Transforming systems of care to address HIV, HIV risk, and substance use disorders in prisons

PROJECT SUMMARY To End the HIV Epidemic in the US, we must transform care quality and access in prisons. People who are incarcerated in state prisons face a disproportionate burden of HIV and HIV risk. More than 65% of people in prison have a substance use disorder (SUD), 4 times that of the general population. To treat and prevent HIV in this population, addressing substance use is central—it is a barrier to HIV prevention and engagement in HIV treatment. Research on HIV prevention and SUD among justice-involved groups has focused on jails and community-based services after release, and there has been little attention to prison systems in large, rural states. The focus on shorter jail sentences and post-release services misses that the foundation for successful HIV treatment, HIV prevention, and SUD recovery after release can be laid during incarceration, particularly for people who may be difficult to reach in the community. The objective of this work is to build foundational knowledge on how to strengthen prison health systems to address disparities in HIV treatment, HIV prevention, and SUD treatment. High-performing healthcare systems, such as the Veterans Health Administration (VA), are Learning Health Systems. In Learning Health Systems, researchers partner with clinical leaders and health systems to improve the quality, efficiency, and reach of care while generating generalizable knowledge on care delivery to inform other systems. This project—embedded in Washington’s state prisons—will develop a novel model of a Prison Learning Health System. To build a Learning Health System across Washington’s 11 state prisons, this project will include four key innovations: 1) Build the foundation for a Learning Health System, including key quality metrics and a patient advisory board that will guide research; 2) Define gaps in care access for key conditions (HIV, HIV risk, hepatitis C, opioid use disorder, and stimulant use disorder) by modeling care cascades; 3) Measure patient experience in prison health care, a foundational measure of care quality and engagement; and 4) Work with prison stakeholders to develop and implement strategies to close HIV and SUD care gaps. Overall, this work will launch a trajectory of research to improve care quality while generating knowledge that can inform service delivery in prisons across the country. The trauma and chronic stress of prison are undoubtably harmful to health, but centering HIV and SUD care during incarceration is one step in both Ending the HIV Epidemic and creating a more rehabilitative criminal legal system.