Abstract
Objectives: This effort provides the first description of barriers and facilitators that Hepatitis C Virus (HCV) and/or Human Immunodeficiency Virus (HIV) -infected Veterans face in seeking medical care after community re-entry from Los Angeles County (LAC) jails. Design: An evaluation of in-depth qualitative interviews with re-entry HCV and HIV-infected Veterans, and clinical and social service providers. The key variables in the analyses are HIV/HCV linkage to care, barriers/facilitators to linkage to care, and staff perspectives. Setting: Qualitative data was collected in person at the VA hospital or by telephone interview within the year the study was conducted. Correctional institutions offer opportunities to identify Veterans with HCV and HIV, and for the US Department of Veterans Affairs (VA) to link them to medical care upon release. Participants: Semi-structured interviews of two cohorts: 1) 16 clinical/non-clinical VA/LAC jail staff; 2) 9 postincarcerated Veterans with HIV and/or HCV. Main outcome measure: Feedback about barriers and facilitators to reduce gaps, strengthen and improve linkage to care efforts. Results: Although some characterized efforts positively, barriers were highlighted. Veterans and staff described insufficient strategies for identifying Veterans, ineffective outreach, and inadequate staffing. Strategies for improving linkage, including routine in-take identification of Veteran status, greater program dissemination and increased staff were noted. Conclusions: Results highlight existing gaps for Veterans transitioning to VA healthcare from LAC jails. Findings can guide future efforts to strengthen gaps between local and federal government
Highlights
Incarcerated individuals are susceptible to communicable diseases such as Hepatitis-C (HCV) and Human Immunodeficiency Virus (HIV) and have higher rates of HIV and Hepatitis C Virus (HCV) than the general population (HCV: 17% vs. 1%); HIV: 1.6% vs. 0.5%) [1,2]
Results highlight existing gaps for Veterans transitioning to Veterans Affairs (VA) healthcare from Los Angeles County (LAC) jails
Facilitators for creating linkages to Health Care for Reentry Veterans (HCRV): The key facilitator described by Veterans for creating linkages to HCRV was being contacted by the VA outreach specialist program (VAOS), or a network set up by VAOS, during incarceration
Summary
Incarcerated individuals are susceptible to communicable diseases such as Hepatitis-C (HCV) and Human Immunodeficiency Virus (HIV) and have higher rates of HIV and HCV than the general population (HCV: 17% vs. 1%); HIV: 1.6% vs. 0.5%) [1,2]. Continuity of medication management is especially challenging for incarcerated Veterans with HIV and/or HCV (HIV/HCV) This has much to do with limited access to care within correctional institutions and barriers to obtaining post-release care, e.g., perceived unavailability of civilian health services, [1] lack of health insurance [4] and poor discharge planning [3,5]. The VA outreach specialist program (VAOS) in the Los Angeles county jail system. A list of self-reported Veterans is provided to program staff that performs an assessment of eligibility for VA healthcare services. The VAOS perform thorough pre-release assessments to identify the needs of Veterans They work with other VA program staff to make necessary referrals and linkages to medical, psychiatric, and social services
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