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Golin CE, Barkley BG, Biddell C, Wohl DA, Rosen DL. Great Expectations: HIV Risk Behaviors and Misperceptions of Low HIV Risk among Incarcerated Men. AIDS Behav 2018; 22:1835-1848. [PMID: 28361452 DOI: 10.1007/s10461-017-1748-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Incarcerated populations have relatively high HIV prevalence but little has been reported about their aggregate HIV risk behaviors or perceptions of risk. A random selection of HIV-negative men (n = 855) entering a US state prison system were surveyed to assess five risk behaviors and his self-perceived HIV risk. Using multivariate logistic regression, we identified factors associated with having elevated actual but low perceived risk (EALPR). Of the 826 men with complete data, 88% were at elevated risk. While 64% of the sample had risk perceptions concordant with their actual risk, 14% had EALPR (with the remainder at low actual but high perceived risk). EALPR rates were lower in those with a pre-incarceration HIV test but higher for those with a negative prison entry HIV test. HIV testing counseling should assess for discordance between actual and perceived risk and communicate the continued risk of HIV despite a negative result.
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Affiliation(s)
- C E Golin
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, 725 MLK Blvd, CB 7590, Chapel Hill, NC, 27599-7590, USA.
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Cecil G. Sheps Center for Health Services Research, UNC-Chapel Hill, Chapel Hill, NC, USA.
| | - B G Barkley
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C Biddell
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, 725 MLK Blvd, CB 7590, Chapel Hill, NC, 27599-7590, USA
| | - D A Wohl
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, 725 MLK Blvd, CB 7590, Chapel Hill, NC, 27599-7590, USA
| | - D L Rosen
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, 725 MLK Blvd, CB 7590, Chapel Hill, NC, 27599-7590, USA
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Kuchinad KE, Hutton HE, Monroe AK, Anderson G, Moore RD, Chander G. A qualitative study of barriers to and facilitators of optimal engagement in care among PLWH and substance use/misuse. BMC Res Notes 2016; 9:229. [PMID: 27103162 PMCID: PMC4841053 DOI: 10.1186/s13104-016-2032-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 04/08/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Persons living with HIV (PLWH) and substance use/misuse experience significant barriers to engagement in HIV care at every step of the HIV care continuum including: (1) HIV testing and diagnosis (2) linkage to clinical care (3) retention in care pre-antiretroviral therapy (ART) (4) ART initiation and adherence (5) viral suppression. We qualitatively explored the facilitators of and barriers to participation in the HIV care continuum among PLWH with substance use/misuse. METHODS We performed semi-structured in-depth interviews with 34 PLWH in care with recent substance use. The transcripts were analyzed in an iterative process using an editing style analysis. Interviews were conducted until thematic saturation was achieved. RESULTS Participants attributed an escalation in drug use at the time of diagnosis to denial of their disease and the belief that their death was inevitable and cited this as a barrier to treatment entry. In contrast, participants reported that experiencing adverse physical effects of uncontrolled HIV infection motivated them to enroll in care. Reported barriers to retention and adherence to care included forgetting medications and appointments because of drug use, prioritizing drug use over HIV treatment and side effects associated with medications. Participants described that progression of illness, development of a medication taking ritual and a positive provider-patient relationship all facilitated engagement and reengagement in care. CONCLUSIONS PLWH with substance use engaged in care describe barriers to and facilitators of optimal engagement related to and distinct from substance use. Greater understanding of the biologic, psychological and social factors that promote and impair engagement in care can inform interventions and reduce the increased morbidity and mortality experienced by PLWH with substance use.
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Affiliation(s)
- Kamini E Kuchinad
- Department of General Internal Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Heidi E Hutton
- Department of General Internal Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Anne K Monroe
- Department of General Internal Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Richard D Moore
- Department of General Internal Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Geetanjali Chander
- Department of General Internal Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
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Beckwith C, Bazerman L, Gillani F, Tran L, Larson B, Rivard S, Flanigan T, Rich J. The feasibility of implementing the HIV seek, test, and treat strategy in jails. AIDS Patient Care STDS 2014; 28:183-7. [PMID: 24617960 DOI: 10.1089/apc.2013.0357] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
To successfully implement the Seek, Test, and Treat (STT) strategy to curb the HIV epidemic, the criminal justice system must be a key partner. Increasing HIV testing and treatment among incarcerated persons has the potential to decrease HIV transmission in the broader community, but whether it is feasible to consider the implementation of the STT within jail facilities is not known. We conducted a retrospective review of Rhode Island Department of Corrections (RIDOC) medical records to assess whether persons newly diagnosed in the jail were able to start ART and be linked to community HIV care after release. From 2001 to 2007, 64 RIDOC detainees were newly diagnosed with HIV. During their index incarcerations, 64% were informed of positive confirmatory HIV test results, 50% completed baseline evaluations, and 9% began ART. Linkage to community care was confirmed for 58% of subjects. Subjects incarcerated for >14 days were significantly more likely to receive HIV test results and complete baseline evaluation (p<0.001). A similar association was not observed for ART initiation until incarceration length reached 60 days (p<0.001). There was no association between incarceration length and linkage to care. This comprehensive analysis demonstrates that length of incarceration impacts HIV test result delivery, baseline evaluation, and ART initiation in the RIDOC. Jails are an important venue to "Seek" and "Test"; however, completing the "Treat" part of the STT strategy is hindered by the transient nature of this criminal justice population and may require new strategies to improve linkage to care.
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Affiliation(s)
- Curt Beckwith
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lauri Bazerman
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
| | - Fizza Gillani
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
| | - Liem Tran
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
| | - Brita Larson
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
| | - Saul Rivard
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
| | - Timothy Flanigan
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Josiah Rich
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Chuang E, Wells R, Alexander J, Green S. How outpatient substance abuse treatment unit director activities may affect provision of community outreach services. DRUGS-EDUCATION PREVENTION AND POLICY 2012; 20:149-159. [PMID: 29170607 DOI: 10.3109/09687637.2012.703261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aims Community outreach services play an important role in infectious disease prevention and engaging drug users not currently in treatment. However, fewer than half of US substance abuse treatment units provide these services and many have little financial incentive to do so. Unit directors generally have latitude about scope of services, including the level of outreach provided to the community. The current study examines how directors' interactions with external stakeholders affect substance abuse treatment units' provision of community outreach services. Methods Cross-sectional logistic and Poisson regression analyses were conducted on a national sample of US outpatient substance abuse treatment units (N = 547). Results Findings suggest that the amount of time directors spent with licensing and monitoring associations was associated with provision of a greater number of community outreach services, while time spent with professional and occupational associations was associated with provision of off-site human immunodeficiency virus and hepatitis C testing. Several other director attributes and organizational characteristics also emerged as significant. Conclusions External stakeholders with whom substance abuse treatment directors interact may influence community outreach through their effects on treatment directors' strategic priorities. Implications for policy and prevention efforts are discussed.
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Affiliation(s)
- Emmeline Chuang
- Division of Health Management and Policy, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Rebecca Wells
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeffrey Alexander
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sherri Green
- Department of Maternal and Child Health, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Beckwith CG, Nunn A, Baucom S, Getachew A, Akinwumi A, Herdman B, DiBartolo P, Spencer S, Brown D, Lesansky H, Kuo I. Rapid HIV testing in large urban jails. Am J Public Health 2012; 102 Suppl 2:S184-6. [PMID: 22401524 DOI: 10.2105/ajph.2011.300514] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
HIV prevalence is higher in jails than in the community, yet many jails do not conduct HIV testing. Jails in Baltimore, Maryland; Philadelphia, Pennsylvania; and the District of Columbia have implemented innovative rapid HIV testing programs. We have summarized the results of these programs, including the numbers of persons tested, rapid and confirmatory HIV test results, and numbers of persons newly diagnosed with HIV. We have described facilitators and challenges of implementation. These programs confirmed that rapid HIV testing in jails was feasible and identified undiagnosed HIV infection. Challenges included limited space to provide confidential rapid HIV testing and rapid turnover of detainees. Implementation required collaboration between local governments, health agencies, and correctional institutions. These programs serve as models for expanding rapid HIV testing in jails.
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Affiliation(s)
- Curt G Beckwith
- Division of Infectious Diseases, The Miriam Hospital/Alpert Medical School of Brown University, Providence, RI 02906, USA.
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Tross S, Campbell ANC, Calsyn DA, Metsch LR, Sorensen JL, Shoptaw S, Haynes L, Woody GE, Malow RM, Brown LS, Feaster DJ, Booth RE, Mandler RN, Masson C, Holmes BW, Colfax G, Brooks AJ, Hien DA, Schackman BR, Korthuis PT, Miele GM. NIDA's Clinical Trials Network: an opportunity for HIV research in community substance abuse treatment programs. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:283-93. [PMID: 21854270 DOI: 10.3109/00952990.2011.596977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND/OBJECTIVES HIV continues to be a significant problem among substance users and their sexual partners in the United States. The National Drug Abuse Treatment Clinical Trials Network (CTN) offers a national platform for effectiveness trials of HIV interventions in community substance abuse treatment programs. This article presents the HIV activities of the CTN during its first 10 years. RESULTS While emphasizing CTN HIV protocols, this article reviews the (1) HIV context for this work; (2) the collaborative process among providers, researchers, and National Institute on Drug Abuse CTN staff, on which CTN HIV work was based; (3) results of CTN HIV protocols and HIV secondary analyses in CTN non-HIV protocols; and (4) implications for future HIV intervention effectiveness research in community substance abuse treatment programs. CONCLUSION/SIGNIFICANCE While the feasibility of engaging frontline providers in this research is highlighted, the limitations of small to medium effect sizes and weak adoption and sustainability in everyday practice are also discussed.
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Affiliation(s)
- Susan Tross
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, NY 10032, USA.
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