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MATLC Meeting Notes 1/27/14Presentation by Dr. Anne SpaldingIntroduced Genetha Mustaafaa Difference between jails and prisonsJail – place awaiting trial; serving less than one yearPrison – found guilty of felony charge; serving longer than year sentenceOne day – prisons hold twice as many people as jailMore movement in jails13 times as many people coming into jailsCycle of incarcerationSlow processHigh turnover in jailsState incarceration rates – high rates in southUSA number one for incarcerationGA number two in USAMany other issues faced in correctionsMental health, substance abuse, housing, etc1.5% rate of HIV among prisonersPublic health field needs to focus on HIV among inmatesOne out of six people with HIV spend part of time in jail/prisonJails – high admissions; high turnover50% of individuals out within five daysMost jails don’t conduct HIV testingHave to work fastAll prisons test with conventional HIV testingRapid-testing in jails – “match made in heaven”MMWR – funded by CDCMyth – HIV in prisons in predominately heterosexualStarted with CDC funding – eventually got Gilead Sciences fundingFunding will run out shortlyCDC / Gilead funded projectHave nurses go HIV testing rather than outside teamMeeting inmates at the doorEmpowers nursing staffOrientation to Fulton County JailFourth largest jail in Georgia40,000 admissions a year1st floor – intake – individuals stay between four to 24 hoursIn past testing was not done in intakeHave access to 100% of individuals in jail at this point2nd floor – have access to 75% of inmates for testingUpstairs – only have access to 50% of inmates for testingIMpact45-50 people tested previously With Rapid Testing – between February 2013 – December 2013, 80 new patients were identified as not previously identified HIV positiveHigh yieldComponents of programIntegrate into medical servicesWith high turnover in jails, not all new positives with start HARRT before dischargeMost of pharmaceutical costs will come from communitySmall grant from Bristol-Myers Squibb to increase linkage to careVery little time to connect people to careSUCCESSAwaiting funding from NIH to test sustainability Questions for Dr. SpaldingMajority of individuals found as preliminary positives were confirmed as positivesUsed INSTI majority of timeHIV testing always done voluntarily Nurses do not see inmates face-to-faceOver 80% asked consentNot offered testing if incompetent (i.e. drunk)Retention in careMany go to prisonTestingHave bubble sheets on all inmatesDon’t ask inmates risk factors / sexual orientation – don’t have timePresentation by Chayne RensiCreated and running program last nine yearsRacial disparities in prisonNew home for young African AmericansHIV testing in prisonsSmall number of new positives when existingUsually individuals with longer sentencesCan request HIV testing once incarcerated Must disclose risk factors (who, what, where)All HAART meds are paid for by correctionsParole mandates disclosure to head of household when releasedSome inmates would rather max out sentence than disclose statusNumbers in prisonGender (male/female) is counted but not transgenderChayne notes transgender Department of Corrections aware of everyone’s HIV statusApproximately 80% of inmates with HIV are on HAART20% - medically don’t need to be on meds or refusedHigh number on meds – good for linkage and maintenance of careOnce discharged – numbers/adherence goes downHIV and GPCCurrently do not segregate inmates with HIVConsolidating inmates with HIV into certain prisons would make it easier to reach and provide servicesHIV and inmates released from GDCInmates being released all over Georgia and other statesHard for linkageOnly working in 15 out of 40 institutionsRepresents 50% of HIV among inmatesExpansion of PRPP via CAPUSGoal is to be active in every statewide facilityNot everything (transition center, day reporting centers)Want to reach more inmates before they are releasedMandatory needs for HIV offendersSometimes do not get word of release until day before Many people need more hand holding than just a medical referralThey receive at least two weeks supply of medsOften takes longer than two weeks to get a medical appointment and get on medsTry to give 30 day supply of medsTry to connect inmates to ADAPCannot begin to access services until released from prisonBarriersHousing – biggest issue with linkageLegal regulations – Section 8 HousingEducational disparities – average 6-8th grade Issues with filling out medical formsParole and probationDirect from prison – can’t get services until releasedNot considered homeless until releasedDetainers – get linked to care and then find out the inmate has a detainer in another countyCell phone number – 478-456-0072Wants anyone to contact her with questions/concerns about inmates with HIVPresentation by Donna SmithBureau of Justice Affairs – funder2009-2011 – pilot re-entry programSupplemental case management and peer guidancePrograms like PRPP began in mid 2000’sDue to evidence suggesting need for helping offenders with transitionReferrals, medicine, medical recordsCommunity ConnectionsBridging gap between PRPP and after being releasedHelping offenders in Metro AtlantaEarly contact is criticalPeer guides to help administer the programLooked for individuals with experience in HIV, offenders, substance abuse/treatmentFirst visit – evaluate readiness for program, assessment of needsOne year commitmentIncentivesMonthly MARTA card and cell phoneControversial – why give individuals before completing program?Feel it’s critical to be about to get in touch with individuals and establish contact with family members/medical careLimitationsNo hard data on CD4 countsResultsHousing, jobs, and stigma were identified as the biggest issues these individuals encounteredImportance of identifying peer guidesFound success in recruiting from AAGoing forwardFuture participants – will administer mental health assessment before enrollingWould not have enrolled certain participants knowing mental health statusSmall grant from Elton John Foundation – peer guide training / curriculumDiscussion QuestionsQuestion One / Question TwoL’Dia Men NaAt Wholistic Stress Control Institute – education, encouraging to think better about themselves (increase self-esteem), incentives for volunteers, stress management activitiesDr. SpaldingDo people want to take testing out of nursing/medical staff hands?Getting staff trained is easier because they have more accessBrandi WilliamsOpt-out testing is idealNeed alternate strategies because every setting has specific needsHow do we establish relationships with jails/prisons for CBO’s to provide linkage?Teresa BellFulton County is working with Recovery Consultants of Atlanta through a MOUWhen inmate is released – set up appointment with Linkage CoordinatorTrying to create one-stop shop for individuals (mental health, medical appointment, labs)Linkage coordinators have established relationships with housing, etcGet connected with ADAPARTASChayne RensiAnyone being released from Atlanta Metro area – connected with Recovery ConsultantsContact made very quicklyNeed to get MOU with other CBO’s in other counties to help with linkageGenetha MustaafaaProject implement strength-based case managementDepends which county they reside inCan follow-up to ensure linkage was madeJeff Cheek In Fulton County – “Frequent flyers”Can check with Fulton County jail to see if people who were lost to care when to jailDo not have contact with other jailsL’Dia Men NaJails were very receptive with CBO’s trying to make relationships to help with linkageDr. SpaldingEasier to obtain relationships with jails through personal relationshipsJail staff more likely to work with someone they knowChayne RensiLinkage with state prison more difficultMost prisons outside of AtlantaMost CBO’s not willing to go out to rural areas / outside AtlantaQuestion ThreePat ParsonsAt St. Joseph’s Mercy Care use social networking strategy to target young AAMSMs through mobile appGet in contact with MSMs through other social networking sites (Facebook, Grinder)Encouraging individuals to come in for all inclusive care along with HIV tesStarted in May 2013 – 3.8% seropositivity rateL’Dia Men NaBe 2 Smart, peer navigatorQuestion FourPat ParsonsSt. Joseph’s Mercy Care is convenient located across from MLK Marta stationCurrently see 800 clientsExcepting new clientsAbout a 2.5 week weight timeLorraine AustinIn Fulton County established Community Advisory GroupMSM group to get inputHow to address needsQuestion FiveLa’Quita RobinsonIn Cobb-Douglas, use emailClients prefer as method of contactCinsia BristolIn DeKalb, contact them, tell them they are a state agency (not HIV related), send referral letter (no mention of HIV)Sometimes will contact offenders before they are releasedTeresa BellConfidentialitySocial needs assessment – ask what specific needs and best way to contact themNext MATLC Meeting – April 21st – Linkage to Care for Adolescents and Atlanta HIV Focus Program ................
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