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BREAKING OUT:

HIV TREATMENT AND CARE WHEN

PLWHIV TRANSITION FROM CUSTODIAL

SETTINGS INTO THE COMMUNITY

Gary Hampton, Michelle Merry,

Leo Barreto, Jenny Douglas

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• Why is there a need for a transitional program for

people with HIV leaving custody?

• Organisational partners in the project

• Project overview

• Summary of outcomes

• Where to from here

Overview of presentation

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Why a transitional program?

PLWHIV in custodial settings: •Seventh National HIV Strategy 2014 - 2017

•NSW HIV strategy 2012-1015: A New Era

• Risk of experiencing treatment interruptions and loss to follow up for HIV care • Prior to this project there was no systematic referral pathway for PLWHIV transitioning from prison back to the community

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Why a transitional program? (2)

• In NSW correctional centres there are 35 – 40 known HIV positive patients at any one time • About half are co-infected (HBV/HCV) and many have complex health and psychosocial needs • PLWHIV can be housed in any of the correctional centres around the state

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Partners: 1. Justice Health &

Forensic Mental Health Network

• Provides comprehensive clinical services to

patients in correctional centres across the state

• About 31 correctional centres in NSW

• Full time custodial population ~11,000 (Sept.

2013)

• 30,000+ new receptions annually

• 150,000+ movements annually

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Mental Health:

• 54% of females and 47% of males have been

treated for an emotional or mental health problem

Drug and Alcohol:

• 84% of inmates reported ever having used illicit

drugs

• 44% of women and 42% of men have used illicit

drugs in prison

Justice & Forensic Mental

Health Network (2)

Justice Health Strategic Plan 2013-2017

2009 NSW Inmate Health Study

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PRESENTATION TITLE

Sub title 26pt • Body Copy size 22pt

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HIV

• Current medical research and evidence supports all

individuals living with HIV to consider treatment with

Anti-Retro Viral Therapy

• Decision making to consider personal health benefits

and risks, and reduction in transmission risk

Justice & Forensic Mental

Health Network (3)

Aust. Department of Health, NSW Health,

Aust. Society of HIV Medicine

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Partners: 2. Adahps

• Formerly known as the AIDS Dementia and HIV

Psychiatry Service

• Adahps provides a statewide service for PLWHIV

with complex needs such as cognitive impairment,

neurological and mental health issues

• Partnership model with clients and services

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Partners: 3. Community HIV teams

Two teams in central Sydney:

• Positive Central (Sydney LHD)

• HIV Outreach Team (SE Sydney LHD)

Team members comprise: • Social workers • Occupational therapists • Physiotherapists • Dietitians • Nurses • Case managers

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Referral Process

Local custodial centre

Justice Health & Forensic Mental Health Network

coordinator

Adahps worker

Local HIV teams &

NSW Sexual Health Network

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Referral options

• There are 2 community HIV teams in inner city

Sydney

• 17 metropolitan sexual health centres

• 25 regional and rural sexual health centres

My role is to refer and educate community services

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Analysis

• Information from Health records were analysed

• Data was collated to examine common

characteristics and themes associated with the

population group

• Consent process and referral pathway created

• Feedback from clinicians

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Outcomes: Referrals (1)

• There were 72 referrals to the project:

• representing 51 unique individuals

• over a 3 year period

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Aboriginal and TSI (2)

25%

75%

Yes

No

Aboriginal or Torres

Strait Islander

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Of 66 patients who were released from prison:

• 39% (n=26) were re-incarcerated

5 people refused a referral to the program while in

prison

Re-incarceration and participation (3)

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Housing (4)

0

5

10

15

20

25

30

35

40

Yes No Unknown

29% (n=19) had secure housing on release

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Patient engagement (5)

Of the 59 referrals who were released at least 6

months prior to data collection:

• 78% (n=46) were still linked in with HIV health

supports

• 22% (n=13) people were lost to follow up after release

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Conclusion

The project was successful in establishing referral pathways for PLWHIV leaving correctional centres in NSW

The project bridges a gap in service delivery between leaving correctional centres and accessing community health services

Service retention rates have been high, and lost to follow up has been minimal

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Ways forward for the project

Maintaining referral pathways between Justice

Health and community health services

Working towards greater access for inmate

populations to existing community health services

Improving communication between Justice Health

and community health

Breaking down institutional barriers

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Thank you

Justice Health & Forensic Mental Health

Network

Adahps, HIV Outreach Team, Positive

Central

Geoff Cole, Heidi Giewald & Carol Gohari

(Adahps), Pene Manolas & Alison Cowell

(Positive Central) & David Murray (HIV

Outreach Team)