270520 H.I.R.E. (health improvement for re-entering ex-offenders) Program at year 3: Measuring adherence in HIV + ex-offenders in Central Florida

Monday, October 29, 2012

Ariel Ludwig, MPH , Re-Entry Programs, Metro Wellness and Community Centers, Tampa, FL
Priya Rajkumar, BA , Client Health Services, Metro Wellness and Community Centers, Tampa, FL
Lorraine Langlois , Prevention and Health Services, Metro Wellness and Community Centers, St. Petersburg, FL
Background: Reentry for ex-offenders is a complex process with numerous barriers, which can be further complicated by an ex-offender's HIV/AIDS status. As New York, Texas and Florida account for nearly half of all HIV-infected inmates, addressing re-entry in these locations is a public health imperative. Purpose: Metro Wellness and Community Centers (Metro) is a non-profit whose HIRE Program was designed to involve multiple stakeholders to provide transition assistance and comprehensive HIV/AIDS-related services in Central Florida. One primary goal is to improve the medical adherence of ex-offenders with HIV/AIDS during their re-integration into the community. Methods: Given its relationship to medication adherence and impact on transmission, ex-offender viral loads were used to assess adherence with appropriate medication and medical care. Demographic and health data were obtained through the Department of Corrections discharge coordinators, the ex-offenders, and their community healthcare providers. Results: 227 ex-offenders with HIV/AIDS enrolled in the HIRE program and were linked to a wide range of services. Of these, 53 were unavailable for analysis because of pending labs (N=26) or losses to care (N=27). 101 (44%) ex-offenders had viral loads that remained undetectable, and another 48 (21%) demonstrated lower viral loads after enrollment. Conclusions: Overall, the HIRE program appeared to promote increased medical adherence for participating ex-offenders, especially compared to prior reports in which only 20% of ex-offenders enrolled in primary care within 30 days of release and experienced significant increases in viral loads. Future research should examine HIRE program components to discern the mechanisms that facilitated these improvements.

Learning Areas:
Chronic disease management and prevention
Planning of health education strategies, interventions, and programs
Protection of the public in relation to communicable diseases including prevention or control
Public health or related research
Social and behavioral sciences

Learning Objectives:
1) List five barriers to care faced by HIV-infected ex-offenders as they re-enter communities. 2) Develop strategies to address the complex needs of ex-offenders with HIV/AIDS. 3) Explain the utility of viral load as a measure of medication adherence for re-entering ex-offenders and its role in prevention.

Keywords: Incarceration, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I currently serve as the Program Coordinator for Re-entry Services at Metro Wellness and Community Centers, a community-based non-profit. While here, I oversee the HIRE (Health Improvement for Re-entering Ex-offenders) Program, and manage its day-to-day activities. Prior to this, I received a Masters in Public Health from Yale University and have over three years of experience working in and researching the intersection of public health, correctional health, and HIV/AIDS.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.