# Presentation: 395405

## HIV and STD Programs in Jail

- Hampden County, Massachusetts
- T Lincoln
- March 2002

## Corrections Statistics- USA

- 2 million incarcerated (world ~ 8 million)
- Including probation and parole, 6 million persons involved with corrections- 3% of all U.S. Adults
- 13% of African-American men cannot vote due to this
- “Invisible population”
- 25% of some neighborhoods
- Incarceration rate has more than tripled since 1980
- “34th state”

## Percent of Total Burden of Infectious Disease Found Among People Passing Through Correctional Facilities, 1996

- Hammet T, Abt Associates, Nat’l HIV Prevention Conf. Aug 1999

## HIV DATA 2000

- <date/time>

- Massachusetts
- annual AIDS rate = 18.9 per 100,000
- 31% IDU,  27% female
- Metropolitan Springfield   (population  1⁄2 million)
- annual AIDS rate = 24.2 per 100,000
- 44% IDU,  37% female
- Hampden County Correctional Center
- 5.5% of men and 8.7% of women  HIV positive on intake (1996)
- usually ~75 known HIV patients at jail

## Slide 5

## Public Health Model    

- Community Integrated Correctional Health Care

- The Hampden County
- Public Health Model

## Springfield Community Partnership and Prevention Alliance, 1995

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## Public Health Model- Current Structure

- <date/time>

- 4 jail health teams integrated with 4 community (neighborhood) health centers
- Patients assigned to health team by zip code or prior association with community health center
- _Dually based team members in 4 health centers and jail_
- Physicians and HIV case managers primarily community health center based
- Nurse practitioners, primary nurses primarily jail based
- Community corrections (probation/parole/DRC) component in development

## Public Health Model for Corrections

- Education
- Prevention
- Early detection
- Treatment
- Continuity of care

-  Reservoir of Illness
-  Proactive v. Reactive
-  Sentinel function
-  Public Health Department
-  Community-integrated       	model

## A Vertically and Horizontally Integrated Model

- Comprehensive,
- Holistic
- Services

- Continuity of Care from Correctional
-  Facility to Community

## STD Nurse Visits By Year ( Not Screening) Men

- HCCC

## Model for Correctional Health Care: Evaluation

- Support: CDC, Soros Foundation, NIJ
- Various facets: Chronic conditions (medical and mental), prevention (HIV, STD, TB, viral hepatitis), HIV treatment, continuity of care
- Cost: $9-10/inmate-day, 10% of $44 million budget. ACA average cost prisons 10%. MA 12%.
- Economic analysis: A-team
- HIV prevention- voluntary counseling & testing
- Urine chlamydia screening and partner services

## Hampden County Correctional Center

- 1800 inmates- 90% men, 10% women
- Pretrial and sentenced
- % released:	20%		36%		67%
- 		at:		3days		2wks		3mo
- 70% street drugs- 80% past month, 11% men & 25% women shared needles
- 46% in jail in past year

## HCCC intake population- self-report 2Q1999

- Sexual Behavior:
- 49%  sex within a year and never use condom,
- 70% drink/use drugs during sex
- 11% report prior chlamydia
- HIV/AIDS:
- 69% ever tested for HIV
- 83% feel low/no chance of getting HIV

## HCCC program flow

- Intake health screen- day 1
- Nurse visit- Brief history & exam includes HIV history, mental health screen
- RPR, CBC, ALT, PPD planted
- UA (with leukocyte esterase), pregnancy test, since 2/99 urine LCx for chlamydia & brief STD questions
- Gonorrhea- Gen-Probe if  symptoms, risk, LET+
- Intake Unit- day 1-3/4
- Education and orientation- includes HIV/hepatitis. Video, instructor led,  peer education.

## HCCC program flow

- History and Physical- day 3/4
- Nurse practitioner
- Documentation of HIV test acceptance/refusal
- HIV voluntary counseling and testing
- Referral from:
- Prior medical (priority fast-tracked) and education events
- Ongoing education programs
- Care of other medical concerns
- Patient request

## HCCC program flow

- HIV voluntary counseling and testing (cont’d)
-  MA Dept Public Health lab and VCT questionnaire
- STD
- Treatment
- Partner elicitation and outreach through MA DPH STD Disease Intervention Specialist includes partners of men with chlamydia
- Continuity of care
- HIV: Case management is key. 90% show rate at follow-up after release

## Syphilis- Hampden County

## Key Points

- Jail is community. Almost everyone returns. Temporarily displaced. At risk.
- Public health opportunity.
- Triad of corrections, community  and public health.
- Program description- set the stage
- Need for economic analysis to inform resource allocation