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AUGUST 2007
News and Literature Reviews
HIV Control Efforts Should Directly Address Incarceration IDCR editorial board member, Rick Altice, in this editorial in The Lancet, asserts that incarceration is one of the major causes of the spread of HIV. He suggests that incarceration can lead to an increase in risk behaviors that lead to acquisition of HIV, disrupt social networks and prevent individuals from maintaining meaningful employment. Additionally, incarceration can inhibit persons with substance abuse problems from entering rehabilitation programs. While incarceration has been framed as an opportunity for a public health intervention in the HIV epidemic, it often provides inadequate treatment of the mental health and substance abuse problems that foster HIV tramsnission. Moreover, HIV-positive offenders often suffer from poor continuity of HIV care upon their release from prison. In response to this problem, Dr. Altice suggests an increase in access to treatment of substance abuse and dependence, solutions to drug-use that balance public safety and public health, advocacy for legislative changes to decriminalize drug use, and activism by communities affected by incarceration. HIV control efforts should directly address incarceration. Altice F. The Lancet. 2007;7:568-69. Post-Release Case Management Services and Health-Seeking Behavior Among HIV-Infected Ex-Offenders Researchers from the Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA) funded Corrections Demonstration Project (CDP) explored the impact of earlier post-release contact with a case manager on the post-release health-seeking behavior of formerly incarcerated HIV-infected individuals. The project, which is designed to foster inter-agency collaboration between public health departments, correctional facilities, and community-based health providers, aims to improve continuity of care for HIV-positive inmates after their release. All participants were receiving some type of case management that was initiated prior to release and continued post-release. The study consisted of 226 ex-offenders who were interviewed six months post-release. Of this group, 104 individuals (46%) were met at the gate at time of prison release by a case manager, while the remaining 122 individuals (54%) were not. The study provided support for the important role of early post-release case management, as ex-offenders who were met at the gate demonstrated an increase in some health-seeking behavior. After controlling for health-seeking behavior before incarceration, the researchers found that ex-offenders who had been met at the gate were more likely to participate in drug or alcohol treatment and not engage in sex exchange during the six months following their release from incarceration. This exhibition of health-seeking behavior was tempered, however, by the finding that early post-release case management was not associated with reduced emergency room use or the use of street drugs. Although the reason for this finding is unclear, this study emphasizes the importance of early post-release case management in improving health-seeking behavior in ex-offenders. Post-Release Case Management Services and Health-Seeking Behavior Among HIV-Infected Ex-Offenders. Arriola, K. et al. Journal of Health Care for the Poor and Underserved. 2007;18:665-74. End-Stage Liver Disease in a State Prison Population Researchers from the University of Texas Medical Branch recently conducted a study to examine the prevalence, mortality, and clinical characteristics of end-stage liver disease (ESLD) in the Texas Department of Criminal Justice (TDCJ) prison system. The study, analyzed the medical data of 370,511 inmates over a 3.5 year period. ESLD is one of the major consequences of hepatitis C virus (HCV) infection and HIV/HCV coinfection, both of which are known to disproportionately affect prison populations. The prevalence of ESLD in U.S. prisons is expected to rise as the prison-population ages, resulting in a growing number of inmates who require liver transplants. The TDCJ prison system offers voluntary HIV testing to all inmates upon incarceration and screens all HIV-positive individuals for HCV-infection. As a result, most of the inmates in the study knew their HIV status, but those who were seronegative for HIV had only been tested for HCV if they had self-reported risk behavior or had requested a test. The study found that, of the 370,511 inmates studied, 484 had ESLD and 213 had died of ESLD during the study-period. Inmates who were Hispanic, aged 40-49 years or 50 years and older, were infected with HIV or HCV or both had an elevated risk of ESLD prevalence and mortality. Ninety percent of inmates with ESLD either had HCV monoinfection or HIV/HCV coinfection. Those inmates with HIV/HCV co-infection had higher mortality rates (64.9%) than patients with HCV mono-infection (42.8%) or patients without HCV infection (36.7%). These findings reinforce the belief that HIV/HCV coinfection accelerates the progression of HCV, resulting in increased mortality from ESLD. The growing prevalence of ESLD in the correctional setting, in combination with the high cost of liver transplants, emphasizes the need for increased HCV prevention, education, and treatment. Baillargeon J, Soloway RD, Paar D. End-Stage Liver Disease in a State Prison Population. Ann Epidemiol. 2007 Aug 4; Epub ahead of print. Costs of Voluntary Rapid HIV Testing and Counseling in Jails in 4 States - Advancing HIV Prevention Demonstration Project, 2003-2006 This study sought to examine the feasibility of using rapid HIV tests in prisons and jails by examining the costs and outcomes of rapid HIV testing and counseling programs in Florida, Louisiana, New York, and Wisconsin from March 1, 2004 to February 28, 2005. Correctional facilities in these states tested 17,433 individuals for HIV during this time period, resulting in 152 newly identified cases of HIV. Although the costs for these tests were extremely variable, the study found that the average cost of HIV testing for HIV-negative inmates was between $29.46 and $44.98. The cost of testing was significantly higher for HIV-positive inmates and was estimated between $71.37 and $137.72 per inmate. The discrepancy in costs relative to HIV serostatus is due to the extra post-test counseling required for individuals who test positive for HIV. Most of the cost of rapid HIV testing was due to variable costs, including time for counseling and testing, nondurable goods and supplies, and test kits. Fixed costs, such as the cost of program management, training, travel, and durable equipment, composed a smaller portion of testing costs. Average costs for testing varied greatly depending on the location of the correctional facility, as more rural facilities required public health officials and counselors to drive to distant sites. Differences in local wage rates also contributed to the variability in costs. It is hoped that this study's findings can be used to develop rapid HIV testing programs in both prisons and jails across the country. Costs of Voluntary Rapid HIV Testing and Counseling in Jails in 4 States --- Advancing HIV Prevention Demonstration Project, 2003-2006. Shrestha, R. et al. Sexually Transmitted Diseases. 2007;34(11):000-000. FDA Approves Novel Antiretroviral Drug The U.S. Food and Drug Administration (FDA) approved the antiretroviral, maraviroc, for production and distribution. This FDA approval followed two controlled studies with over 1,000 clinical trial participants, 840 of which received maraviroc. The drug, which will be sold under the trade name Selzentry, received a priority review by the FDA and is the first of a new class of antiretroviral drugs that prevent HIV from entering lymphocytes by blocking the CCR5 co-receptor required by certain types of HIV to gain entry into the cell. Maraviroc is approved for use in combination with other antiretroviral drugs for the treatment of adults with CCR5-tropic HIV-1, who have been treated with other HIV medications and who have evidence of elevated levels of plasma HIV. Health care providers should exercise caution in prescribing maraviroc for treatment-naïve adults and pediatric, as it has not been adequately tested in these individuals. Maraviroc's product labeling has a boxed warning about the dangers of liver toxicity (hepatoxicity) and possibility of heart attack. Common side effects of the drug included cough, fever, upper respiratory tract infections, rash, musculoskeletal symptoms, abdominal pain, and dizziness. http://www.fda.gov/bbs/topics/NEWS/2007/ NEW01677.html Compiled by Christine Devore, IDCR Intern
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