“It's Not Like Taking Chocolates”: Factors Influencing the Feasibility and Sustainability of Universal Test and Treat in Correctional Health Systems in Zambia and South Africa

Topp, Stephanie M.; Chetty-Makkan, Candice M.; Smith, Helene J.; Chimoyi, Lucy; Hoffmann, Christopher J.; Fielding, Katherine; Reid, Stewart E.; Olivier, Abraham J.; Hausler, Harry; Herce, Michael E; Charalambous, Salome

doi:10.9745/ghsp-d-19-00051

Cited by 14 publications

(17 citation statements)

References 37 publications

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“…A study conducted in Ghana found that female prisoners reported poor access to quality healthcare and that their perceptions were influenced by marital status, educational background, and occupation [ 19 ]. A study from Zambia found that female prisoners’ access to healthcare was limited due to lack of in-house clinics, weak responsiveness by prison officers to their requests for healthcare and a general favor to male prisoners for providing health services [ 20 , 21 ]. A scoping review of literature reported a lack of support for female prisoners’ needs around menstruation in prisons in Namibia, Uganda, Mozambique, Malawi, Cameroon, Ethiopia, Zimbabwe, Zambia, Nigeria and South Africa [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Prisoners’ access to HIV services in southern Malawi: a cross-sectional mixed methods study

et al. 2021

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Background The prevalence of Human Immunodeficiency Virus (HIV) among prisoners remains high in many countries, especially in Africa, despite a global decrease in HIV incidence. Programs to reach incarcerated populations with HIV services have been implemented in Malawi, but the success of these initiatives is uncertain. We explored which challenges prisoners face in receiving essential HIV services and whether HIV risk behavior is prevalent in prisons. Methods We conducted a mixed-methods (qualitative and quantitative), cross-sectional study in 2018 in six prisons in Southern Malawi, two large central prisons with on-site, non-governmental organization (NGO) supported clinics and 4 smaller rural prisons. Four hundred twelve prisoners were randomly selected and completed a structured questionnaire. We conducted in-depth interviews with 39 prisoners living with HIV, which we recorded, transcribed and translated. We used descriptive statistics and logistic regression to analyze quantitative data and content analysis for qualitative data. Results The majority of prisoners (93.2%) were male, 61.4% were married and 63.1% were incarcerated for 1–5 years. Comprehensive services were reported to be available in the two large, urban prisons. Female prisoners reported having less access to general medical services than males. HIV risk behavior was reported infrequently and was associated with incarceration in urban prisons (adjusted odds ratio [aOR] 18.43; 95% confidence interval [95%-CI] 7.59–44.74; p = < 0.001) and not being married (aOR 17.71; 95%-CI 6.95–45.13; p = < 0.001). In-depth interviews revealed that prisoners living with HIV experienced delays in referrals for more severe illnesses. Prisoners emphasized the detrimental impact of poor living conditions on their personal health and their ability to adhere to antiretroviral therapy (ART). Conclusions Malawian prisoners reported adequate knowledge about HIV services albeit with gaps in specific areas. Prisoners from smaller, rural prisons had suboptimal access to comprehensive HIV services and female prisoners reported having less access to health care than males. Prisoners have great concern about their poor living conditions affecting general health and adherence to ART. These findings provide guidance for improvement of HIV services and general health care in Malawian institutionalized populations such as prisoners.

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Section: Discussionmentioning

confidence: 99%

Prisoners’ access to HIV services in southern Malawi: a cross-sectional mixed methods study

et al. 2021

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“…Interestingly, while releasees preferred referrals to government ART clinics for continuing HIV care once in the community, a substantial number of participants expressed a preference for receiving care from healthcare workers conversant with the unique needs of releasees living with HIV. Such a result may reflect a preference for client‐centred care more generally, or a specific desire for services responsive to the unique needs of releasees, particularly in the face of dual stigma posed by their HIV status and incarceration history [ 71 ]. While assistance with partner disclosure did not feature strongly in participant preferences, helping releasees voluntarily disclose their HIV status may help overcome barriers to family and community re‐integration.…”

Section: Discussionmentioning

confidence: 99%

Preferences for transitional HIV care among people living with HIV recently released from prison in Zambia: a discrete choice experiment

et al. 2021

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Introduction No studies from sub‐Saharan Africa have attempted to assess HIV service delivery preferences among incarcerated people living with HIV as they transition from prisons to the community (“releasees”). We conducted a discrete choice experiment (DCE) to characterize releasee preferences for transitional HIV care services in Zambia to inform the development of a differentiated service delivery model to promote HIV care continuity for releasees. Methods Between January and October 2019, we enrolled a consecutive sample of 101 releasees from a larger cohort prospectively following 296 releasees from five prisons in Zambia. We administered a DCE eliciting preferences for 12 systematically designed choice scenarios, each presenting three hypothetical transitional care options. Options combined six attributes: (1) clinic type for post‐release HIV care; (2) client focus of healthcare workers; (3) transitional care model type; (4) characteristics of transitional care provider; (5) type of transitional care support; and (6) HIV status disclosure support. We analysed DCE choice data using a mixed logit model, with coefficients describing participants’ average (“mean”) preferences for each option compared to the standard of care and their distributions describing preference variation across participants. Results Most DCE participants were male ( n = 84, 83.2%) and had completed primary school ( n = 54, 53.5%), with 29 (28.7%) unemployed at follow‐up. Participants had spent an average of 8.2 months in the community prior to the DCE, with 18 (17.8%) reporting an intervening episode of re‐incarceration. While we observed significant preference variation across participants ( p < 0.001 for most characteristics), releasees were generally averse to clinics run by community‐based organizations versus government antiretroviral therapy clinics providing post‐release HIV care (mean preference = –0.78, p < 0.001). On average, releasees most preferred livelihood support (mean preference = 1.19, p < 0.001) and HIV care support (mean preference = 1.00, p < 0.001) delivered by support groups involving people living with HIV (mean preference = 1.24, p < 0.001). Conclusions We identified preferred characteristics of transitional HIV care that can form the basis for differentiated service delivery models for prison releasees. Such models should offer client‐centred care in trusted clinics, provide individualized HIV care support delivered by support groups and/or peer navigators, and strengthen linkages to programs providing livelihood support.

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“…Furthermore, logistics within prisons and the impact of stigma on incarcerated individuals, and how these factors influence the uptake, acceptability, and feasibility of interventions should be considered. 7 Strategies to promote continued engagement in care for incarcerated individuals following their release from correctional facilities are required to ensure sustainability of efforts. 8 The ongoing COVID-19 pandemic and subsequent development of effective vaccines have demonstrated what can be done when there is a collective political will and resources are made avail able.…”

Section: Tuberculosis In Prisons: An Unintended Sentence?mentioning

confidence: 99%

Tuberculosis in prisons: an unintended sentence?

Velen

Charalambous

2021

The Lancet Public Health

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“It's Not Like Taking Chocolates”: Factors Influencing the Feasibility and Sustainability of Universal Test and Treat in Correctional Health Systems in Zambia and South Africa

Cited by 14 publications

References 37 publications

Prisoners’ access to HIV services in southern Malawi: a cross-sectional mixed methods study

Prisoners’ access to HIV services in southern Malawi: a cross-sectional mixed methods study

Preferences for transitional HIV care among people living with HIV recently released from prison in Zambia: a discrete choice experiment

Tuberculosis in prisons: an unintended sentence?

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