Interorganizational strategies to improve the delivery of HIV services to inmates: Lessons from a national multisite implementation study

Despite their elevated risk for HIV infection while incarcerated and following their release, many jail and prison inmates do not receive adequate HIV testing, prevention, and treatment services. These services gaps include failure to adhere to CDC testing and treatment guidelines, lack of evidence-based primary and secondary prevention services, and lack of continuity and integration of antiretroviral medications and HIV medical care when HIV-positive inmates are released back to the community. Failure to adequately identify, prevent, and treat HIV infections among inmates presents serious public health problems requiring innovative solutions. Many of these problems reflect organizational and system barriers to implementation and organizational change in correctional facilities. The HIV Services and Treatment Implementation in Corrections project (HIV-STIC) is a recently completed NIDA-funded, national multisite project that tested a local change team process improvement intervention for improving delivery of HIV services to inmates, as part of NIDA's Criminal Justice Drug Abuse Treatment Studies collaborative. In a cluster randomized trial, 16 of 32 correctional facilities in 8 states and Puerto Rico implemented a local change team process improvement model with external coaching, with the goal of improving implementation of HIV services in a specific area identified by a senior correctional official. The 6-10 staff members of each change team were from various correctional, medical care, and community HIV services agencies involved in HIV service delivery to inmates. They were trained on evidence-based HIV service delivery to inmates and an external coach guided the team through a process improvement strategy involving regular team meetings, walk-throughs, data collection, rapid cycle testing of change strategies, and development of a sustainability plan. Over a project period of 10 months, the change teams were able to achieve a number of concrete and significant improvements in processes and policies that are likely to lead to improved inmate access to HIV services and increased use of evidence-based practices. Using data from staff interviews, surveys, site observations, and analysis of HIV testing, prevention, and treatment data from the 16 experimental study sites, this presentation summarizes the process improvement strategies and accomplishments of the change teams, including types of HIV services issues addressed, organizational change strategies tested, and policy and service delivery improvements made. Barriers encountered by the teams and strategies to address them are also discussed, as well as lessons learned for using focused and systematic interorganizational and staff initiatives to make meaningful improvements in HIV services for inmates.