Efficacy of a Process Improvement Intervention on Delivery of HIV Services to Offenders: A Multisite Trial

Abstract

Objectives. We tested a modified Network for the Improvement of Addiction Treatment (NIATx) process improvement model to implement improved HIV services (prevention, testing, and linkage to treatment) for offenders under correctional supervision. Methods. As part of the Criminal Justice Drug Abuse Treatment Studies, Phase 2, the HIV Services and Treatment Implementation in Corrections study conducted 14 cluster-randomized trials in 2011 to 2013 at 9 US sites, where one correctional facility received training in HIV services and coaching in a modified NIATx model and the other received only HIV training. The outcome measure was the odds of successful delivery of an HIV service. Results. The results were significant at the .05 level, and the point estimate for the odds ratio was 2.14. Although overall the results were heterogeneous, the experiments that focused on implementing HIV prevention interventions had a 95% confidence interval that exceeded the no-difference point. Conclusions. Our results demonstrate that a modified NIATx process improvement model can effectively implement improved rates of delivery of some types of HIV services in correctional environments.

Assessment of HIV Knowledge in Correctional Facility Health Care Workers

“…17,18 Local change teams doubled the odds of successful delivery of HIV services (point estimate for odds ratio ¼ 2.14) and increased health care staff perceptions of the value of HIV services compared to the control group. 19,20 From a public health viewpoint, the disproportionate burden of HIV in incarcerated populations presents both a challenge and an opportunity. Correctional facilities provide an opportunity to engage a traditionally ''hard to reach'' demographic that often slips through the conventional community-based health system.…”

Can TasP Approaches Be Implemented in Correctional Settings?: A review of HIV testing and linkage to community HIV treatment programs

“…36,60 Evaluation of client outcomes (i.e., increases in HIV testing and linkage to community treatment upon release) were negligible. 35 However, inmates in experimental correctional facilities did demonstrate an increase in awareness of HIV and perceived relevance of HIV services. 41 …”

“…Pearson et al 35 found that out of two cluster-randomized trials focused on increasing opt-out HIV testing, there was no significant overall effect of increased HIV testing between experiment and control conditions (logOR=0.16, 95%CI: −0.24–0.57). Trial-specific analyses revealed a significant effect for one trial (logOR=0.37SE=0.07) and closer examination of both intervention sites reported increases in uptake of testing of up to 23%.…”

“…As part of the HIV-STIC multi-site randomized trial comparing the change team approach, which comprised both correctional and community HIV staff, to standard HIV training of correctional staff, Pearson et al 35 found across 7 cluster randomized trails, 88.4% of HIV-positive participants were linked to care (compared with 69.5% in control arm), with neither overall significant effect of successful linkage to HIV treatment and care (logOR=0.70; 95%CI:−0.33–1.74) or site-specific effects.…”

Caregivers’ Support Network Characteristics Associated with Viral Suppression among HIV Care Recipients

“…Baltimore City also has high rates of heroin, cocaine and substance abuse; by one estimate 1 in 8 adults needs substance use treatment (6). Baltimore also has an incarceration rate that is three times the national average and PLHIV with an incarceration history experience gaps in ART and health care access both within prisons and when they reintegrate into communities (7–10). It is within this context of high levels of poverty, incarceration and substance use disorders that PLHIV in Baltimore and their informal caregivers are living with and managing HIV and other often highly stigmatized chronic conditions.…”