Community Reentry Research Articles

30 Does Peer Support Facilitate Social Integration Following Burn Injury?

Abstract Introduction Facilitating access to one-to-one peer support is an important criterion in providing aftercare for individuals with a burn injury. Although there is an increase in understanding of the perceived benefits of peer support, there are not many studies examining peer support as an intervention to promote community re-entry. This comparative study aims to examine if there is a difference in physical and mental health outcomes, including social reintegration between a group that received one-to-one peer support (PS) and a group that did not receive the peer support (NPS). Methods Subjects include adults (>=18y) with a major burn injury who received treatment at a major burn center and consented to participate in a longitudinal national database at discharge from hospital, 6-, 12-, and 24-months post injury. The physical and mental health outcomes were measured using the SF-12 Health Questionnaire – Physical (PCS) and Mental (MCS) component (50 is the average score or norm); the Satisfaction with Life Scale, and Social Integration (SI) was measured by the Community Integration Questionnaire Social Component Scale (score range 0–12; 0 is no community integration and 12 is excellent community integration). The PS program offered at the burn center is a standardized program that includes an 8-hour peer volunteer training. Independent Samples t Tests were conducted to see if there were significant differences in health outcomes between the group that received PS and the group that did not receive PS (NPS). Results Over a period of 5 years, 228 subjects consented to participate in the database. Subjects were predominantly male (70%) and White (72%), with a mean age of 44 years and the mean total body surface area was 24.8%. Sixty-three (28%) subjects received peer visits during their stay in the hospital. Compared to the NPS group, the social integration score for the PS group was higher at all time points, although it was statistically significant only at 24 months (PS= 8.22, NPS=7.13, p< .01). The PS group scored significantly higher in satisfaction with life at 6 months (p< .01) and at 12 months (p< .05). There were significant differences found in TBSA %burn (PS = 31%, NPS = 22%; p< .001), average length of acute hospital stay (PS= 52 days, NPS = 31 days; p< .01), and average length of in-patient rehabilitation stay (PS= 12 days, NPS = 5 days; p< .05). Conclusions The social integration and satisfaction with life scores of the PS group was higher when compared to those of the NPS group. The study highlights the profile of patients who seek peer support visits and has implications for delivery and utilization of burn aftercare programs. Applicability of Research to Practice The study findings highlight the emerging need for providing burn survivors with resources such as peer support to facilitate successful community reentry, and examine the effects of such interventions on health outcomes.

Effect of Community Re-Entry Program (CRP) on Insight of Patients with Schizophrenia

Introduction: The use of rehabilitation treatments along with drug therapy can greatly help in the treatment of schizophrenic patients and their return to society. The purpose of this study was to evaluate the effectiveness of the Community Re-entry Program on improving insight in people with schizophrenia.Methods: The present study is a pre-test, post-test clinical trial with the statistical population including all patients with schizophrenia admitted to the Tolue rehabilitation center. For this purpose, 40 patients admitted to Tolue Rehabilitation Center who met the inclusion criteria were selected by convenience sampling method and were randomly assigned to experimental (n = 20) and control (n = 20) groups. The experimental group received a community Re-entry program for sixteen sessions. The groups were tested by Anderson's positive and negative symptoms questionnaire before and after the intervention, after completion and two months later. Data were analyzed using t-test for two independent groups, and covariance analysis by SPSS Inc., Chicago, IL; Version 18 Results: The results showed that patients in experimental group compared to control group after implementation of community Re-entry program on negative symptom scales (P = 0.000), disruption (P = 0.000), excitement (P = 0.000)). Anxiety, depression (P = 0.000), positive symptoms (P = 0.000) and total positive and negative symptoms (P = 0.000) at posttest and follow-up on negative symptom scales (P = 0.000). Significant differences were observed between rupture (P = 0.000), excitement (P = 0.01), anxiety and depression (P = 0.000), positive symptoms (P = 0.000) and total positive and negative symptoms (P = 0.001). (P-value<0/05).Conclusion: Psychosocial interventions improve insight in patients with schizophrenia

Peer-Mentored Community Reentry Reduces Recidivism

Most people released from incarceration in the criminal justice system return to prison within 3 years. To improve community reentry, national initiatives have promoted new and revitalized programming, including peer mentorship, though this approach remains largely unstudied. Fifty-five men participated within a pilot randomized controlled trial investigating the effect of peer mentorship upon recidivism. Hierarchical binary logistic regression including recidivism risk, as well as group assignment to either a standard services for community reentry condition or standard services plus peer mentorship condition, showed that those receiving mentorship had significantly lower recidivism. It appears that peer mentorship with a model focus upon early intervention, relationship quality, criminal desistance, social navigation, and gainful citizenship may promote the complex task of early community reentry. Given this pilot’s small sample, future research should confirm this association on a larger scale, enabling longitudinal and treatment component analyses examining the relative contributions of mentorship model factors.

Parent and provider perspectives on recently incarcerated youths’ access to healthcare during community reentry

Incarcerated youth have numerous healthcare needs, yet access to healthcare following community reentry is limited. Healthcare and juvenile justice providers, along with parents, strongly influence access to care for youth undergoing reentry. However, their perspectives are often missing from the literature. We examined parent and provider perspectives on youths’ access to healthcare during community reentry. We conducted 72 longitudinal interviews with parents of youth undergoing reentry (n = 34 parents) and cross-sectional interviews with health and juvenile justice providers (n = 20 providers). We performed inductive analysis of interview transcripts to identify the major themes related to access to healthcare during reentry. Respondents identified key leverage points that influence access to healthcare along the spectrum of individual, community, and policy-level factors. Parent and provider perspectives demonstrated substantial overlap, strongly concurring on the essential role of parents in linking youth to care and the external factors that limit parents’ ability to connect youth to care. However, providers discussed parents not buying-in to treatment plans as a barrier to care, and parents uniquely described feeling powerless when their children were not motivated to receive care. Parents and providers agreed on priority solutions for improving care access during reentry. Immediate solutions centered on: (1) increasing reliability and continuity of providers, (2) providing free or low-cost transportation to healthcare visits, and (3) eliminating gaps in Medicaid coverage post-incarceration. Findings also signal the broader need to pursue strategies that increase family engagement in healthcare during reentry. In doing so, health and juvenile justice providers can partner with parents to overcome barriers to healthcare for youth during reentry.

Message framing to reduce stigma and increase support for policies to improve the wellbeing of people with prior drug convictions

BackgroundIndividuals with drug convictions are at heightened risk of poor health, due in part to punitive public policies. This study tests the effects of message frames on: (1) public stigma towards individuals with felony drug convictions and (2) support for four policies in the United States (U.S.) affecting social determinants of health: mandatory minimum sentencing laws, ‘ban-the-box’ employment laws, and restrictions to supplemental nutrition and public housing programs. MethodsA randomized experiment (n = 3,758) was conducted in April 2018 using a nationally representative online survey panel in the U.S. Participants were randomized to a no-exposure arm or one of nine exposure arms combining: (1) a description of the consequences of incarceration and community reentry framed in one of three ways: a public safety issue, a social justice issue or having an impact on the children of incarcerated individuals, (2) a narrative description of an individual released from prison, and (3) a picture depicting the race of the narrative subject. Logistic regression was used to assess effects of the frames. ResultsSocial justice and the impact on children framing lowered social distance measures and increased support for ban-the-box laws. ConclusionThese findings can inform the development of communication strategies to reduce stigma and advocacy efforts to support the elimination of punitive polices towards individuals with drug convictions.

Barriers to Health Care for Latino Youths During Community Reentry After Incarceration: Los Angeles County, California, 2016-2018.

Objectives. To examine barriers to health care for Latino youths during reentry after incarceration.Methods. For this in-depth qualitative study, we conducted 69 semistructured interviews with 22 Latino youths and their parents at 1, 3, and 6 months after incarceration. We performed thematic analysis of interview transcripts, from which a preliminary conceptual model emerged describing barriers to care for Latino youths. We then conducted trajectory analyses of dyadic youth-caregiver pairs to test the conceptual model. We collected longitudinal interviews in Los Angeles County, California, from November 2016 to March 2018.Results. Beyond recognized stressors experienced by youths during reentry, most of which families related to poverty and neighborhood environment, Latino youths also experienced cultural barriers to care (i.e., self-reliance and pride, religiosity and reproductive care as taboo, preference for home remedies, language) as well as barriers to care because of undocumented status (i.e., fear of deportation, job insecurity).Conclusions. Reentry is challenging, and Latino youths face additional barriers to care during reentry related to culture and legal status, but have cultural strengths. Increased access to culturally sensitive, safety-net health care, regardless of immigration status, may reduce health inequalities for Latino youths undergoing reentry.

Capabilities of Practitioners Supporting Young Men with Mild-to-Borderline Intellectual Impairment

ABSTRACT This paper identifies key capabilities for practice identified by community practitioners who seek to support the re-entry and reintegration in community after imprisonment of young men with mild-to-borderline intellectual impairment. It is based on a recent qualitative study undertaken in south-east Queensland, Australia, drawing on in-depth and semistructured interviews with community practitioners working with this population group that is over-represented in the criminal justice system. Applying the capability approach based on the work of Amartya Sen, the study examined community practitioners’ self-reported engagement with young men with mild-to-borderline intellectual impairment involved in the criminal justice system. The analytical strategy was based on grounded theory and from the findings a set of practitioner capabilities and functionings were developed to guide future work by practitioners who support young men with mild-to-borderline intellectual impairment in community re-entry and reintegration. IMPLICATIONS Systems for community re-integration of young men with mild-to-borderline (MB) intellectual impairment involved in the criminal justice system require revisioning with a view to developing effective practice in engagement. A capabilities framework for community practitioners, informed by research, is required to guide practice in re-entry services for young men with MB intellectual impairment.

A Qualitative Exploration of Reentry Service Needs: The Case of Fathers Returning From Prison.

The challenge of community and family reentry after a parent's release from prison remains an under-addressed area of collateral damage stemming from high rates of U.S. incarceration. Many fathers released from prison return to living with family, and later attribute family connections and parent-child contact as key factors in their post-release success. However, reentry planning is hampered by a dearth of research on family-focused reentry services, and consequently, often omits attention to resuming family and parenting roles. To address this gap, we conducted 38 semi-structured interviews with 19 previously incarcerated fathers, 9 co-parenting mothers, and 10 relatives to explore service needs of fathers during reentry. Findings suggest programs not only should be multimodal, emphasizing family connections complemented by socioeconomic, self-care, and social support services, but also should be accessible and relatable, offered within the community, and engaging for fathers and family members. Findings reinforce the importance of self-determination and human agency while underscoring the multiple challenges fathers face upon reentry. By including the voices of those most affected by incarceration, this study advances knowledge to shape reentry programs and policies, contributes to efforts addressing criminal justice inequities, and promotes well-being among formerly incarcerated parents and their families.

Using concept mapping to inform the development of a transitional reintegration intervention program for formerly incarcerated people with HIV

BackgroundAccessing HIV-related care is challenging for formerly incarcerated people with HIV. Interventions informed by the perspectives of these individuals could facilitate engagement with care and address competing priorities that may act as barriers to this process.MethodsWe used concept mapping to identify and prioritize the main obstacles to engaging with HIV-related care following prison release. In brainstorming sessions, formerly incarcerated people with HIV generated responses to a focused prompt regarding the main barriers to reengaging with care. These were consolidated in 35 statements. Next, participants sorted the consolidated list of responses into groups and rated each from lowest to highest in terms of its importance and feasibility of being addressed. We used cluster analysis to generate concept maps that were interpreted with participants.ResultsOverall, 39 participants participated in brainstorming sessions, among whom 18 returned for rating and sorting. Following analysis, a seven-cluster map was generated, with participants rating the ‘Practical Considerations’ (e.g. lack of transportation from prison) and ‘Survival Needs’ (e.g. securing housing and food) clusters as most important. Although ratings were generally similar between women and men, women assigned greater importance to barriers related to reconnecting with children.ConclusionsUsing concept mapping, we worked with formerly incarcerated people with HIV to identify and prioritize key challenges related to accessing health and social services following prison release. Transitional intervention programs should include programs and processes that address meeting basic subsistence needs and overcoming logistical barriers related to community re-entry.

Association of Restrictive Housing During Incarceration With Mortality After Release

Restrictive housing, otherwise known as solitary confinement, during incarceration is associated with poor health outcomes. To characterize the association of restrictive housing with reincarceration and mortality after release. This retrospective cohort study included 229 274 individuals who were incarcerated and released from the North Carolina prison system from January 2000 to December 2015. Incarceration data were matched with death records from January 2000 to December 2016. Covariates included age, number of prior incarcerations, type of conviction, mental health treatment recommended or received, number of days served in the most recent sentence, sex, and race. Data analysis was conducted from August 2018 to May 2019. Restrictive housing during incarceration. Mortality (all-cause, opioid overdose, homicide, and suicide) and reincarceration. From 2000 to 2015, 229 274 people (197 656 [86.2%] men; 92 677 [40.4%] white individuals; median [interquartile range (IQR)] age, 32 years [26-42]), were released 398 158 times from the state prison system in North Carolina. Those who spent time in restrictive housing had a median (IQR) age of 30 (24-38) years and a median (IQR) sentence length of 382 (180-1010) days; 84 272 (90.3%) were men, and 59 482 (63.7%) were nonwhite individuals. During 130 551 of 387 913 incarcerations (33.7%) people were placed in restrictive housing. Compared with individuals who were incarcerated and not placed in restrictive housing, those who spent any time in restrictive housing were more likely to die in the first year after release (hazard ratio [HR], 1.24; 95% CI 1.12-1.38), especially from suicide (HR, 1.78; 95% CI, 1.19-2.67) and homicide (HR, 1.54; 95% CI, 1.24-1.91). They were also more likely to die of an opioid overdose in the first 2 weeks after release (HR, 2.27; 95% CI, 1.16-4.43) and to become reincarcerated (HR, 2.16; 95% CI, 1.99-2.34). This study suggests that exposure to restrictive housing is associated with an increased risk of death during community reentry. These findings are important in the context of ongoing debates about the harms of restrictive housing, indicating a need to find alternatives to its use and flagging restrictive housing as an important risk factor during community reentry.

Virtual Reality as a Rehabilitation Tool for Community Re-Entry Activities

Virtual Reality as a Rehabilitation Tool for Community Re-Entry Activities

Prison Arts and Future IDs: A Social Art Practice Personal Narrative

Prison art programs are essential to helping people with conviction histories develop prosocial behavior, enhancing self-esteem, and strengthening community ties. I know this because participation in prison arts programs helped move me from being a confused young man in prison to what I am today. Despite correctional administrators’ robust history of promoting rehabilitation for the incarcerated, statistics on recidivism are daunting with the vast majority of persons released from prison being re-arrested within five years. Traditional rehabilitation programs and legislative efforts to reduce barriers to employment for former inmates are focused on successful community re-entry. However, the quality and diversity of correctional programming beyond job skills training also has implications for community re-entry. Research has linked arts education with development of the right brain functions of focus, creativity, patience, and the ability to work with others. Prison arts programs increase preparation for community re-entry by building skills, positive attitudes toward self and higher learning, and community connections, benefiting returning citizens and contributing to public safety. In California, Arts in Corrections programs, begun in the 1970s but decreased because of funding in 2000, have been re-launched. Led by artist Gregory Sale and highlighted to visitors at Alcatraz, Future IDs is a multiyear, social art project examining individual transformation stories that help reframe the narrative of re-entry. The program allows incarcerated participants to conceive and develop a vision for a future self, reimagining themselves and their positions in society. It also raises public awareness, communicating the value of criminal justice reform, and helping generate the critical community support necessary to reframe the reintegration narrative. Although raised in a supportive environment, the author faced incarceration and the uncertainty that comes with the conflict between official rules and prison culture and with release and recidivism. The Future IDs program’s focus on artistic expression helped the author to heal the trauma of dehumanization experienced during incarceration and to regain a sense of self-worth and confidence. Creating his Future ID helped him to find greater clarity about his identity, to liberate himself, and to embrace a new life he walks today in service to others.

Life after release from prison: The experience of ex-offenders with intellectual disabilities.

In the UK, little is known about the experience of ex-prisoners with intellectual disabilities. A qualitative study was therefore conducted to investigate what life is like for ten men with intellectual disabilities who left prison at least 9months previously. Semi-structured interviews were employed to explore the men's views of post-prison life, including opportunities/challenges and support received from services. Through interpretative phenomenological analysis, four over-arching themes were constructed: the nature of support and services, the difficulty of staying out of trouble, the importance of family and the need to act the "tough guy". The participants reported being extremely under-supported. They were often hostile about staff who they felt were too focused on their previous crime. In general, men were very under-supported and the upheavals of post-prison lives appeared to be "normalized" by them. Better understanding of their lives within their social context would benefit their community re-entry.

Helping and Hindering Factors for Inmates Meeting the Challenges for Successful Community Reentry

The purpose of this research study is to explore what helping and hindering factors may exist for an inmate living in a Transitional Housing Unit (THU) in a Pennsylvania state prison that is preparing for community reentry so that recommendations can be made for possible improvements to the reentry program. In January 2014, transitional housing units (THUs) began operating in six of the state correctional institutions. The THU was designed to provide reentry services to inmates who will be released to geographic areas near the institutions, thus allowing for contact with outside agencies that can provide ongoing support services for community reentry. The THU was chosen as the reentry program of study because this type of evaluative research has not been conducted in the THU in the past from the perspective of an inmate preparing for community reentry. An Enhanced Critical Incident Technique (ECIT) was used to examine what helps and hinders inmates that are living in the THU who are preparing for community reentry. A study group of 30 men living in the THU will be identified for interviewing to explore their lived experiences of community reentry preparedness. Each participant was asked how they define community reentry preparedness /what community reentry preparedness means to them, and what helps and hinders, and might help (wish list items) community reentry preparedness. ECIT analysis of participant responses result in the identification of critical incidents, helping incidents, hindering incidents, and wish list items (WL items). Keywords: Inmate, learning, community reentry, transitional housing unit

Prevalence of Gambling Disorder Among Prisoners: A Systematic Review.

This article presents the first systematic review of studies on the prevalence of gambling disorder among prisoners across international jurisdictions. Only original studies that were published in English and employed reliable and valid screening tools are included in this analysis. The review finds that rates of problem or pathological gambling in prison populations are highly variable, ranging from 5.9% to 73% of male and female inmates surveyed. Nevertheless, recorded rates of problem and pathological gambling among inmates are consistently and significantly higher than rates of problem and pathological gambling recorded among the general population. The review indicates that the institution of problem gambling treatment programmes in carceral settings is necessary, to aid community re-entry and reduce the likelihood of re-offending. Moreover, it is suggested that the screening of inmates should become standard practice across penal institutions and other criminal justice organisations, with a view to better addressing the needs of offenders.

Race as a Carceral Terrain: Black Lives Matter Meets Reentry

In the United States, racialized people are disproportionately selected for punishment. Examining punishment discourses intersectionally unearths profound, unequal distinctions when controlling for the variety of victims’ identities within the punishment regime. For example, trans women of color are likely to face the harshest of realties when confronted with the prospect of punishment. However, missing from much of the academic carceral literature is a critical perspective situated in racialized epistemic frameworks. If racialized individuals are more likely to be affected by punishment systems, then, certainly, they are the foremost experts on what those realities are like. The Black Lives Matter hashtag came about during the aftermath of the George Zimmerman non-verdict in the killing of Trayvon Martin, and it helped to cultivate the organization which turned into a multiracial international movement in defense of Black dignity and humanity. While Black Lives Matter was initially inspired by police violence, it has expanded its reach to include causes beyond police malpractice and brutality. This special issue of The Prison Journal seeks to merge principles associated with Black Lives Matter (as noted on their website) with critical issues endemic to community reentry after incarceration and the racialized and gendered impediments it produces. The empirical pieces included are qualitative to reflect the epistemologies of the affected, as we believe that narratives more powerfully capture these hard-to-reach (or deviant in comparison to the norm) perspectives. This special issue includes articles that critically foreground the voices of formerly incarcerated citizens (including some who are mothers and fathers) and reentry service providers. Importantly, it provides suggestions for new directions in reimagining a more democratic and racially equitable society without current punishment regimes.

Trauma-Informed Care: a Strategy to Improve Primary Healthcare Engagement for Persons with Criminal Justice System Involvement

Trauma is pervasive in the USA, but disproportionately present in individuals and communities burdened by poverty, violence, and exposure to the criminal justice system. Engagement in clinical care, especially community-based primary care, is particularly important in the immediate period following community reentry from incarceration, where opportunities to engage clients in services are essential for improved health and reduced recidivism. Trauma-informed care offers an important and innovative opportunity for healthcare systems and primary care providers to improve quality of care and the patient experience, thereby increasing longitudinal engagement of marginalized and hard-to-reach patient populations like persons with criminal justice system exposure. Trauma-informed care implementation includes educating providers and transforming practices to incorporate safety, trust, peer support, collaboration, empowerment, and cultural perspectives into everyday operations and care delivery. While comprehensive trauma-informed care involves transformation on a system level, trauma-informed approaches can also be adopted by the individual provider to improve the clinical consultation. By recognizing the role of trauma and its impact on an individual’s physical, emotional, and behavioral health, providers and clients can build mutual trust, focus on individual growth, and begin to foster healing.

122 The Efficacy of Community Reintegration Programming in the Physical and Psychosocial Recovery of Pediatric Burn Survivors

Community Reintegration (CR) programming in burn rehabilitation is a crucial tool in development of resiliency and coping skills outside the hospital setting. Survivors face novel trials upon discharge, and goal-based CR programming allows patients to practice skills in a supportive environment. Few prospective studies exist to document this impact. Three surveys were utilized, with each subject completing a pre & post-outing State Trait Anxiety Inventory/State Trait Anxiety Inventory for Children (STAI) to capture short-term effects, a Pediatric Quality of Life Inventory Short Form 15 Generic Core Scale (PedsQL) before the 1st and after the 3rd outing to address mid-range impact, and an adapted Burn Outcomes Questionnaire/Young Adult Burn Outcome Questionnaire (BOQ) at baseline and after 6–12 months to identify long-term results. Caregivers completed a parent version of PedsQL at the same intervals. Of the 23 enrolled subjects, 2 were removed from the study due to incomplete data, leaving 8 subjects ages 6–8 years, 10 ages 8–12 years, and 3 ages 13–18 years. Twenty-one subjects completed the 1st STAI survey, 15 submitted the 2nd, and 9 completed the 3rd. All subjects and parents completed the 1st PedsQL, 9 parents and 8 subjects completed the 2nd. Only 3 BOQs have been returned to date. Results from the STAI surveys are detailed below in table 1.1. Overall score comparisons from the PedsQL showed increased quality of life (QOL) in 62.5% and decreased QOL in 37.5%. Data collected to date from the adapted BOQ continues to be analyzed pending receipt of surveys from the remaining participants. Though small, the study provides meaningful evidence that CR programming, designed and implemented by skilled professionals, improves the pediatric patient’s anxiety levels and self-reported QOL. While the first interaction exhibited the most significant change in anxiety, positive results persisted after the third encounter. Burn care professionals are constantly searching for ways to support patients as they heal. With continued focus on the psychosocial aspects of recovery, we must remain innovative in how we aid the patient through community re-entry. Goal-oriented CR programs such as this are essential to promote full recovery. 1 - Pre/Post Outing Anxiety Comparison from STAI Surveys 1 - Pre/Post Outing Anxiety Comparison from STAI Surveys

Use of an mHealth Intervention to Improve Engagement in HIV Community-Based Care Among Persons Recently Released from a Correctional Facility in Washington, DC: A Pilot Study.

We examined the preliminary effectiveness of a computerized counseling session plus post-incarceration text messaging intervention (CARE + Corrections) to support ART adherence and linkage/engagement in community care among recently incarcerated persons with HIV in Washington, D.C. Recently incarcerated persons with HIV ≥ 18years old were recruited from the D.C. jail or community outreach and randomized to CARE + Corrections or control arm. Participants completed assessments at baseline, 3-months and 6-months. Multivariable random effects modeling identified predictors of suppressed viral load (≤ 200 copies/mL) and engagement in HIV care at 6months. Participants (N = 110) were aged 42 (IQR 30-49); 58% male, 24% female, 18% transgender, 85% Black, and lifetime incarceration was a median of 7years (IQR 2-15). More controls had a regular healthcare provider at baseline. Although not statistically significant, intervention participants had increased odds of viral suppression versus controls at 6months (AOR 2.04; 95% CI 0.62, 6.70). Those reporting high ART adherence at baseline had higher odds of viral suppression at follow-up (AOR 10.77; 95% CI 1.83, 63.31). HIV care engagement was similar between the two groups, although both groups reported increased engagement at 6months versus baseline. We observed a positive but non-significant association of viral suppression in the CARE + Corrections group, and care engagement increased in both groups after 6months. Further attention to increasing viral suppression among CJ-involved persons with HIV upon community reentry is warranted.

Retention in clinical trials after prison release: results from a clinical trial with incarcerated men with HIV and opioid dependence in Malaysia

Background: Study retention is a major challenge in HIV clinical trials conducted with persons recruited from correctional facilities.Objective: To examine study retention in a trial of within-prison methadone initiation and a behavioral intervention among incarcerated men with HIV and opioid dependence in Malaysia.Methods: In this 2x2 factorial trial, 296 incarcerated men with HIV and opioid dependence were allocated to (1) an HIV risk reduction intervention, the Holistic Health Recovery Program for Malaysia (HHRP-M), (2) pre-release methadone initiation, (3) both interventions, or (4) standard care (NCT02396979). Here we estimate effects of these interventions on linkage to the study after prison release and completion of post-release study visits.Results: Most participants (68.9%) completed at least one post-release study visit but few (18.6%) completed all 12. HHRP-M was associated with a 13.5% (95% confidence interval (CI): 3.8%, 23.2%) increased probability of completing at least one post-release study visit. Although not associated with initial linkage, methadone treatment was associated with an 11% (95% CI: 2.0%, 20.6%) increased probability of completing all twelve post-release study visits. Being subject to forced relocation outside Kuala Lumpur after prison release decreased retention by 43.3% (95% CI: −51.9%, −34.8%).Conclusion: Retaining study participants in HIV clinical trials following prison release is challenging and potentially related to the broader challenges that participants experience during community reentry. Researchers conducting clinical trials with this population may want to consider methadone and HHRP as means to improve post-release retention, even in clinical trials where these interventions are not being directly evaluated.