Jail, an unappreciated medical home: Assessing the feasibility of a strengths-based case management intervention to improve the care retention of HIV-infected persons once released from jail. Spaulding, A. C., Drobeniuc, A., Frew, P. M., Lemon, T. L., Anderson, E. J., Cerwonka, C., Bowden, C., Freshley, J., & del Rio, C. PLoS ONE, March, 2018.
Jail, an unappreciated medical home: Assessing the feasibility of a strengths-based case management intervention to improve the care retention of HIV-infected persons once released from jail [link]Paper  doi  abstract   bibtex   
Background 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. Methods and findings 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, \textgreater = 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. Conclusions 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. Trial registration ClinicalTrials.gov NCT02185742
@article{spaulding_jail_2018,
	title = {Jail, an unappreciated medical home: {Assessing} the feasibility of a strengths-based case management intervention to improve the care retention of {HIV}-infected persons once released from jail},
	volume = {13},
	issn = {1932-6203},
	shorttitle = {Jail, an unappreciated medical home},
	url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877830/},
	doi = {10.1371/journal.pone.0191643},
	abstract = {Background
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.

Methods and findings
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, {\textgreater} = 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.

Conclusions
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.

Trial registration
ClinicalTrials.gov NCT02185742},
	number = {3},
	urldate = {2018-06-22},
	journal = {PLoS ONE},
	author = {Spaulding, Anne C. and Drobeniuc, Ana and Frew, Paula M. and Lemon, Tiffany L. and Anderson, Emeli J. and Cerwonka, Colin and Bowden, Chava and Freshley, John and del Rio, Carlos},
	month = mar,
	year = {2018},
	pmid = {29601591},
	pmcid = {PMC5877830}
}
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