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Because certain groups at high risk for HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) come together in correctional facilities, seroprevalence was high early in the epidemic. The share of the HIV/AIDS epidemic borne by inmates of and persons released from jails and prisons in the United States (US) in 1997 was estimated in a previous paper. While the number of inmates and releasees has risen, their HIV seroprevalence rates have fallen. We sought to determine if the share of HIV/AIDS borne by inmates and releasees in the US decreased between 1997 and 2006. We created a new model of population flow in and out of correctional facilities to estimate the number of persons released in 1997 and 2006. In 1997, approximately one in five of all HIV-infected Americans was among the 7.3 million who left a correctional facility that year. Nine years later, only one in seven (14%) of infected Americans was among the 9.1 million leaving, a 29.3% decline in the share. For black and Hispanic males, two demographic groups with heightened incarceration rates, recently released inmates comprise roughly one in five of those groups' total HIV-infected persons, a figure similar to the proportion borne by the correctional population as a whole in 1997. Decreasing HIV seroprevalence among those admitted to jails and prisons, prolonged survival and aging of the US population with HIV/AIDS beyond the crime-prone years, and success with discharge planning programs targeting HIV-infected prisoners could explain the declining concentration of the epidemic among correctional populations. Meanwhile, the number of persons with HIV/AIDS leaving correctional facilities remains virtually identical. Jails and prisons continue to be potent targets for public health interventions. The fluid nature of incarcerated populations ensures that effective interventions will be felt not only in correctional facilities but also in communities to which releasees return.

Despite 15,000 people enter US jails yearly with undiagnosed HIV infection, routine HIV testing is not standard. Maximizing the yield and speed of HIV testing in short-term detention facilities could promote rapid entry or re-entry of people living with HIV (PLWH) into care. The goal of this study was to evaluate the impact of third generation, rapid point-of-care (rPOC) vs. fourth generation, laboratory-based antigen/antibody (LBAg/Ab) testing on the HIV care cascade in a large urban jail during a planned transition. We used aggregate historical data to compare rPOC testing and LBAg/Ab testing in the D.C. Department of Corrections. We examined two time periods, January to August 2019 when rPOC testing was performed, and October 2019 to January 2020 after LBAg/Ab testing began. We calculated monthly rates of HIV tests performed, HIV test results received, HIV test results received among those tested, antiretroviral therapy (ART) initiation, and proportion of PLWH receiving discharge planning prior to release. We then conducted an interrupted time series analysis to assess the differences between testing periods. There were 14,237 entrants during the first time period and 7,569 entrants during the second. Transitioning from rPOC to LBAg/Ab testing increased the rate of test uptake by 38.5% (95% CI: 14.0, 68.3), decreased the rate of test results received among those tested by 13.1% (95% CI: -14.0, -12.1), and increased the combined rate of HIV tests performed and results received by 20.4% (95% CI: 1.5, 42.8). Although the rate of HIV testing was greater under LBAg/Ab, PLWH received results immediately through rPOC testing, which is critically important in short-stay enviroments. Increasing rPOC uptake would increase its value and combined testing may maximize the detection of HIV and receipt of results among persons passing through jails.

In year one of the COVID-19 epidemic, the incidence of infection for US carceral populations was 5.5-fold higher than that in the community. Prior to the rapid roll out of a comprehensive jail surveillance program of Wastewater-Based Surveillance (WBS) and individual testing for SARS-CoV-2, we sought the perspectives of formerly incarcerated individuals regarding mitigation strategies against COVID-19 to inform acceptability of the new program. In focus groups, participants discussed barriers to their receiving COVID-19 testing and vaccination. We introduced WBS and individual nasal self-testing, then queried if wastewater testing to improve surveillance of emerging outbreaks before case numbers surged, and specimen self-collection, would be valued. The participants’ input gives insight into ways to improve the delivery of COVID-19 interventions. Hearing the voices of those with lived experiences of incarceration is critical to understanding their views on infection control strategies and supports including justice-involved individuals in decision-making processes regarding jail-based interventions.

Institution-level wastewater-based surveillance was implemented during the COVID-19 pandemic, including in carceral facilities. We examined the relationship between COVID-19 diagnostic test results of residents in a jail in Atlanta, Georgia, USA (average population ≈2,700), and quantitative reverse transcription PCR signal for SARS-CoV-2 in weekly wastewater samples collected during October 2021‒May 2022. The jail offered residents rapid antigen testing at entry and periodic mass screenings by reverse transcription PCR of self-collected nasal swab specimens. We aggregated individual test data, calculated the Spearman correlation coefficient, and performed logistic regression to examine the relationship between strength of SARS-CoV-2 PCR signal (cycle threshold value) in wastewater and percentage of jail population that tested positive for COVID-19. Of 13,745 nasal specimens collected, 3.9% were COVID-positive (range 0%-29.5% per week). We observed a strong inverse correlation between diagnostic test positivity and cycle threshold value (r = -0.67; p<0.01). Wastewater-based surveillance represents an effective strategy for jailwide surveillance of COVID-19.

People caught up in the U.S. justice system have already been affected by SARS-CoV-2, and improved preparation is essential to minimizing the impact of this pandemic on incarcerated persons, correctional staff, and surrounding communities.

Background Implementing public health interventions can be challenging in carceral settings. Jails are institutions with the shortest lengths of stay, resulting in frequent turnover and constantly shifting populations. Jails had particularly acute challenges during the early stages of the COVID-19 pandemic when incarcerated persons were highly susceptible to infection and severe disease. The purpose of this study was to identify barriers and facilitators to wastewater-based surveillance (WBS) and nasal self-testing (NST) as a combined strategy of COVID-19 surveillance in Fulton County Jail (FCJ), Atlanta, Georgia. Implications for efficient and effective infectious disease testing among this susceptible population are relevant for ongoing surveillance of current endemic pathogens and future epidemics. Methods We utilized a multilevel, theory-informed qualitative approach to conduct semi-structured one-on-one and small group interviews with nine distinct jail stakeholder groups: jail custody leadership, administrators, officers, maintenance workers, Georgia Department of Health’s COVID-19 testing contractor, jail health care leaders, nursing staff, laboratory leadership, and staff. Interview guides and analyses were informed by the Consolidated Framework for Implementation Research (CFIR). We used Applied Thematic Analysis to identify domains within CFIR reflecting barriers and facilitators to WBS combined with NST in large urban jail settings. Results Twelve interviews were conducted with administrative, healthcare, maintenance, custody, and laboratory personnel from July 2022 to November 2022. Seven CFIR constructs were identified as barriers, sixteen as facilitators, and one as a neutral factor for the implementation of WBS combined with NST. Jail stakeholders underscored the relative advantage of self-testing, highlighted limited resources, and expressed concerns for the sustainability of WBS due to competing priorities. Many of the stakeholders within the jail setting that were interviewed had hierarchical organizational structures, which made decision-making processes regarding WBS and NST complex and challenging to implement. Conclusions Given the political, structural, and organizational factors in a jail setting, innovations such as NST and WBS require a rigorous implementation strategy supported by ongoing engagement and collaboration with a multitude of stakeholders.

Linkage to and retention in care for US persons living with HIV (PLWH) after release from jail usually declines. We know of no rigorously evaluated behavioral interventions that can improve this. We hypothesized that a strengths-based case management intervention that we developed for PLWH leaving jail would increase linkage/retention in care (indicated by receipt of laboratory draws) and a suppressed HIV viral load (VL) in the year following release. We conducted a quasi-experimental feasibility study of our intervention for PLWH jailed in Atlanta. We recruited 113 PLWH in jail starting in 2014. \"SUCCESS\" (Sustained, Unbroken Connection to Care, Entry Services, and Suppression) began in jail and continued post-release. Subjects who started the intervention but subsequently began long-term incarcerations were excluded from further analysis. Persons who were retained in the intervention group were compared to contemporaneously incarcerated PLWH who did not receive the intervention. Identities were submitted to an enhanced HIV/AIDS reporting system (eHARS) at the state health department to capture all laboratories drawn. Both community engagement and care upon jail return were assessed equally. For 44 intervention participants released to Atlanta, 50% of care occurred on subsequent jail stays, as documented with EventFlow software. Forty-five receiving usual services only were recruited for comparison. By examining records of jail reentries, half of participants and 60% of controls recidivated (range: 1-8 returns). All but 6 participants in the intervention and 9 subjects in the comparison arm had ≥1 laboratory recorded in eHARS post-release. Among the intervention group, 52% were retained in care (i.e., had two laboratory studies, > = 3 months apart), versus 40% among the comparison group (OR = 1.60, 95% CI (0.71, 3.81)). Both arms showed improved viral load suppression. There was a trend towards increased retention for PLWH released from jail after SUCCESS, compared to usual services. Measuring linkage at all venues, including jail-based clinics, fully captured engagement for this frequently recidivating population. ClinicalTrials.gov NCT02185742.

On the streets, for example, the very supplies needed to follow World Health Organization (WHO) recommended hand hygiene guidelines [ 10], including access to clean water, soap and hand sanitizer, are scarce. For PWUD in community settings, disruptions in global supply chains and implementation of physical distancing measures in response to the COVID‐19 pandemic may limit access to drugs and harm reduction services. [...]because various physical distancing measures in response to COVID‐19 are anticipated to remain in place for the foreseeable future, PWUD may have difficulty accessing healthcare services, including opioid substitution therapy, medication‐assisted treatment and other substance use treatment services.

BackgroundThis paper describes the means by which a United States National Institute on Drug Abuse (NIDA)-funded cooperative, Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS), utilized an established implementation science framework in conducting a multi-site, multi-research center implementation intervention initiative. The initiative aimed to bolster the ability of juvenile justice agencies to address unmet client needs related to substance use while enhancing inter-organizational relationships between juvenile justice and local behavioral health partners.MethodsThe EPIS (Exploration, Preparation, Implementation, Sustainment) framework was selected and utilized as the guiding model from inception through project completion; including the mapping of implementation strategies to EPIS stages, articulation of research questions, and selection, content, and timing of measurement protocols. Among other key developments, the project led to a reconceptualization of its governing implementation science framework into cyclical form as the EPIS Wheel. The EPIS Wheel is more consistent with rapid-cycle testing principles and permits researchers to track both progressive and recursive movement through EPIS. Moreover, because this randomized controlled trial was predicated on a bundled strategy method, JJ-TRIALS was designed to rigorously test progress through the EPIS stages as promoted by facilitation of data-driven decision making principles. The project extended EPIS by (1) elucidating the role and nature of recursive activity in promoting change (yielding the circular EPIS Wheel), (2) by expanding the applicability of the EPIS framework beyond a single evidence-based practice (EBP) to address varying process improvement efforts (representing varying EBPs), and (3) by disentangling outcome measures of progression through EPIS stages from the a priori established study timeline.DiscussionThe utilization of EPIS in JJ-TRIALS provides a model for practical and applied use of implementation frameworks in real-world settings that span outer service system and inner organizational contexts in improving care for vulnerable populations.Trial registrationNCT02672150. Retrospectively registered on 22 January 2016.

Hepatitis C virus (HCV) prevalence in prison systems is about 10 times higher than in the community. As such, prison systems offer a unique opportunity to control the HCV epidemic. New HCV-treatment drugs are very effective, but providing treatment to all inmates is prohibitively expensive unless prices fall. Current practice is to prioritize treatment based on disease severity and puts less emphasis on other factors such as the remaining sentence length and injection drug use behavior. In “Prioritizing Hepatitis C Treatment in U.S. Prisons,” T. Ayer, C. Zhang, A. Bonifonte, A. Spaulding, and J. Chhatwal analyze optimal approaches for treatment prioritization under resource constraints by developing a restless bandit modeling framework. They present an easy-to-implement closed-form index policy to support hepatitis C treatment prioritization decisions in U.S. prisons. They also test their proposed policy using a detailed, realistic agent-based simulation model and shed light on several controversial health policy decisions related to hepatitis C treatment prioritization. Hepatitis C virus (HCV) prevalence in prison systems is 10 times higher than in the general population, and hence prison systems offer a unique opportunity to control the HCV epidemic. New HCV treatment drugs are very effective, but providing treatment to all inmates is prohibitively expensive, which precludes universal HCV treatment in prison systems. As such, current practice recommends prioritizing treatment based on clinical and incarceration-related factors, including disease staging, remaining sentence length, and injection drug use (IDU) status. However, there is controversy about how these factors should be incorporated because of the complicated trade-offs. In this study, we propose a restless bandit modeling framework to support hepatitis C treatment prioritization decisions in U.S. prisons. We first prove indexability for our problem and derive several structural properties of the well-known Whittle’s index, based on which we derive a closed-form expression of the Whittle’s index for patients with advanced liver disease. From the interpretation of this closed-form expression, we anticipate that the performance of the Whittle’s index would degrade as the treatment capacity increases, and to address this limitation, we propose a capacity-adjusted closed-form index policy. We parameterize and validate our model using real-world data and published studies and test the performance of our proposed policy against several benchmark policies using a realistic agent-based simulation model. Our results shed light on several controversial health policy issues in hepatitis C treatment prioritization: (1) prioritization based on only liver health status, a commonly practiced policy, is suboptimal compared with many other policies; further, considering remaining sentence length of inmates and IDU status in addition to liver health status in prioritization decisions can lead to a significant performance improvement; (2) while usually prioritizing patients with longer sentence lengths is the right choice, prioritizing patients with shorter remaining sentence lengths may be preferable if the treatment capacity inside the prison system is not very tight and the linkage-to-care level outside the prison system is low; and (3) among patients with advanced liver disease, IDUs should not be prioritized unless their reinfection is very well controlled. The online appendix is available at https://doi.org/10.1287/opre.2018.1812 .