Journal of correctional health care : the official journal of the National Commission on Correctional Health Care最新文献

Incarceration during pregnancy is a pressing public health issue, but interventions to minimize harms for this population are not frequently described in the literature. We developed Justice Core, a pretrial diversion intervention for pregnant people with substance use disorders (SUDs), to minimize exposure to incarceration during pregnancy and increase access to SUD treatment. The intervention was feasible and acceptable to referring jail staff. In parallel, we conducted a needs assessment and identified an estimated 1,220 to 1,461 annual incarcerations during pregnancy among 77 responding jails (80% of North Carolina jails), and an estimated prevalence of perinatal SUDs of 66%. The Justice Core model of diversion into SUD treatment holds promise as a means to limit the duration and extent of incarceration, with a potential concomitant reduction in the harms experienced by pregnant people with SUD in jails and prisons.

Unregulated tattoos and injection drug use remain common risk factors for hepatitis C virus (HCV) transmission within correctional facilities. The Centers for Disease Control and Prevention recommends routine HCV screening at intake into a correctional facility and if risk or exposure is ongoing; however, risk behaviors may not be reported, thus increasing the risk for in-custody HCV transmission and outbreaks within the facility. This case study describes a multiwave HCV outbreak within a California county jail, including case demographics, clinical characteristics, risk factors, and factors that necessitated testing beyond routine screening at admission. Over a 12-month period beginning in late 2023, a total of 12 HCV cases were detected in a single high-security housing unit through a combination of routine screening, symptomatic testing, self-requested screening, and response testing. Recent tattooing (75%) and tattooing with shared ink (50%) were the most commonly reported risk factors, followed by 25% who reported sharing sharps or identifying as people who inject drugs. Of the five sequenced samples, three were genetically linked, and two had viral levels too low to sequence. The initial and ongoing outbreak response efforts can inform future policy and practice to prevent in-custody HCV transmission and outbreaks within correctional facilities.

The analysis of tuberculosis (TB) registers in prisons provides insights into TB transmission and highlights conditions that increase susceptibility. This study aims to characterize TB patient surveillance in Ecuador's largest male penitentiary over the course of 3 years. Using national TB administrative records from January 1, 2017, to December 31, 2019, we calculated five operational indicators. In addition, the number of clinical consultations (register entries) per patient over the 3 years was calculated. The linkage process involved merging data from the administrative files to create a new dataset using encrypted tokens as the linking variables. Data merging yielded 6,560 records and enabled analysis of 645 symptomatic patients, 427 with confirmed TB. Of these, 82.9% had two to six records, and 88.9% maintained the same diagnosis. Among those with diagnostic changes, 38.5% converted from Ziehl-Neelsen negative to positive after 6 months. The median time to diagnosis was 0 days (range 0-12); and to treatment, 13 days (range 0-652). Treatment outcomes were available for 353 of 427 patients (82.7%), with a success rate of only 65.2% and a fatality rate of 0.8%. These results highlight surveillance challenges and the need for improving TB prevention and control in prisons.

This study assessed factors associated with case management uptake among people on antiretroviral therapy released from correctional facilities in Gauteng, South Africa. Using data from an observational study and multiple logistic regression, the cross-sectional analysis included 185 participants, mainly male, with a median age of 33 years. Seventy percent attended at least one case management session. Participants released on parole (adjusted odds ratio [AOR] = 3.61, 95% confidence interval [CI]: 1.57-8.27) and those who disclosed their human immunodeficiency virus (HIV) status (AOR = 4.78, 95% CI: 1.94-11.79) were significantly more likely to use case management, whereas those who started antiretroviral therapy before incarceration were less likely (AOR = 0.35, 95% CI: 0.15-0.85). Given the high HIV prevalence in correctional facilities and the global need to ensure uninterrupted treatment for people living with HIV, these findings highlight the feasibility of case management strategies in supporting treatment continuity after incarceration. Future research should aim to enhance HIV disclosure and social support to maximize the effectiveness of these interventions.

Justice-involved individuals have many cooccurring socioeconomic and medical needs. Here, we characterize the needs of justice-involved individuals with substance use history at risk for or living with human immunodeficiency virus (HIV) in Texas (TX) and Connecticut (CT). All participants are part of a larger trial linking justice-involved people to community-based substance use and HIV services. Comprehensive baseline needs were assessed; frequencies of needs were quantified and compared using chi-square analysis. Participants (N = 356) reported greater socioeconomic than medical needs in both TX (n = 198) and CT (n = 158). Housing, transportation, food, employment, and financial benefits were endorsed by more than 60% of participants. Health needs were emphasized in both states. Demand in TX was higher for health insurance (52.0% vs. 26.6%, p < .01) and identification/documentation (60.6% vs. 46.2%, p < .01), but not naloxone access (25.3% vs. 38.6%, p < .01). Substance use treatment/harm reduction and HIV preexposure prophylaxis were low priorities overall. The prioritization of socioeconomic over medical needs suggests a hierarchy of needs and resources. State-specific differences may reflect different sociopolitical environments and resources. Despite the high risks of living with or acquiring HIV and overdose, most participants reported low need for HIV and/or substance use services.

Incarcerated individuals in the United States face poor health care outcomes in part due to insufficient provider training in carceral care. Emerging initiatives, including lectures, clinical rotations, and service-learning address this gap. This scoping review evaluates the scope and effectiveness of such interventions to produce an evidence-based guide for future improvements in medical education and health care for incarcerated populations. We searched PubMed/MEDLINE, Embase, and Web of Science for peer-reviewed articles regarding initiatives involving both undergraduate medical education and carceral care. Seventeen articles from 2014 to 2024 fit these criteria. Our analysis reveals that future initiatives led by a combination of clinicians, academics, and community leaders trained in this space are strongly poised to impart meaningful changes in advancing carceral care in medical education.

The health of Canadians in correctional facilities is poor when compared with the general population. Pharmacists effectively manage chronic illness and minor ailments; pharmacist-led prescriber clinics are being introduced in the community to improve access to care. However, there are no data on this model in correctional facilities. This article aims to evaluate the role of a pharmacist-led prescriber clinic in a provincial remand facility in Alberta, Canada, via a retrospective chart review of a weekly pharmacist-led clinic in a remand center from January to May of 2023. Data were collected for number of patients, drug therapy problems addressed, types and acceptance of interventions, and follow-up plans. Pharmacists saw an average of 8.8 patients per clinic with 1.9 interventions per patient. Most patients (83%) presented with untreated symptoms or indication. For many, pharmacists' interventions resulted in care that fully resolved concerns in a manner acceptable to patients, and 13% of cases were referred to alternative prescribers. This review adds to current literature on pharmacist intervention capacity; however, it does not include clinical outcomes. Pharmacists with prescribing authority in a clinic setting provide patients effective medication support, opening possibilities of expanding pharmacist practice models for quality patient care and increasing access to timely care.