Reducing HIV service gaps among inmates: Using local change teams to improve implementation

Jail and prison inmates are at very high risk for HIV infection related to illicit drug use and risky sexual behavior. Yet numerous gaps exist in delivering prevention, testing, and treatment services to inmates. Evidence-based practices for testing, prevention, and treatment are not always used, and there are many gaps in providing continuity of treatment to medical care and ensuring medications are continued uninterrupted to HIV-infected inmates when they are released. Many of these problems reflect organizational and system barriers to implementation and organizational change. The HIV Services and Treatment Implementation in Corrections project (HIV-STIC) is a NIDA-funded national multisite project testing a local change team process improvement intervention to improve the delivery of HIV services to inmates, part of NIDA's Criminal Justice Drug Abuse Treatment Studies collaborative. The study involves 32 correctional facilities in 8 states and Puerto Rico randomized within site clusters to either a control condition receiving basic training and information about improving HIV services, or an experimental condition implementing a local change team process improvement model with demonstrated efficacy in other behavioral health settings. The change team intervention incorporates a modified version of the NIATx model, consisting of 6-10 staff from agencies involved in HIV service delivery to inmates, under the leadership of a change team leader and with support from senior correctional facility and agency administrators. An external coach guides the team through the process improvement strategy that uses a variation of the Plan-Do-Study-Act approach. This presentation describes the project and summarizes the change activities at the 16 experimental sites, including types of HIV services issues addressed, organizational change strategies being tested, and policy and service delivery improvements made by the change teams. The initial findings suggest that local change teams can quickly identify service gaps and barriers, and then test and implement process improvement strategies to reduce those gaps.