Lessons learned when adapting an evidence-based HIV behavioral intervention for women prisoners: Issues delivering the intervention before and after release from prison

Issues: Incarcerated women are at high risk of sexually transmitted infections, including HIV. Few HIV prevention interventions have been designed specifically for women prisoners, and little is known about the sustainability of intervention effects over time. There are numerous challenges to implementing a research study in a prison setting to ascertain intervention effects over time. Description: We highlight specific problems encountered at all levels of the research process when implementing an adapted HIV risk-reduction intervention in a novel setting. Implementation problems included navigating the prison culture, and gaining access to the women prisoners. Another major obstacle to successful implementation involved high rates of loss to follow-up after women were released from prison. Lessons Learned: Lessons learned during study implementation involved fostering trust between researchers and prison personnel who assisted with access to the women prisoners, learning the prison culture and schedule, knowing the rules and regulations of the facilities, and being flexible to deal with unexpected circumstances. Frequent contact with participants prior to release, immediately after release, and throughout the follow-up period was essential to retention. Recommendations: Engage the Department of Corrections at all levels of the research process to obtain approvals and for continued support of research activities. Always remember that research staff are a ”guest in their house (i.e., prison).” It is critical to continue contact with women prisoners within a week of their release, and check public websites to track early release, transfers, and re-incarceration to improve retention rates.