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Using qualitative data to develop a health navigation intervention for improving engagement and retention in HIV care among recently released HIV-positive jail inmates

Wednesday, November 6, 2013

Jane Rohde Bowers, MPH, Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA
Trista A. Bingham, MPH, PhD, Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA
Nina T. Harawa, MPH, PhD, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA
William E. Cunningham, MD, MPH, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
BACKGROUND: HIV prevalence among incarcerated individuals is approximately three times that of the general population and an estimated one in seven persons living with HIV passes through a correctional facility at some point each year. Upon their release from jail, Los Angeles County inmates are half as likely as the general population to be engaged and retained in community-based HIV care.

METHODS: We conducted semi-structured, one-on-one interviews with 20 HIV-positive current and ex-inmates, 11 HIV case managers and 10 medical providers (n = 41) in Los Angeles County. Through open coding and frequency counts, we identified the most commonly mentioned perceived barriers to and facilitators of HIV care once inmates are released from jail.

RESULTS: Top listed barriers to HIV care among respondents included substance abuse issues, HIV stigma and disclosure concerns, lack of social support, side effects from HIV medications, limited HIV knowledge, lack of housing, and negative peer influences. Top listed facilitators to HIV care included social support, daily routines, transportation, appointment reminders, mental health and substance abuse treatment, case management, and available housing resources.

CONCLUSIONS: Results highlight a multitude of factors that impede inmates' engagement in HIV care. Programs must address inmates' basic needs before expecting them to prioritize their HIV care. We used these qualitative findings to design a peer-based health system navigation intervention for HIV-positive inmates upon release from jail and to evaluate the intervention's efficacy to improve linkage to and retention in HIV care, self-reported ART adherence, and HIV RNA viral load suppression.

Learning Areas:

Diversity and culture
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
Identify top perceived barriers and facilitators to HIV care as defined by HIV positive current and ex-inmates. Discuss perceived and preferred components of an effective health navigation intervention as defined by HIV providers with experience working with incarcerated populations and HIV positive current and ex-inmates.

Keyword(s): Access to Care, Incarceration

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a PI or coPI on multiple studies of the epidemiology of HIV-related risk factors. I have also conducted HIV prevention interventions with high-risk post-incarcerated men and in custody settings. Currently, I am involved in this and another study of linkage to and retention in HIV medical care for previously incarcerated people.
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.

Back to: 5006.0: Barriers to HIV prevention