Commentary
Linking criminal justice-involved individuals to HIV, Hepatitis C, and opioid use disorder prevention and treatment services upon release to the community: Progress, gaps, and future directions

https://doi.org/10.1016/j.drugpo.2021.103283Get rights and content

Abstract

Improving HIV and Hepatitis C Virus (HCV) management among people involved in the criminal justice (CJ) system who use drugs, in particular those with opioid use disorder (OUD), requires effective approaches to screening, linkage, and adherence to integrated prevention and treatment services across correctional and community agencies and providers. This manuscript reviews the literature to explore gaps in HIV, Hepatitis C, and OUD prevention, treatment, and delivery cascades of care for persons involved in the CJ system. Specifically, we compare two models of linkage to prevention and treatment services: Peer/Patient Navigation (PN) wherein the PN links CJ-involved individuals to community-based infectious disease (ID) and substance use prevention and treatment services, and Mobile Health Units (MHU) wherein individuals are linked to a MHU within their community that provides integrated ID and substance use prevention and treatment services. The most notable finding is a gap in the literature, with few to no comparisons of models linking individuals recently released from the CJ system to integrated HIV, Hepatitis C, and OUD prevention and treatment and other harm reduction services. Further, few published studies address the geographical distinctions that affect service implementation and their effects on these substance use, ID and harm reduction care cascades. This manuscript makes specific recommendations to fill this gap through a detailed evaluation of PN and MHU linkage models to co-located and integrated HIV, Hepatitis C, and OUD prevention and treatment services across different communities within the U.S.

Section snippets

Background

Improving HIV and Hepatitis C Virus (HCV) management in the United States among people involved in the criminal justice (CJ) system who use drugs, in particular those with opioid use disorder (OUD), requires effective approaches to screening, linkage, and adherence to integrated prevention and treatment services across correctional and community agencies and providers. Reentry represents a critical opportunity to link these individuals to a broad spectrum of service providers, including

Methods

A brief review was conducted of key studies involving interventions with PNs or MHUs that focused on linkage to HIV, HCV or OUD services and were relevant to U.S. criminal justice involved populations. Data were summarized within the manuscript and in Tables 1 and 2 for each study including author, date of publication, study design, population, intervention, measures and reported study outcomes.

Barriers of linkage care models

A growing body of evidence suggests PNs and MHUs are effective models to link underserved populations, including CJ-involved persons, with ID and SUD prevention and treatment services in the community. Barriers, which include stigma, geographical differences, social determinants of health (e.g., housing instability, insurance), and COVID-19, impact these linkage care models and should be considered when testing their effectiveness. As it is not clear how such barriers might impact PN or MHU

Future directions

To date, no studies to our knowledge have compared the full treatment and prevention of HIV, HCV and OUD care cascade outcomes of these two approaches or the cost-effectiveness of implementation for those being released from prison or jail. The effectiveness of MHUs or PNs on linkage to infectious disease and SUD prevention and treatment services for CJ-involved persons as they reenter the community relies upon integration into the larger socio-political sphere within which they operate.

Conclusion

CJ-involved individuals are among the most vulnerable populations with respect to OUD, HIV and HCV, and their linkage to care must integrate multiple services, including but not limited to MOUD, HIV and HCV treatment and HIV prevention (PrEP). The need for a randomized controlled trial comparing PN to MHU in service delivery for linkage to ID and SUD prevention and treatment services for those released from CJ settings combined with implementation research will help to fill a gap in the

Declarations of Interest

Springer has received consultation honoraria from Alkermes Inc . Springer has received in-kind study drug donations of Vivitrol from Alkermes Inc and of Sublocade from Indivior pharmaceutical company for NIH-Sponsored research projects.

Acknowledgements

This research was funded by the National Institute on Drug Abuse (U01DA053039, Springer, Knight, Nijhawan), and for career development by the National Institute on Drug Abuse (K02 DA032322) for Springer. The funders were not involved in the research design, analysis or interpretation of the data or the decision to publish the manuscript.

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