Juvenile justice staff endorsement of HIV/STI prevention, testing, and treatment linkage

Sheena K Gardner,Connie Baird-Thomas,Angela A Robertson,Carrie B Oser,Danica K Knight,Sofia Huang,Ralph J Diclemente,Katherine S Elkington,Anne C Spaulding

doi:10.1186/s40352-019-0096-7

Abstract

BackgroundWhile involvement in the legal system offers an opportunity to educate, screen, and treat high-risk youth, research shows that staff attitudes toward these practices can serve as barriers to implementation. The current study investigates the degree to which JJ staff endorse HIV prevention, testing, and treatment linkage practices with youth under community supervision and examines differences between individuals who supervise youth (e.g., juvenile probation officer) and those working in non-supervisory roles (e.g., case manager, assessment specialist).MethodsJuvenile justice staff consenting to participation in JJ-TRIALS completed an initial staff survey (N = 501). Survey items measured perceived importance of HIV/STI prevention (4 items); perceived importance of HIV/STI testing (7 items); and perceived importance of HIV/STI treatment linkage (8 items).ResultsConfirmatory Factor Analysis (CFA) was computed (SAS CALIS procedure) for each of the three domains. Findings suggest that while staff recognize that youth are at risk for HIV/STIs and require provision of HIV/STI prevention and treatment linkage, attitudes concerning the importance of procuring or providing testing services for youth is substantially lower. Furthermore, analytic models comparing staff with and without supervision responsibilities (computed using SAS PROC MIXED) indicated that attitudes differed by site and staff responsible for supervision rated HIV treatment linkage practices as less important compared to non-supervising staff.ConclusionsEstablishing partnerships with health agencies equipped with resources and skillsets to provide HIV/STI testing and related services may be an effective model to promote greater awareness and use of best practices among JJ staff and more effectively address the unmet needs of this high-risk population of youth.

Highlights

While involvement in the legal system offers an opportunity to educate, screen, and treat high-risk youth, research shows that staff attitudes toward these practices can serve as barriers to implementation
The purpose of this study is to investigate the degree to which juvenile justice (JJ) staff endorse Human Immunodeficiency Virus (HIV) prevention, testing, and treatment linkage practices with youth under community supervision and to examine differences between individuals who supervise youth versus those working in non-supervisory roles
While 20% of JJ staff reported that their job responsibilities included provision of substance use education and drug court, only 2% (n = 9) reported responsibility for HIV/Sexually Transmitted Infection (STI) testing, treatment, and prevention services

Summary

Introduction

While involvement in the legal system offers an opportunity to educate, screen, and treat high-risk youth, research shows that staff attitudes toward these practices can serve as barriers to implementation. Persons under 25 years of age accounted for just over 40% of new HIV infections in the United States in 2016 (Centers for Disease Control and Prevention, 2017), between 67%–72% have never had an HIV test (Van Handel, Kann, Olsen, & Dietz, 2016) and approximately 60% of youth living with HIV are unaware of their status (Zanoni & Mayer, 2014). The. Centers for Disease Control and Prevention (CDC) estimates that those unaware of their status account for about 40% of all new HIV infections (Gopalappa, Farnham, Chen, & Sansom, 2017). Access to timely HIV prevention, including Pre-Exposure Prophylaxis (PrEP), can reduce risk of HIV infection among youth under community supervision, and early identification (i.e., HIV testing) with prompt referral to treatment for youth who are found to be living with HIV and STIs, may reduce the transmission of the infections in their communities (Allen, Gordon, Krakower, & Hsu, 2017; Donenberg, Emerson, & Kendall, 2018; Donenberg, Emerson, Mackesy-Amiti, & Udell, 2015; Godin et al, 2003; Tolou-Shams, Stewart, Fasciano, & Brown, 2010)

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