Efficacy of a Process Improvement Intervention on Inmate Awareness of HIV Services: A Multi-Site Trial.

Holly Swan,Michele Pich,Carmen E Albizu-Garcia,Daniel J O’Connell,Michele Pich,Matthew L Hiller,Yvonne Patterson

doi:10.1186/s40352-015-0023-5

Abstract

BackgroundThe prevalence of HIV among U.S. inmates is much greater than in the general population, creating public health concerns and cost issues for the criminal justice system. The HIV Services and Treatment Implementation in Corrections protocol of the NIDA funded Criminal Justice Drug Abuse Treatment Studies tested the efficacy of an organizational process improvement strategy on improving HIV services in correctional facilities.MethodsFor this paper, we analyzed efficacy of this strategy on improving inmate awareness and perceptions of HIV services. The study used a multi-site (n = 28) clustered randomized trial approach. Facilities randomized to the experimental condition used a coach-driven local change team approach to improve HIV services at their facility. Facilities in the control condition were given a directive to improve HIV services on their own. Surveys about awareness and perceptions of HIV services were administered anonymously to inmates who were incarcerated in study facilities at baseline (n = 1253) and follow-up (n = 1048). A series of one-way ANOVAs were run to test whether there were differences between inmates in the experimental and control facilities at baseline and follow-up.ResultsDifferences were observed at baseline, with the experimental group having significantly lower scores than the control group on key variables. But, at post-test, following the intervention, these differences were no longer significant.ConclusionsTaken in context of the findings from the main study, these results suggest that the change team approach to improving HIV services in correctional facilities is efficacious for improving inmates’ awareness and perceptions of HIV services.Electronic supplementary materialThe online version of this article (doi:10.1186/s40352-015-0023-5) contains supplementary material, which is available to authorized users.

Highlights

The prevalence of HIV among U.S inmates is much greater than in the general population, creating public health concerns and cost issues for the criminal justice system
Persons living in prisons or under criminal justice supervision in the community are at high risk for acquiring HIV, and the prevalence of HIV in criminal justice settings is substantially higher than that of the general population (Maruschak 2012)
Pretest and posttest comparisons One-way Analysis of Variance (ANOVA) on pre-intervention awareness and perceptions of HIV services showed that inmates who were incarcerated in control facilities scored significantly higher on the HIV services awareness index, with a medium effect size [F(1, 1250) = 28.43; p = .000; Cohen’s d = .30], and on their impressions of staff impact with a small effect size [F(1, 1235) = 12.50; p = .000, Cohen’s d = .20], than inmates in facilities in the experimental condition

Summary

Introduction

The prevalence of HIV among U.S inmates is much greater than in the general population, creating public health concerns and cost issues for the criminal justice system. The Centers for Disease Control and Prevention (CDC) has published guidelines to assist the criminal justice sector in the adoption of evidence-based practices to reduce inmate HIV risks and to provide HIV treatment in correctional settings (CDC 2009). Based on these guidelines, O’Connell et al (2013) designed a continuum of care model for HIV. According to the continuum of care model for HIV in correctional settings (O’Connell et al 2013), all persons are tested for HIV at intake to a correctional facility unless they decline (i.e., opt-out testing). Prior to release and community reentry, all inmates regardless of HIV serostatus, receive an evidence-based HIV prevention intervention to encourage risk reduction during the

Methods

Results

Conclusion