Lauren Brinkley-Rubinstein

Clinical care of incarcerated people with HIV, viral hepatitis, or tuberculosis

The burden of HIV/AIDS and other transmissible diseases is higher in prison and jail settings than in the non-incarcerated communities that surround them. In this comprehensive review, we discuss available literature on the topic of clinical management of people infected with HIV, hepatitis B and C viruses, and tuberculosis in incarcerated settings in addition to co-occurrence of one or more of these infections. Methods such as screening practices and provision of treatment during detainment periods are reviewed to identify the effect of community-based treatment when returning inmates into the general population. Where data are available, we describe differences in the provision of medical care in the prison and jail settings of low-income and middle-income countries compared with high-income countries. Structural barriers impede the optimal delivery of clinical care for prisoners, and substance use, mental illness, and infectious disease further complicate the delivery of care. For prison health care to reach the standards of community-based health care, political will and financial investment are required from governmental, medical, and humanitarian organisations worldwide. In this review, we highlight challenges, gaps in knowledge, and priorities for future research to improve health-care in institutions for prisoners.

Social, structural, behavioral and clinical factors influencing retention in Pre-Exposure Prophylaxis (PrEP) care in Mississippi

Pre-exposure prophylaxis (PrEP) is a biomedical intervention that can reduce rates of HIV transmission when taken once daily by HIV-negative individuals. Little is understood about PrEP uptake and retention in care among the populations most heavily impacted by the HIV epidemic, particularly among young men who have sex with men (YMSM) in the Deep South. Therefore, this study explored the structural, social, behavioral, and clinical factors that affect PrEP use and retention in care among YMSM in Jackson, Mississippi. Thirty MSM who were prescribed PrEP at an outpatient primary care clinic were interviewed and included 23 men who had been retained in PrEP care and seven who had not been retained. The mean age of participants was 26.6 years. Most (23) participants were African American. Major factors affecting PrEP use and retention in PrEP care included 1) structural factors such as cost and access to financial assistance for medications and clinical services; 2) social factors such as stigma and relationship status; 3) behavioral factors including sexual risk behaviors; and 4) clinical factors such as perceived and actual side effects. Many participants also discussed the positive spillover effects of PrEP use and reported that PrEP had a positive impact on their health. Four of the seven individuals who had not been retained re-enrolled in PrEP care after completing their interviews, suggesting that case management and ongoing outreach can enhance retention in PrEP care. Interventions to enhance retention in PrEP care among MSM in the Deep South will be most effective if they address the complex structural, social, clinical, and behavioral factors that influence PrEP uptake and retention in PrEP care.

Defining the HIV pre-exposure prophylaxis care continuum

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy. There is little scientific consensus about how to measure PrEP program implementation progress. We draw on several years of experience in implementing PrEP programs and propose a PrEP continuum of care that includes: (1) identifying individuals at highest risk for contracting HIV, (2) increasing HIV risk awareness among those individuals, (3) enhancing PrEP awareness, (4) facilitating PrEP access, (5) linking to PrEP care, (6) prescribing PrEP, (7) initiating PrEP, (8) adhering to PrEP, and (9) retaining individuals in PrEP care. We also propose four distinct categories of PrEP retention in care that include being: (1) indicated for PrEP and retained in PrEP care, (2) indicated for PrEP and not retained in PrEP care, (3) no longer indicated for PrEP, and (4) lost to follow-up for PrEP care. This continuum of PrEP care creates a framework that researchers and practitioners can use to measure PrEP awareness, uptake, adherence, and retention. Understanding each point along the proposed continuum of PrEP care is critical for developing effective PrEP interventions and for measuring public health progress in PrEP program implementation.

Postincarceration Fatal Overdoses After Implementing Medications for Addiction Treatment in a Statewide Correctional System

This analysis examines the association of death from overdose among individuals released from the Rhode Island correctional system after implementation of a comprehensive program of medications for addiction therapy.

Addressing excess risk of overdose among recently incarcerated people in the USA: harm reduction interventions in correctional settings

Purpose The purpose of this paper is to discuss overdose among those with criminal justice experience and recommend harm reduction strategies to lessen overdose risk among this vulnerable population. Design/methodology/approach Strategies are needed to reduce overdose deaths among those with recent incarceration. Jails and prisons are at the epicenter of the opioid epidemic but are a largely untapped setting for implementing overdose education, risk assessment, medication assisted treatment, and naloxone distribution programs. Federal, state, and local plans commonly lack corrections as an ingredient in combating overdose. Harm reduction strategies are vital for reducing the risk of overdose in the post-release community. Findings Therefore, the authors recommend that the following be implemented in correctional settings: expansion of overdose education and naloxone programs; establishment of comprehensive medication assisted treatment programs as standard of care; development of corrections-specific overdose risk assessment tools; and increased collaboration between corrections entities and community-based organizations. Originality/value In this policy brief the authors provide recommendations for implementing harm reduction approaches in criminal justice settings. Adoption of these strategies could reduce the number of overdoses among those with recent criminal justice involvement.

A randomized, open label trial of methadone continuation versus forced withdrawal in a combined US prison and jail: Findings at 12 months post-release

Recently, incarcerated individuals are at increased risk of opioid overdose. Methadone maintenance treatment (MMT) is an effective way to address opioid use disorder and prevent overdose; however, few jails and prisons in the United States initiate or continue people who are incarcerated on MMT. In the current study, the 12 month outcomes of a randomized control trial in which individuals were provided MMT while incarcerated at the Rhode Island Department of Corrections (RIDOC) are assessed. An as-treated analysis included a total of 179 participants-128 who were, and 51 who were not, dosed with methadone the day before they were released from the RIDOC. The results of this study demonstrate that 12 months post-release individuals who received continued access to MMT while incarcerated were less likely to report using heroin and engaging in injection drug use in the past 30 days. In addition, they reported fewer non-fatal overdoses and were more likely to be continuously engaged in treatment in the 12-month follow-up period compared to individuals who were not receiving methadone immediately prior to release. These findings indicate that providing incarcerated individuals continued access to MMT has a sustained, long-term impact on many opioid-related outcomes post-release.

Commentary: the importance of Medicaid expansion for criminal justice populations in the south

Though the full implications of a Trump presidency for ongoing health care and criminal justice reform efforts remain uncertain, whatever policy changes are made will be particularly salient for the South, which experiences the highest incarceration rates, highest uninsured rates, and worst health outcomes in the United States. The passage of the Affordable Care Act (ACA) in 2010 was a watershed event and many states have taken advantage of opportunities created by the ACA to expand healthcare coverage to their poorest residents, and to develop partnerships between health and justice systems. Yet to date, only four have taken advantage of the benefits of healthcare reform. Expanding Medicaid would provide Southern states with the opportunity to significantly impact health outcomes for criminal justice-involved individuals. In the context of an uncertain policy landscape, we suggest the use of three strategies, focusing on advancing incremental change while safeguarding existing gains, rebranding Medicaid as a local or statewide initiative, and linking Medicaid expansion to criminal justice reform, in order to implement Medicaid expansion across the South.

The Path to Implementation of HIV Pre-exposure Prophylaxis for People Involved in Criminal Justice Systems

The criminal justice (CJ)-involved population in the United States (US) is among the most vulnerable to and heavily impacted by HIV [1]. HIV prevalence is three to five times higher among incarcerated populations than in the general population [2] and one in seven people living with HIV (PLH) pass through CJ systems each year [3]. Among racial and ethnic minorities, HIV and incarceration are even more closely intertwined: one of every five HIV-infected black or Hispanic/Latino adults passes through CJ systems annually [4]. Individuals involved in CJ systems experience a confluence of factors at the individual (e.g., substance abuse, mental health issues, childhood abuse), interpersonal (e.g., inconsistent condom use, intimate partner violence exposure), and community level (e.g., housing instability, unemployment, poverty, disengagement from medical services, stigma) that increase their risk of HIV [5–15]. HIV risk is exceptionally high immediately following release from prisons or jails, termed “community re-entry,” when relapse to substance use, discontinuous healthcare engagement, homelessness and under-insurance compounds, and other health disparities [16] Additionally, individuals from populations with an elevated risk of HIV acquisition (i.e., Black men who have sex with men [MSM], people who inject drugs [PWID], commercial sex workers [CSWs]) frequently come into contact with CJ systems [14, 17–21]. These subpopulations that experience intersecting risk, exacerbated by CJ involvement, need to be engaged in HIV prevention interventions. However, traditional HIV prevention approaches alone, such as risk reduction counseling and condom distribution programs, have had limited success with currently and recently incarcerated populations [22, 23]. One possible innovative strategy to address HIV risk during community re-entry is to implement pre-exposure prophylaxis (PrEP) uptake and adherence interventions. Many individuals with recent CJ involvement may be clinically indicated for PrEP due to engaging in high-risk and overlapping sexual and substance use networks. In addition, the World Health Organization has recently introduced the concept of “substantive risk” as a precursor to PrEP initiation. Those at “substantive risk of HIV” include any individuals belonging to a group that has a disproportionate burden of HIV, which includes those with a history of incarceration [22]. Despite these recommendations, PrEP implementation in real-world settings including CJ settings and during community reentry among at-risk populations remains low [24, 25] and, to our knowledge, PrEP linkage is not currently available in any closed CJ settings in the US. PrEP’s optimal impact depends on awareness, acceptability, uptake, and adherence among high-risk groups living in the community. PrEP awareness and acceptability vary (depending on the population) [16], and uptake and adherence to PrEP is influenced by social and structural factors such as access to health services, copayments, social norms, and, for recently incarcerated individuals in particular, an often chaotic postrelease environment. Recently incarcerated individuals often face numerous competing priorities during community reentry such as intersectional stigma, discrimination, loss of * Lauren Brinkley-Rubinstein Lauren_Brinkley@med.unc.edu

Institutionalization and Incarceration of LGBT Individuals

Experiences of social exclusion, stigma, and discrimination have had a sizable impact on both the unique mental health issues that members of the LGBT community face and their health-seeking behavior and access to care. Additional injustices experienced by LGBT people who are incarcerated further contribute to the burden of trauma accumulated across the life course and must be appropriately addressed during the recovery process. In this chapter we provide a brief history of the move to institutionalization and incarceration of LGBT individuals and the subsequent effect certain policies have had specifically on physical and mental health.

Risk behaviors and HIV care continuum outcomes among criminal justice-involved HIV-infected transgender women and cisgender men: Data from the Seek, Test, Treat, and Retain Harmonization Initiative

Background Transgender persons are highly victimized, marginalized, disproportionately experience incarceration, and have alarmingly increased rates of HIV infection compared to cis-gender persons. Few studies have examined the HIV care continuum outcomes among transgender women (TW), particularly TW who are involved with the criminal justice (CJ) system. Methods To improve our understanding of HIV care continuum outcomes and risk behaviors among HIV-infected TW who are involved with the CJ system, we analyzed data from the National Institute on Drug Abuse-supported Seek, Test, Treat, Retain (STTR) Data Harmonization Initiative. Baseline data were pooled and analyzed from three U.S. STTR studies to examine HIV risk and care continuum indicators among CJ-involved HIV-infected TW compared to cisgender men (CM), matched on age (within 5 years) and study at a ratio of 1:5. Results Eighty-eight TW and 440 CM were included in the study. Among matched participants, TW were more likely to report crack and cocaine use compared to CM (40%,16% respectively, p<0.001); both TW and CM reported high rates of condomless sex (58%, 64%, respectively); TW were more likely than CM to have more than one sexual partner (OR = 2.9, 95% CI: 1.6, 5.2; p<0.001) and have engaged in exchange sex (OR = 3.9, 95% CI: 2.3, 6.6; p<0.001). There were no significant differences between TW and CM in the percentage currently taking ART (52%, 49%, respectively), the mean percent adherence to ART (77% for both groups), and the proportion who achieved viral suppression (61%, 58%, respectively). Conclusions HIV-infected CJ-involved TW and CM had similar use of ART and viral suppression but TW were more likely than matched CM to engage in exchange sex, have multiple sexual partners, and use crack/cocaine. TW and CM had similarly high rates of condomless sex and use of other drugs. TW require tailored risk reduction interventions, however both CJ-involved TW and CM require focused attention to reduce HIV risk and improve HIV continuum of care outcomes.