Would Defer ART By CD4+ Count and Injection Drug Use Status
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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?
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HAART as HIV Prevention
GD Kirk, et al., 2001, Poster presented at the 18th Conference on Retroviruses and Opportunistic Infections , Boston MA, February 27-March 3, 2011.
Montaner et al., Lancet 2008
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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.
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.
Treatment planning for drug abusing offenders should include strategies for chronic medical conditions (e.g. HIV/AIDS, Hep B/C, & TB)
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ENTRY(Arrest)
ADJUDICATION(Trial)
PROSECUTION(Court, Pre-Trial Release, Jail)
SENTENCING(Fines, Community Supervision,Incarceration)
CORRECTIONS(Probation, Jail, Prison)
COMMUNITY REENTRY(Probation, Parole, Release)
Crime victimPoliceFBI
Crime victimPoliceFBIJudge
Key Players
Screening/Referral
Intervention Opportunities
ProsecutorDefense AttorneyDefendantJuryJudge
JudgeJury
Probation OfficersCorrectional Personnel
Probation/ Parole OfficersFamilyCommunity-based providers
Diversion ProgramsDrug CourtsCommunity TreatmentTASC
Drug CourtTerms of IncarcerationRelease Conditions
Drug Treatment
Drug treatmentAftercareHousingEmploymentMental HealthHalf-way HouseTASC
N/A
Where and How do you Implement STTR in the Criminal Justice System?
Seek Test Treat Retain
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```
State Receiving FundingNIDA funded PI single awardNIDA + NIAID funded PINIMH funded PIJail/Prison Location
Seek, Test, & Treat: Addressing HIVin the Criminal Justice System
Puerto Rico
Vietnam
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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?
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Baillargeon J et al., JAMA 301(8):848-857, 2009.
Percentage of Inmates Who Filled an
ART Prescription Within 60 Days of Release
Perc
ent
5.4%
17.7%
30%
0
20
40
60
80
100
10 days 30 days 60 days
Only a small percentage of Texas prison inmatesreceiving ART while incarcerated filled an initial ART prescription within 60 days of release
Had prescriptionfilled within:
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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?
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How Do We Leverage Our Scientific Investment?
Data Harmonization
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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?
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Central core measures are used in every study, forming a pool of common itemsSpecialty core measures may be asked based on specific interests of a sub-set of studiesExample: Cost/Cost Effectiveness, Climate/Culture of Jails Regarding HIV Intervention, etc.
The Cores
STTRHarmonizat
ion Constructs
Demographics
Mental HealthCJ
Status
Drug Use
HIV/IDU Risk
HIV/HCV
Testing
Access to Care
Treatment Utilization Adhe
renceBiological
DataMeasure Level
Construct Level
VAS, HAART ACTG Questionnaire, ART Pill Count, Chart Review
Item Level
Core Domains
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Thank YouQuestions
www.drugabuse.gov/aids