Designing a system for linking HIV positive inmates to care after release from jail: Overview and lessons learned from the Baltimore City Detention Center

Issue: Over 40,000 persons are in custody at the Baltimore City Jail each year. Inmates who test positive for HIV receive primary care, HIV medication, and other services. Processes to ensure that persons are linked to care after release are essential, especially in jails where many people have poor prior engagement to medical care.

Description: In August 2010 the Maryland Department of Corrections; Maryland Infectious Disease and Environmental Health Administration (IDEHA), the Baltimore Ryan White (RW) Part A Program, and Baltimore City Health Department HIV/STD program initiated a pilot in Baltimore City jail by which IDEHA refers inmates to RW Providers in the community. Providers offer core medical and supportive services for persons without sufficient health care coverage or financial resources for coping with HIV. RW providers meet with HIV positive inmates during incarceration and link them to primary medical care and other services upon their release. The HIV/STD program receives information for individuals whom are released prior to meeting with a RW provider to locate them and their partners and engage them in care.

Lessons Learned: Challenges for the providers include gaining clearance into the jail and locating persons released. This pilot established a formal process for linking HIV positive persons to care after release and persons who are difficult to find while not incarcerated.

Recommendations: Moving forward, this pilot will be expanded to include other RW providers. Also, voluntary testing programs within the BCDC will be able to refer positive inmates to RW providers in the community.