Abstract
BackgroundPersons held in correctional facilities are at high risk for HIV infection and their prevalence of HIV is substantially higher than in the general population. Thus, the need for proper surveillance and care of this high risk population is a paramount public health issue. This study aims to evaluate an organization-level intervention strategy for improving HIV services for persons in prison or jail.Methods/DesignHIV Services and Treatment Implementation in Corrections (HIV-STIC) is using a cluster randomized trial design to test an organization-level intervention designed to implement improvements in preventing, detecting, and treating HIV for persons under correctional supervision. Matched pairs of prison or jail facilities were randomized using a SAS algorithm. Facility staff members in both Experimental and Control conditions involved in HIV service delivery are recruited to receive training on HIV infection, the HIV services continuum, and relevant web-based resources. Staff members in both conditions are tasked to implement improvements in HIV prevention, testing, or treatment in their facility. In the Control condition facilities, staff participants use existing techniques for implementing improvement in a selected area of HIV services. In contrast, the Experimental condition staff participants work as a Local Change Team (LCT) with external coaching and use a structured process improvement approach to improve a selected part of the HIV services continuum. The intervention period is 10 months during which data are obtained using survey instruments administered to staff members and aggregate services delivery data. The study is being implemented in 13 pairs of correctional facilities across nine states in the US. Experimental sites are hypothesized to show improvements in both staff attitudes toward HIV services and the number and quality of HIV services provided for inmates.DiscussionThe current study examines a range of process and outcome data relevant to the implementation of a Change Team approach across diverse correctional settings in the United States. This initial study represents an important step toward a national best practices approach to implementing change in U.S. correctional settings and could serve as an exemplar for designing similar implementation studies.Electronic supplementary materialThe online version of this article (doi:10.1186/2194-7899-1-8) contains supplementary material, which is available to authorized users.
Highlights
Persons held in correctional facilities are at high risk for HIV infection and their prevalence of HIV is substantially higher than in the general population
The current study examines a range of process and outcome data relevant to the implementation of a Change Team approach across diverse correctional settings in the United States
This initial study represents an important step toward a national best practices approach to implementing change in U.S correctional settings and could serve as an exemplar for designing similar implementation studies
Summary
Persons held in correctional facilities are at high risk for HIV infection and their prevalence of HIV is substantially higher than in the general population. Prison inmates are at high risk for incident HIV infection and their prevalence of HIV is substantial, estimated at 1.5% of all inmates in federal or state custody at the end of 2010, making the need for proper surveillance and care a paramount public health issue (Maruschak 2012). A number of barriers limit expansion of HIV testing among inmates, including stigma and discrimination (Earnshaw & Chaudoir 2009), timing of the tests, and lack of linkage with routine clinical exams (Kavasery et al 2009). Both primary and secondary interventions are important for this population. For inmates released to parole or under other types of community supervision, HIV prevention is not usually a priority, and access to HIV testing/counseling and prevention services is not routinely available (Beckwith et al 2010; Springer & Altice 2005)
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