Factors associated with HIV testing and treatment among young Black MSM and trans women in three jail systems.

Black men who have sex with men (BMSM) and transgender women (BTW) are disproportionately affected by incarceration and HIV. We assessed factors associated with HIV testing and viral suppression among 176 incarcerated BMSM and BTW in Chicago, IL; Los Angeles, CA; and Houston, TX. In multivariable logistic regression, having a sexual orientation of bisexual, heterosexual, or other vs. gay or same-gender loving was associated with higher odds of testing in custody (aOR 8.97; 95% CI 1.95 - 41.24). Binge drinking (aOR 0.19; 95% CI 0.04 - 0.92) and being unemployed prior to incarceration (aOR 0.03; 95% CI 0.00 - 0.23) were associated with lower odds of testing; participants in Los Angeles were also more likely to be tested than those in Chicago. Being housed in protective custody (aOR 3.12; 95% CI 1.09-9.59) and having a prescription for ART prior to incarceration (aOR 2.58; 95% CI 1.01-6.73) were associated with higher odds of viral suppression when adjusted for site and duration of incarceration, though the associations were not statistically significant in the full multivariable model. Future research should examine structural and process level factors that impact engagement in HIV testing and treatment among detained BMSM and BTW.

The Association of Ethnic Pride With Health and Social Outcomes Among Young Black and Latino Men After Release From Jail.

The goal of this study was to understand whether ethnic pride among young, incarcerated Black and Latino men was associated with successful community reentry. We interviewed 397 Black and Latino men 16 to 18 years old in a New York City jail and then again 1 year after their release to determine the relationship between participants' sense of ethnic pride during incarceration, and substance use, violence, recidivism, and education/ employment after release from jail. Participants with higher ethnic pride scores were less likely to engage in illegal activities and be reincarcerated. Ethnic pride was also associated with feeling safe in gangs and positive attitudes toward avoiding violence in situations of conflict. Ethnic pride was not associated with substance use, education, or engagement in community-based organizations post release. This study demonstrated that ethnic pride might be a source of strength that young men of color can harness for successful community reentry after release from jail.

Detecting Disease Transmission: Comparing SARS-CoV-2 Cases in a County Jail and the Surrounding Community.

Early detection of infectious disease transmission is an important public health tool. We sought to evaluate how positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases, identified within 14 days of admission to a jail setting, are linked to local county incidence. Data were extracted from the electronic health record and publicly accessible websites. We compared positive cases of SARS-CoV-2 identified in the Santa Clara County (SCC) jail within 14 days of admission (250 cases) with positive cases reported in SCC (141,841 cases) between March 15, 2020, and October 2, 2021. There was a strong, positive correlation between cases of SARS-CoV-2 identified within 14 days of jail admission and SCC cases the following week (r = .785). Our findings show that admission SARS-CoV-2 testing data from jails may be useful for detecting disease transmission in the surrounding community.

Data Sharing Between Jail and Community Health Systems: Missing Links and Lessons for Re-Entry Success.

Data sharing and interoperability between jail systems and community health providers are critical for successful re-entry of incarcerated individuals into the mainstream community. Using a case study approach, we present an account of interoperability efforts between jail and community health systems in the County of Orange (California, USA), including the overall infrastructure comprising of the jail management system, jail health system, and the community health system. We also describe outcomes and lessons from the Jail to Community Re-entry Program implemented in the County of Orange, along with recommendations and common data elements required for effective care transitions from custody to community.

Implementation of a COVID-19 Infection Control Plan in a Large Urban Jail System.

When the COVID-19 pandemic hit the United States, the number of people confined in correctional facilities on a single day numbered 1.8 million. Incarcerated people are at an increased risk of contracting and spreading SARS-CoV-2. Recommendations from the Centers for Disease Control and Prevention on case recognition, management, isolation, and contact tracing are particularly challenging in jails because of the high turnover of incarcerated people. Beginning in late February 2020, the Department of Correctional Health Services in the Los Angeles County Jail system implemented a multipronged COVID-19 mitigation plan that was progressively amended in accordance with local and national recommendations. This plan entailed the creation of housing for people under investigation, SARS-CoV-2 screening upon entry, a mass-testing program, and identification and monitoring of medically vulnerable people. After the identification of the first laboratory-confirmed case on March 29, 2020, predictive models were generated to visualize potential disease spread and gain support for mitigation strategy planning, which forecasted approximately 3300-4600 cumulative cases during a 278-day period. From March 7 through December 31, 2020, the percentage positivity among unique people tested for SARS-CoV-2 was 11.6% (3933 of 33 921 tested). Among those screened at intake, the percentage positivity was 2.0% (502 of 25 702 tested). The ethnic distribution among people with a positive SARS-CoV-2 test result was largely representative of the overall jail population, and most people were asymptomatic. A sustainable, multifaceted mitigation plan that relies on collaboration among medical, custodial, and local public health personnel is essential for limiting the spread of SARS-CoV-2 infection in correctional facilities.

An Outcome Study on the Naloxone Education/Dispensing Program for Departure Patients at Cermak Health Services of Cook County.

The objective of this study was to evaluate the utilization of the naloxone nasal spray kit provided to patients after discharge from Cermak Health Services of Cook County (CHS). During May and June 2018, the records of currently incarcerated CHS patients were reviewed to identify patients who (1) received the naloxone education and nasal spray kit upon previous discharge from CHS and (2) were then readmitted to the facility. Of the 76 potential participants, 60 interviews were conducted. This study has shown that 38.3% of patients utilized the nasal sprays provided to them upon discharge. Of those who reported using the nasal spray, 95.7% achieved positive outcomes. This study showed the positive impact the Naloxone Education/Dispensing Program had on patients discharged from CHS. In addition to identifying success in the number of lives saved, the study recognizes the long-term effect on patient safety that emerges from the program.

Establishing an Epidemiologic Profile of Hepatitis C Virus Infection at the Los Angeles County Jail.

OBJECTIVE: The hepatitis C virus (HCV) is the most common blood-borne infection in the United States. Although 2% to 3% of the global population is estimated to be infected with HCV, an estimated 18% of the US prison population may be infected. The objective of this study was to establish an epidemiologic profile of HCV infection in the largest urban jail system in the United States. METHODS: We retrospectively analyzed 20 years of data on demographic characteristics, risk factors, and HCV positivity among 80 681 individuals incarcerated at the Los Angeles County Jail who were tested for HCV infection from January 1, 2000, through December 31, 2019. We used multivariate logistic regression analysis to determine predictors of HCV positivity. RESULTS: Of the 80 681 individuals tested, 27 881 (34.6%) had positive test results for HCV infection. In the multivariate analysis, HCV positivity was most strongly associated with injection drug use (adjusted odds ratio [aOR] = 34.9; 95% CI, 24.6-49.5) and being born during 1946-1955 (aOR = 13.0; 95% CI, 11.9-14.2). Men were more likely than women to have HCV infection (aOR = 1.4; 95% CI, 1.3-1.5), and Hispanic (aOR = 4.2; 95% CI, 3.9-4.4) and non-Hispanic White (aOR = 3.8; 95% CI, 3.5-4.0) individuals were more likely than non-Hispanic African American individuals to have HCV infection. Noninjection drug use, homelessness, and mental health issues were also significantly associated with HCV positivity. CONCLUSION: Even in the absence of resources for universal screening for HCV infection, the creation of a risk profile and its implementation into a screening program may be a beneficial first step toward improving HCV surveillance and establishing an accurate estimate of HCV infection in the incarcerated population.

Seeking recognition through carceral health care bureaucracy: Analysis of medical care request forms in a County Jail.

People experiencing incarceration in the U.S. have a constitutional right to have access to health care. Yet actualizing this right is constrained by the everyday reality of an environment designed to punish and limit autonomy. The principal means for accessing health care in a carceral facility is for an individual to submit a written request, which then gets handled through the jail's bureaucratic processes. In this paper, we provide quantitative and qualitative analyses of the content and circulation of one month of these written requests-called "medical care request" (MCR) forms-at an urban, U.S. jail to understand the meanings of health and health care for a group of individuals who are systematically marginalized. In one month in 2012 at this jail housing 140 individuals, 527 MCRs were submitted. We coded requests into categories: medications, amelioration of living conditions, specific symptoms, and requests for a specific health care service. The most common request was for pain medication. In qualitative analysis, four key themes emerged: reliance on the clinic to mediate the needs of daily life; deservingness of health care; hyperawareness of bodily and psychic discomfort; and temporal techniques for asserting control over individuals' time and bodies in jail. We show that MCRs are a key mechanism through which incarcerated individuals seek recognition of their physical and psychic suffering, and more broadly, of their very existences. When considered in the broader context of controlling carceral regimes and health inequities that characterize U.S. society, MCRs become dynamic terrain through which jail health care providers and incarcerated people negotiate the tensions of deservingness of care.

An Outcome Study on the Naloxone Education/Dispensing Program for Departure Patients at Cermak Health Services of Cook County.

The objective of this study was to evaluate the utilization of the naloxone nasal spray kit provided to patients after discharge from Cermak Health Services of Cook County (CHS). During May and June 2018, the records of currently incarcerated CHS patients were reviewed to identify patients who (1) received the naloxone education and nasal spray kit upon previous discharge from CHS and (2) were then readmitted to the facility. Of the 76 potential participants, 60 interviews were conducted. This study has shown that 38.3% of patients utilized the nasal sprays provided to them upon discharge. Of those who reported using the nasal spray, 95.7% achieved positive outcomes. This study showed the positive impact the Naloxone Education/Dispensing Program had on patients discharged from CHS. In addition to identifying success in the number of lives saved, the study recognizes the long-term effect on patient safety that emerges from the program.

Risk-Based HIV Testing at Los Angeles County Men's Central Jail.

Incarcerated populations tend to be disproportionately affected by HIV and sexually transmitted infections (STIs), and men who have sex with men (MSM) are an especially high-risk subset of these populations. Despite the Centers for Disease Control and Prevention's recommendations for universal HIV screening, a lack of resources and high inmate turnover make it difficult to implement such guidelines in jails. From September 2013 to May 2016, the Infection Control Unit of the Los Angeles County Jail used existing resources to implement a voluntary, risk-based HIV educational and screening program targeting MSM inmates during early incarceration. The results revealed a high percentage of previously unknown HIV infections (8.5% = 57 of the 671 tested) and some unknown non-HIV STI cases. In the absence of resources for universal HIV screening, the risk-based approach is a sustainable and cost-effective approach for improving HIV surveillance in the correctional setting.

Patient navigators effectively support HIV-infected individuals returning to the community from jail settings.

Purpose Patient navigation is an evidence-based approach for enhancing medical and support service co-ordination and ensuring linkage to medical care for people living with HIV released from jail. The paper aims to discuss this issue. Design/methodology/approach This brief describes the benefits of patient navigation and issues to consider when implementing a navigator program. The authors use process data to describe the type and amount of navigation services delivered as part of a randomized study, the "The San Francisco Navigator Project." Findings Navigation programs are able to accommodate a range of service needs; most clients required multiple types of services, particularly during the first two months after release. Originality/value Navigation programs should be prioritized because they provide unique and essential support for people leaving jail during the particularly vulnerable time immediately after release navigation plays a crucial role in retaining individuals in care and preventing onward transmission of HIV.

Comparison of Digital Chest Radiography to Purified Protein Derivative for Screening of Tuberculosis in Newly Admitted Inmates.

This study compares purified protein derivative (PPD) screening to digital chest radiography (CXR) screening for tuberculosis (TB) in newly admitted inmates in the San Diego County Jail system. The study period lasted from 2002 to 2014, during which 45 cases of active TB were detected, a rate of 69.2 cases per 100,000 person-years. Compared to PPD, CXR reduces the median number of days active TB cases were in the general population from 44.4 to 5.2 days and the number of exposures from 1,222 to 138 persons. These results confirm that CXR remains a more effective method for preventing exposure to active TB in jail facilities.