Yale AIDS Program Yale School of Medicine Yale University New Haven, CT Frederick L' Altice, MD

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Yale AIDS ProgramYale School of MedicineYale
UniversityNew Haven, CTFrederick L. Altice, MD

• TRANSITIONS
• Enhancing Linkages to HIV Primary Care in Jail
  Settings
• Grantee Meeting
• 10/25/2007 10/26/2007
• Rockville, MD

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TRANSITIONS Description

• Will use the following evidence-based
  interventions to create a comprehensive
  transitional program
• Enhanced rapid HIV testing within jails
• Intensive case management
• Continuity of BUP tx from jail to community
• Novel money management program

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Project Goals

• To develop a unique jail-release model utilizing
  a jail-based discharge planner, community-based
  case managers, opiate substitution therapy and
  community outreach that results in improved HIV
  treatment, substance abuse and social
  stabilization outcomes
• To adapt and test a Money Management program for
  inmates being released from jail
• To compare the HIV, substance abuse and social
  stabilization outcomes for those who receive vs.
  not receive MM services.

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Enhancements to Existing Services Available for
HIV Inmates

• Increased HIV screening for those at greatest
  risk
• Introduction of discharge planning for jail
  inmates
• Strengthened linkages to medical support and
  opiate substitution therapy upon release
• Availability of intensified case management
• Addition of rep payee and other money management
  services upon release

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Project Team and Collaborative Partners

• Grantee Yale AIDS Program
• Project Team
• Frederick L. Altice, MD Principal Investigator
• Mark Rosen, MD Co- Investigator
• Laurie Sylla/ David Smith Study Coordinators
• Shu Chen Evaluator
• Mary Walton, PA-C Community Healthcare Van
  Coordinator
• Jo Anne Mezger Data Manager
• TBN Intensive CM/MM
• TBN RA

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Project Team and Collaborative Partners

• Jails New Haven Community Correctional Center
  (men) and York Correctional Institution (women)
• DOC Administrators and Coordinators
• TBN Referrals Coordinator
• Waterbury Infectious Disease Clinic
• 3 Clinic ID Physicians
• TBN Intensive Case Manager/Money Manager
• South Central Rehabilitation Services (SCRC)

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Target Population

• 5-8 per day for HIV screening
• 60 participants for BMT
• 60 participants for ICM
• 30 participants for MM who are also receiving ICM
• 70 male, 30 female
• 45 African American, 34 Hispanic, 20 White, 1
  other
• Inmates released to either New Haven or
  Waterbury, small urban centers of poverty and
  crime
• High rates of co-occurring mental health
  disorders, substance abuse, HCV and chronic
  homelessness

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Local Evaluation Strategy

• Chart review
• VL and CD4 testing
• Standardized interviews
• Encounter numbers

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Local Data Collection(Individual)

• BPN (eligible subjects only)
• Chart Review
• VL and CD4
• Standardized Questions
• Health care utilization
• Receipt and Adherence (visual analogue scale) to
  HAART
• Needs Assessment for Services
• Substance abuse treatment services
• Urine toxicology (more may be done by other
  providers)
• Addiction Severity Index
• HIV risk behaviors (ACASI, previous three months)
• Social entitlements (including ADAP)
• Social support
• Illegal activities
• Homelessness
• Reincarceration
• Screening and treatment for mental illness

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Local Data Collection

• Program/Systems
• Percent HIV tested
• Service Utilization
• Percent receiving BUP prior and post release
• Percent remaining opiate free

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Method of Data Collection

• Chart review
• Urine toxicology screening
• Clinical lab tests
• Counseling and case management notes
• Interview data
• Aggregate clinical data
• Research team minutes
• Client satisfaction surveys
• Scannable data forms

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Who is Collecting Local Data

• Research Assistants
• Case Managers
• Referrals Coordinator
• Data Manager

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Outcomes

• Outcomes measures for buprenorphine treatment
• Retention in buprenorphine treatment
• Percent opiate free urines
• Recidivism to drug use, incarceration and
  criminal behavior
• Outcomes measures for Intensive Case Management
• Retention in intensive case management
• Retention in HIV, psychiatric and medical care
• Use of emergency department and inpatient
  hospitalization
• Outcomes measures for Money Management
• Retention in money management
• Recidivism to homelessness
• Requests for withdrawal of inappropriate funds

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Expected Challenges Possible Solutions

• High rate of turnover in jail populations
• Solution Rapid linkage to the in house
  Referral Coordinator
• Poor acceptance of inmates of money management
• Solution - We will allow for self selection
  rather than randomization
• Transportation from jail to clinical care site
• Solution - Referrals coordinator to provide
  documents, bus token, medical information and
  medications on DOR if inmate will return to jail
  lobby after court

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Expected Challenges Possible Solutions

• Lack of willingness for the Jail or Community HIV
  programs to integrate the TRANSITIONS program
  into routine care
• Solution - We have obtained support from
  administrative leaders and will work on a daily
  basis with field staff to overcome obstacles
• High rates of HIV testing but inability to
  provide post test HIV counseling
• Solution - Inmates who are tested will sign a
  release form for referral to CARE program blood
  for WB confirmation will be drawn on same day

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Contact Information

• Frederick L. Altice, MD raltice_at_aol.com
• 203-737-2883
• Laurie Sylla laurie.sylla_at_yale.edu
• 203-785-5538
• David Smith david.smith.ds643_at_yale.edu
• 203-785-2038