Seek, test, treat and retain: A university/community partnership to address HIV among persons who are incarcerated or leaving jail and prison

Issue:  Communities with high rates of HIV often experience high rates of incarceration, which makes jails and prisons key sites for addressing HIV diagnosis and management. Improvements are needed in identifying inmates with undiagnosed or untreated infections, treating them during incarceration, linking inmates to HIV care when returning to the community, and retaining them in care.

Description: Jails and prisons hold populations with rates of HIV infection 3-5 times greater than the general population. Appropriate treatment and retention in care may improve the health of those living with HIV and reduce new infections in their communities. We created a coalition of providers comprising the University of Illinois at Chicago, Cook County Jail, Illinois Department of Corrections, and the AIDS Foundation of Chicago that formed, implemented or evaluated means for improving HIV testing, linkage to medical care, HIV treatment for the reentry population, linkage to HIV treatment after leaving jail/prison, and adherence and retention in care.  These strategies include opt-out HIV testing, discharge planning, subspecialty care for prisoners using telemedicine, and corrections-oriented community-based case management. 

Lessons learned:  A strong commitment to goals and a community-level perspective served the coalition well. Large institutions faced bureaucratic issues that could slow program execution.  Opt-out testing was more difficult to implement in jail than in prison.  Telemedicine proved highly effective in treating HIV-positive inmates. Case management appears to be effective in helping persons adhere to HIV care after release from incarceration, but many former inmates fail to link to post-release case management and medical care.