Division of Disease Control and Health Protection

1. Florida Department of Health: Corrections Programs Prison Pre-Release Planning and Jail Linkage Division of Disease Control and Health Protection

2. Introduction • HIV Care Continuum • Prisons vs Jails • Counseling and Testing • Prevention and Linkage • Collaboration and Challenges Division of Disease Control and Health Protection

3. HIV Care Continuum Cascade cascade source: www.aids.gov Division of Disease Control and Health Protection

4. Socioeconomic Factors and HIV • Poverty • Discrimination, stigma • HIV Prevalence • Undiagnosed/untreated STDs • Language barriers • Incarceration Division of Disease Control and Health Protection

5. Differences: Prisons vs Jails • Prisons • Funded/operated by state • Length of stay between 3 - 5 years • Level of care similar to community standards Division of Disease Control and Health Protection

6. HIV-infected Inmates • HIV/AIDS rates in corrections settings are 3 - 5 times higher than general population • Over 95% of inmates will return to their communities • Appx 100,000 inmates in FL prison system ... about 3,000 have HIV/AIDS • Appx 100 HIV-infected inmates leave prison each month Division of Disease Control and Health Protection

7. Pre-Release Planning Program (PRPP) • DOC mandated to test for HIV within 60 days of inmate's release • DOH contracts with DOC to provide PRPP services to HIV-infected inmates • Contract totals $450,000 • PRPP includes all DOC institutions and some transitional programs • Funded by Ryan White Part B Division of Disease Control and Health Protection

8. Pre-Release Planning Program (PRPP) • Five PRPP planners employed by DOC - divided among 5 regions • Planner coordinates with CBO or medical providers to link inmate to care • Inmates given copies of med record if requested and 30-day supply of meds Division of Disease Control and Health Protection

9. PRPP Inmates Served CY 2012-13 (n=1,618 thru Oct 2013) Division of Disease Control and Health Protection

10. PRP Map Division of Disease Control and Health Protection

11. Community Linkage Coordinators (CLC) • More intensive services in Broward, Miami-Dade and Orange counties • PRPP and CLC coordinate inmate appointments upon release from prison • Medical appointment within one week of release • Linkages to medical, SAMH, ADAP, case mgmt, housing, transportation, etc • Up to six-month follow up with inmate after release Division of Disease Control and Health Protection

12. CLC Inmates Served CY 2012-13 (n=315 thru Oct 2013) Division of Disease Control and Health Protection

13. Peer Education Training Program (PET) • DOC program located at Central Florida Reception Center (CFRC) • Provide peer education train-the-trainer sessions • Education and prevention information • Trainer supervises inmate peer educators as they conduct sessions Division of Disease Control and Health Protection

14. Peer Education Training Program (PET) • 2012: • 2 train-the trainer classes held • 8 inmate peer educators trained • 57 orientation sessions held • 4,176 inmates attended sessions • 2,977 (71.3%) requested HIV test after sessions Division of Disease Control and Health Protection

15. Differences: Prisons vs Jails • Jails • Funded/operated by local govt • Length of stay between 23 - 46 days, not more than 1 year • Appx 50% released within 48 hours Division of Disease Control and Health Protection

16. Jail Linkage Program (JLP) • Counties submitted proposals to provide services • JLPs operate through CHD with no contracts • Instead use MOAs • JLP located in 16 jails • Funding appx $1.2 million Division of Disease Control and Health Protection

17. JLP Inmates Tested CY 2012-13 (n=47,762 thru Sept 2013) 0.5% Positive 0.8% Positive 0.6% Overall Positive Rate Division of Disease Control and Health Protection

18. JLP Linkages CY 2012-13 (n=3,959 thru Sept 2013) Division of Disease Control and Health Protection

19. JLP Annual Comparison Testing, Linkages, Positives 2008-2013 (thru Sept 2013) Division of Disease Control and Health Protection

20. Jail Linkage Program (JLP) • Bureau of Communicable Diseases • Florida Department of Health • JLP in 16 Counties: • 15 Counties funded by DOH • 1 County unfunded (Monroe) Division of Disease Control and Health Protection

21. Corrections Infections Workgroup HIV/AIDS Epidemiology Hepatitis Education STD and TB Substance Abuse/Mental Health Corrections Correctional Medical Authority Juvenile Justice Division of Disease Control and Health Protection

22. Challenges: The Future • Funding • Sequestration Round 1 - 2013 • Sequestration Round 2 - 2014 • Program evaluations/reviews • "High-impact" prevention Division of Disease Control and Health Protection

23. www.floridahealth.gov Division of Disease Control and Health Protection

24. HIV Care Continuum Cascade + Literacy Overall: HIV+ more common with < HS education Almost half FL HIV+ inmates < HS education cascade source: www.aids.gov Division of Disease Control and Health Protection

25. HIV Care Continuum Cascade + Unemployed Overall: 45% are unemployed 88% FL HIV+ inmates with min-mod skills cascade source: www.aids.gov Division of Disease Control and Health Protection

26. HIV Care Continuum Cascade + Depression Overall: 33% to 60% affected by depression cascade source: www.aids.gov Division of Disease Control and Health Protection

27. HIV Care Continuum Cascade + Alcohol and Other Drugs Overall: 53% alcohol use in past month 33% FL HIV+ inmates poly-drug users Overall: 50% drug use in past year 15% FL HIV+ inmates IDU Overall: 15% considered heavy drinkers cascade source: www.aids.gov Division of Disease Control and Health Protection

28. HIV Care + Combination Prevention Combination Prevention: Services Integration cascade source: www.aids.gov Division of Disease Control and Health Protection

29. VANCE BURNS CORRECTIONS SPECIALIST HIV/AIDS AND HEPATITIS SECTION BUREAU OF COMMUNICABLE DISEASES (850) 245-4424, EXT 2565 vance.burns@flhealth.gov Division of Disease Control and Health Protection