Josiah D. Rich, MD, MPH Professor of Medicine and Community Health The Miriam Hospital, Brown University The Center for Prisoner Health and Human

Transcription

1 Josiah D. Rich, MD, MPH Professor of Medicine and Community Health The Miriam Hospital, Brown University The Center for Prisoner Health and Human Rights

2 Sponsor Accreditation: Howard University College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Credits for Physicians: Howard University College of Medicine, Office of Continuing Medical Education, designates this live activity for a maximum of 0.5 AMA PRA Category I Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Goulda A. Downer, PhD, RD, LN, CNS Principal Investigator/Project Director Funded by Health Resources Services Administration (HRSA) Grant #H4AHA24081

3 AETC-Capitol Region Telehealth Project Planning Committee : The following committee members have nothing to disclose in relation to this activity: Goulda A. Downer, PhD, RD, LN, CNS Denise Bailey, MEd Marjorie Douglas-Johnson, BA Kwame Frimpong Speaker: The following speaker has nothing to disclose in relation to this activity: Josiah D. Rich, MD, MPH

4 Intended Audience: Low volume clinicians (i.e. those with fewer than 25 patients in their case load who are HIV positive): Physicians, Physician Assistants, Nurse Practitioners, Pharmacists, Dentists, Nurses, Social Workers, Case Managers and other Clinical Personnel. Webinar Requirements: A computer, phone, etc. with Internet accessibility and a telephone line. Your presence on the call must be acknowledged at the start of each session. Please log in for the session announce your name loud and clear at the beginning of the session. You will not be able to receive CME credits if you leave the session early. At the end of the Webinar our Training Coordinator will a CME Evaluation Survey. All participants are required to complete and return the CME Evaluation Survey at the end of each session. It may be scanned and ed back to mdouglas@howard.edu, or faxed to: AETC-Capitol Region Telehealth Project (FAX#: ) ATTN: Training Coordinator. Please indicate in your or FAX if you would like to receive CMEs.

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6 In the United States, about how many people are arrested and released from prison or jail each year? A. 1 million B. 3 million C. 10 million D. 20 million

7 Of all people with HIV in the U.S., what percent passes through the correctional system each year? A. 31% B. 14% C. 4% D. 0.7%

8 CDC reports that the rate of confirmed AIDS cases among state and federal prisoners was about: A. 0.4 times the rate in the general US population B. 1.4 times the rate in the general US population C. 2.4 times the rate in the general US population D. 8.4 times the rate in the general US population

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10 Upon completion of this webinar, participating providers will have the enhanced ability to: Understand the burden of HIV and comorbidities in the criminal justice-involved population Understand the broader context from which many justice-involved patients come Identify risk factors for HIV transmission common in this population.

11 Steve is a 25 year-old African-American male you are seeing for the first time Released 3 months ago from jail, where he was diagnosed with HIV CD4 count and viral load were measured while he was incarcerated Did not receive results prior to his release but was told by the nurse to take Bactrum Reports trouble taking the Bactrum regularly His partner is expecting a child in 7 months This is Steve s first child and he plans to be a very involved Dad in his child s life

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14 As of 2012, 2.23 million persons were incarcerated in the U.S. About 700,000 return to the community each year.

15 The U.S. imprisons more people per capita than any other country in the world. In the 1990s alone, our inmate population grew by 239%. Russian Federation England and Wales Canada Italy France Japan Source: International Centre for Prison Studies, Inmates per 100K Citizens

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17 Incarceration rates for males >18 years of age o White: 1 in 106 o Latino: 1 in 36 o Blacks: 1 in 15 (1 in 9 aged years) Incarceration rates for females years of age o White: 1 in 335 o Latino: 1 in 297 o Blacks: 1 in 100 The Pew Center on States. Available at: 1_FORWEB.pdf.

18 Predominantly male; 9:1 male to female. Predominantly poor, from low-income communities Disproportionately minority Higher rates of cognitive and low literacy rates and years of educational attainment Historically mostly poor non-disabled men with no health insurance (ineligible for Medicaid in the past) and may not be used to obtaining primary health care

19 Condition Jails (%) State Prisons (%) Federal Prisons (%) Mental illness Drug and/or alcohol dependence or abuse (combined total) 68 Drug dependence or abuse Alcohol dependence or abuse 47 (1) James DJ and Glaze LE. Mental Health Problems of Prison and Jail Inmates. BJS Special Report NCJ , September (2) Karberg JC and James DJ. Substance Dependence, Abuse, and Treatment of Jail Inmates, BJS Special Report NCJ , July (3) Mumola CJ and Karberg JC. Drug Use and Dependence, State and Federal Prisoners, BJS Special Report NCJ , October 2006.

20 Prisoners have significantly higher rates of many diseases.

21 More than 2 million people are incarcerated in the US. At the end of 2010, 1,612,395 persons were in state and federal prisons In 2010, black males had an imprisonment rate that was nearly 7 times that of white males and almost 2.5 times that of Hispanic/Latino males That same year, black females had an imprisonment rate that was nearly 3 times that of white females and almost 2 times that of Hispanic/Latino females In 2007 (the most recent year for which this information is available), the rate of confirmed AIDS cases among state and federal prisoners was about 2.4 times the rate in the general US population

22 Age-Standardized Prevalence of Select Chronic Conditions Condition Federal Inmates, % (SE) State Inmates, % (SE) Jail Inmates, % (SE) US Population, % (SE) Diabetes mellitus 11.1 (3.6) 10.1 (2.0) 8.1 (1.7) 6.5 (0.5) Hypertension 29.5 (2.9) 30.8 (1.5) 27.9 (2.1) 25.6 (1.0) Prior myocardial infarction 4.5 (4.5) 5.7 (2.8) 2.1 ( (0.3) Wilper et al., AJPH 2009.

23 Condition Percent AIDS 16% Total HIV/AIDS 20-26% Chronic Hepatitis B 12-16% Hepatitis C 29-32% TB Disease 38% Hammett et al AJPH 2002

24 Testing at entry Linkage to care on inside access to telemedicine and co-located providers Consistent access to healthcare and medications Basic needs met (food, shelter, etc.) Relatively little drug use Linkage to care on outside

25 Compared two cohorts, one managed on-site by correctional physicians, another managed by a university-based team of multidisciplinary subspecialty team via telemedicine clinics Telemedicine-managed cohort had higher mean CD4 count

26 Mean prevalence 1.5%; Max: up to 5% in some state prisons 14% of PLWA in U.S. (1/7) pass through corrections each year Spaulding et al. PLoS One, 2009

27 CDC MMWR June 2011 Washington, January December 2010

28 Rapid turnover of Jail population Problems with conventional EIA test result delivery Improve linkage to care for persons testing positive Opportunity for HIV prevention counseling ence.com/files/implementation%20of%20rapid%20hiv%20testing%20in%2 0Large%20Urban%20Jails%20_Be.pdf

29 Prior to rapid HIV testing (RHT), 0.4 on detainees completed HIV testing RHT testing began in 2008 o Supported by MD Dept of Health and CDC Voluntary opt-out testing with OraQuick Advance Test on day 3-4 of incarceration o Blood specimen (syphilis testing) Immediate RHT results, confirmatory results in 7 days Verbal consent, educational materials

30 Prior to RHT, 12% on detainees completed HIV testing RHT testing began in 2006 o Supported by DC Dept of Health Voluntary automatic testing with OraQuick Advance test at intake o Oral fluid specimen Immediate RHT results, confirmatory results in 2-3 days No requirement for informed consent, educational materials provided Large%20Urban%20Jails%20_Be.pdf

31 Early release of jail detainees: o Initial uptake of RHT o Completion of confirmatory testing o Delivery of results Maintaining a confidential environment Stigma Staffing/intake procedures Linkage to community HIV care Testing%20in%20Large%20Urban%20Jails%20_Be.pdf

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34 Steve is a 25 year-old African-American male you are seeing for the first time Released 3 months ago from jail, where he was diagnosed with HIV CD4 count and viral load were measured while he was incarcerated Did not receive results prior to his release but was told by the nurse to take Bactrum Reports trouble taking the Bactrum regularly His partner is expecting a child in 7 months This is Steve s first child and he plans to be a very involved Dad in his child s life.

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36 Steve was released into the community prior to receiving his test results. How would you access them? Bactrum was prescribed prior to his release this suggests a low CD4 count. What would be the justification to prescribe ARVs? Medication adherence Linkage to and retention in care Partner notification Harm reduction strategies Perinatal Care Parenting support Treatment Cascade

37 1. Althoff AL, Zelenev A, Meyer JP, et al. Correlates of retention in HIV care after release from jail: results from a multi-site study. AIDS and behavior. 2013;17 Suppl 2:S Baillargeon JG, Giordano TP, Harzke AJ, Baillargeon G, Rich JD, Paar DP. Enrollment in outpatient care among newly released prison inmates with HIV infection. Public health reports (Washington, DC : 1974). 2010;125 Suppl 1: Binswanger IA, Stern MF, Deyo RA, Heagerty PJ, Cheadle A, et al. High risk of death for former inmates. N Engl J Med 2007;356: Mallik-Kane, K.; Visher, CA. Health and prisoner reentry: how physical, mental, and substance abuse conditions shape the process of reintegration [Internet]. Washington (DC): Urban Institute, Justice Policy Center; 2008 Feb. (Research Report). 5. Meyer, JP et al. Gender Disparities in HIV Treatment Outcomes Following Release from Jail: Results from a Multicenter Study. Am J Public Health. Mar 2014; 104(3): Milloy MJ, Kerr T, Buxton J, et al. Dose-response effect of incarceration events on nonadherence to HIV antiretroviral therapy among injection drug users. The Journal of infectious diseases. 2011;203(9): Palepu A, Tyndall MW, Chan K, Wood E, Montaner JS, Hogg RS. Initiating highly active antiretroviral therapy and continuity of HIV care: the impact of incarceration and prison release on adherence and HIV treatment outcomes. Antiviral therapy. 2004;9(5): Spaulding AC, Seals RM, Page MJ, Brzozowski AK, Rhodes W, Hammett TM. HIV/AIDS among Inmates of and Releasees from US Correctional Facilities, 2006: Declining Share of Epidemic but Persistent Public Health Opportunity. PLoS ONE. Nov 2009;4(11):e Wang EA, White MC, Jamison R, Goldenson J, Estes M, Tulsky JP. Discharge planning and continuity of health care: findings from the San Francisco County Jail. Am J Public Health. 2008; 98(12): [PubMed: ] 10. Wang EA et al. A Pilot Study Examining Food Insecurity and HIV Risk Behaviors Among Individuals Recently Released from Prison. AIDS Educ Prev. Apr 2013; 25(2): Wang EA, Wang Y, Krumholz HM. A High Risk of Hospitalization Following Release from Correctional Facilities in Medicare Beneficiaries. JAMA Intern Med. Sept 2013;173(17): doi: /jamainternmed

38 Wohl DA, Scheyett A, Golin CE, White B, Matuscewski J, 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 control trial. AIDS Behav. 2011;15(2): Springer SA, Chen S, Altice FL. Improved HIV and substance abuse treatment outcomes for released HIV-infected prisoners: the impact of buprenorphine treatment. J Urban Health. 2010;87: Springer, S, Spaulding, A. Public Health Implications for Adequate Transitional Care for HIV-Infected Prisoners: Five Essential Components. Clin Infect Dis Sep;53(5):

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40 In the United States, about how many people are arrested and released from prison or jail each year? A. 1 million B. 3 million C. 10 million D. 20 million

41 Of all people with HIV in the U.S., what percent passes through the correctional system each year? A. 31% B. 14% C. 4% D. 0.7%

42 CDC reports that the rate of confirmed AIDS cases among state and federal prisoners was about: A. 0.4 times the rate in the general US population B. 1.4 times the rate in the general US population C. 2.4 times the rate in the general US population D. 8.4 times the rate in the general US population

43 Howard University HURB th Street NW, 2 nd Floor Washington, DC (Office) (Fax) As a Reminder: At the end of the Webinar, participants are required to complete and return the CME Evaluation Survey. It may be scanned and ed back to mdouglas@howard.edu, or faxed to: AETC-Capitol Region Telehealth Project (FAX#: ) ATTN: Training Coordinator. Please indicate in your or FAX if you would like to receive CMEs.