Models for Improving Linkage to Care for People Living with HIV Released from Jail or Prison

Models for Improving Linkage to Care for People Living with HIV Released from Jail or Prison

June 15, 2017
National Center for Innovation in HIV Care
 Cover Page

With HIV prevalence among state and federal prisons more than three times higher than the general population (1.3% compared to 0.4%), correctional facilities offer a unique opportunity to engage with PLWH and offer care. For many PLWH, this time during incarceration may be the only time they have access to HIV care. For others, due to intense stigma against HIV and homosexuality in hypermasculine corrections settings, incarceration may interrupt HIV treatment they were previously receiving in the community. It is essential that AIDS service organizations (ASOs) and community-based organizations (CBOs) work with newly released PLWH to ensure continuity of care for incarcerated PLWH as they reenter society.

The HIV care continuum involves five sequential steps: (1) diagnosis of HIV infection, (2) linkage to care, (3) retention in care, (4) receipt of antiretroviral therapy (ART), and (5) achievement of viral suppression. Barriers to accessing care can include lack of stable housing, poverty, mental health and/or substance use disorder issues, and lack of access to culturally competent care. Formerly incarcerated individuals often struggle with various issues, including: substance use disorders, mental health, family estrangement, lack of support, lack of employment and housing after being released back into their communities. Thus, continuity of care for incarcerated PLWH is particularly important. Interventions that address barriers to engagement in care are vitally important.

This resource guide summarizes effective models and best practices of linkage to care programs for PLWH who are leaving jail or prison and reentering society. It is based on project reports, training manuals and resource guides on post-incarceration linkage to care programs, including the HRSA-CDC Corrections Demonstration Project, HRSA HIV/AIDS Bureau’s (HRSA HAB’s) Special Projects of National Significance Program (SPNS): Enhancing Linkages to HIV Primary Care & Services in Jail Settings Initiative (EnhanceLink), The Bridging Group’s Project START Plus, ActionAIDS’ Philadelphia Linkage Program’s Care Coach Model, and the Change Team Model in Delaware Study.