Abstract
Imprisonment provides opportunities for the diagnosis and successful treatment of HIV, however, the benefits of antiretroviral therapy are frequently lost following release due to suboptimal access and utilization of health care and services. In response, some have advocated for development of intensive case-management interventions spanning incarceration and release to support treatment adherence and community re-entry for HIV-infected releasees. We conducted a randomized controlled trial of a motivational Strengths Model bridging case management intervention (BCM) beginning approximately 3 months prior to and continuing 6 months after release versus a standard of care prison-administered discharge planning program (SOC) for HIV-infected state prison inmates. The primary outcome variable was self-reported access to post-release medical care. Of the 104 inmates enrolled, 89 had at least 1 post-release study visit. Of these, 65.1% of BCM and 54.4% of SOC assigned participants attended a routine medical appointment within 4 weeks of release (P > 0.3). By week 12 post-release, 88.4% of the BCM arm and 78.3% of the SOC arm had at attended at least one medical appointment (P = 0.2), increasing in both arms at week 24–90.7% with BCM and 89.1% with SOC (P > 0.5). No participant without a routine medical visit by week 24 attended an appointment from weeks 24 to 48. The mean number of clinic visits during the 48 weeks post release was 5.23 (SD = 3.14) for BCM and 4.07 (SD = 3.20) for SOC (P > 0.5). There were no significant differences between arms in social service utilization and re-incarceration rates were also similar. We found that a case management intervention bridging incarceration and release was no more effective than a less intensive pre-release discharge planning program in supporting health and social service utilization for HIV-infected individuals released from prison.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Maruschak LM, Beavers R. Bureau of justice statistics: HIV in prisons, 2007–08. U.S. Department of Justice: Bureau of Justice Statistics; 2009 12/09. Report No.: NCJ 228307. http://bjs.ojp.usdoj.gov/content/pub/pdf/hivp08.pdf.
Spaulding AC, Seals RM, Page MJ, et al. HIV/AIDS among inmates of and releasees from US correctional facilities, 2006: declining share of epidemic but persistent public health opportunity. PLoS One. 2009;4(11):e7558.
Wohl D, Fleg A, Napravnik S, et al. Virologic response to HAART among incarcerated HIV + individuals [THAB0503]. In: 17th International AIDS society conference, August 3–8, 2008, Mexico City.
Maruschak LM. HIV in prisons, 2003. Bureau of Justice Statistics Bulletin. 2006. www.ojp.usdoj.gov/bjs/abstract/hivp04.htm.
Stephenson BL, Wohl DA, Golin CE, et al. Effect of release from prison and re-incarceration on the viral loads of HIV-infected individuals. Public Health Rep. 2005;120(1):84–8.
Springer SA, Pesanti E, Hodges J, et al. Effectiveness of antiretroviral therapy among HIV-infected prisoners: reincarceration and the lack of sustained benefit after release to the community. Clin Infect Dis. 2004;38(12):1754–60.
Stephenson BL, Wohl DA, McKaig R, et al. Sexual behaviours of HIV-seropositive men and women following release from prison. Int J STD AIDS. 2006;17(2):103–8.
Baillargeon J, Giordano TP, Rich JD, et al. Accessing antiretroviral therapy following release from prison. JAMA. 2009;301(8):848–57.
Zaller ND, Holmes L, Dyl AC, et al. Linkage to treatment and supportive services among HIV-positive ex-offenders. J Health Care Poor Underserved. 2008;19:522–31.
Leukefeld CG, Staton M, Hiller ML, et al. A descriptive profile of health problems, health services utilization, and HIV serostatus among incarcerated male drug abusers. J Behav Health Serv Res. 2002;29(2):167–75.
Pollack H, Khoshnood K, Altice F. Health care delivery strategies for criminal offenders. J Health Care Finance. 1999;Fall;26(1):63–77.
Molitor F, Kuenneth C, Waltermeyer J, et al. Linking HIV-infected persons of color and injection drug users to HIV medical and other services: the California Bridge Project. AIDS Patient Care STDS. 2005;19(6):406–12.
Gardner LI, Metsch LR, Anderson-Mahoney P, et al. Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS. 2005;19(4):423–31.
Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36:1–10.
Rapp RC, Siegal HA, Li L, Saha P. Predicting postprimary treatment services and drug use outcomes: a multivariate analysis. Am J Drug Alcohol Abuse. 1998;24:603–15.
Rapp CA, Wintersteen R. The strengths model of case management: results from twelve demonstrations. Psychosoc Rehabil J. 1989;13:23–32.
The Health Cost and Utilization Study website, Rand Corporation. http://www.rand.org/health/projects/hcsus/questionnaires.html. Accessed 31 March 2010.
University of California, San Francisco (2008) Enhancing prevention with positives evaluation center. http://www.caps.ucsf.edu/tools/surveys/pdf/EPPEC-PatientAssessment.pdf. Accessed 31 March 2010.
Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1992;1:385–401.
Ware JE, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33.
Gardner LI, Marks G, Craw J, et al. Demographic, psychological, and behavioral modifiers of the Antiretroviral Treatment Access Study (ARTAS) intervention. AIDS Patient Care STDs. 2009;23(9):735–42.
Haley D, Scheyett A, Golin C, et al. perceptions of release among incarcerated hiv-infected persons and implications for practice: the UNC Bridges to Good Health and Treatment (BRIGHT) project qualitative substudy. Abstract THPE0717. 16th International AIDS Conference, August 13–18, 2006, Toronto.
Acknowledgments
The authors wish to thank the staff of the NCDOC, specifically the HIV Outreach Nurses and their Director, Edwin Cutler, and the staff of the NCDOC ID Clinic, Carol Anne Harrell and Sigrid Harris, for the assistance that made this research possible. In addition, we thank Bertha Allen, Nancy Jackson and Kathryn Keicher for their efforts on behalf of the study participants and our research associates Monique Williams, Tracina Williams and Catherine Cunningham. Wally Kisthardt, Joanne Garrett and Sharon Parker provided technical assistance. Lastly, we appreciate the contribution of the study participants. This paper is dedicated to the enduring memory of our colleague and mentor, Andrew Kaplan. This study received grant support from National Institute of Mental Health, National Institutes of Health (R01 MH068719) and the University of North Carolina Center for AIDS Research (CFAR) (AI 50410-04).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wohl, D.A., Scheyett, A., Golin, C.E. et al. Intensive Case Management Before and After Prison Release is No More Effective Than Comprehensive Pre-Release Discharge Planning in Linking HIV-Infected Prisoners to Care: A Randomized Trial. AIDS Behav 15, 356–364 (2011). https://doi.org/10.1007/s10461-010-9843-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-010-9843-4