The Effect of a Local Change Team Intervention on Staff Attitudes Towards HIV Service Delivery in Correctional Settings: A Randomized Trial

Abstract

The National Criminal Justice Drug Abuse Treatment Studies research program conducted cluster randomized trials to test an organizational process improvement strategy for implementing evidence-based improvements in HIV services for preventing, detecting, and/or treating HIV for individuals under correctional supervision. Nine research centers conducted cluster randomized trials in which one correctional facility used a modified Network for Improvement of Addiction Treatment (NIATx) change team approach to implementing improved HIV services and the other facility used their own approach to implement the improved HIV services. This paper examines whether the intervention increased the perceived value of HIV services among staff of correctional and community HIV organizations. Baseline and follow-up measures of the perceived acceptability, feasibility, and organizational support for implementing HIV service improvements were collected from correctional, medical, and community HIV treatment staff. Results indicated that the perceived acceptability and feasibility of implementing HIV services improved among staff in the facilities using the modified NIATx change team approach as compared to staff in the comparison facilities.

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

“…The CJ-DATS: HIV-STIC intervention is the only study found as part of this review that examined an implementation strategy targeting organizational-level barriers to improve uptake of HIV services across the care continuum. 28,35,41,60 Emerging findings from this study suggest a complex interaction of staff and system level factors that influence the successful rollout and uptake of evidence-based practices for HIV for inmates. Future research that employs a multi-level, ecological model to examine implementation facilitators and barriers at system-, staff-, and inmate-levels will help inform the development of implementation strategies for linkage programs that can successfully work within correctional settings and that will allow the scale-up and sustainability of efficacious programs across various correctional and community settings.…”

“…36,59,60 Correctional agencies’ focus on security contrasted with the HIV community agencies’ focus on health and well-being of inmates. Additionally, policies and procedures within corrections agencies also hindered implementation of programs.…”

“…36,60 Regardless of administrative mandates, relationships with on the ground workers were seen as the linchpin to successfully getting programs, or their specific elements, to work. For example, programs designed to meet a participant immediately upon release (at the gate) were only able to do so with excellent communication with correctional staff who would inform program staff if inmates were being released early, moved, or otherwise advancing unexpectedly through or out of the system.…”

“…Taken together, these findings indicate that differences in staff attitudes may highlight the potential differences in mission between medical and correctional staff, particularly in the context of unchanging organizational support. 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.…”

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.…”