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Centers for Disease Control and Prevention: public health and corrections update.

Individuals in correctional settings often have multiple risk factors for human immunodeficiency virus (HIV), sexually transmitted diseases (STDs), viral hepatitis and tuberculosis (TB). Therefore, correctional facilities can provide an opportunity for screening, testing, treatment and prevention services, said Laurie C. Reid, public health advisor for correctional health for the Centers for Disease Control and Prevention (CDC) and moderator of a Tuesday morning CDC public health and corrections update.

The workshop began with Samantha Williams, Ph.D., a CDC research psychologist, providing an overview of the two-day Corrections and Public Health Consultation that CDC hosted in March to allow CDC staff and external stakeholders to exchange ideas, strategies and best practices on infectious disease prevention and treatment both inside and outside of correctional facilities. Williams said it opened up the discussion of how public health and corrections can better partner, even with lean resources. "It served as an opportunity for corrections subject matter experts out in the field as well as those within CDC to talk and dialog."

CDC had five goals for the consultation:

* Assist in the development of the priorities around corrections within CDC;

* Provide suggestions for continuity of care and linkages to the community;

* Create an adaptable strategy to reduce the burden of infectious diseases within correctional settings;

* Develop suggestions that can guide policies, programs and research efforts; and

* Identify models of best practice for integration in improved public health programs in corrections.


The consultation featured several speakers who set the stage for a productive training event. There were also three breakout sessions that were organized thematically and looked at the role of public health and prevention in correctional settings, how to better integrate principles and responsibilities, and the importance of best practices and outcomes. Attendees were placed in sessions that mixed people from different areas of corrections (jails, prisons, federal corrections, etc.) so that various perspectives could be heard and captured.

Throughout the course of the consultation, participants developed several recommendations, including a suggestion from external partners that CDC should consider, acknowledge and identify expertise among correctional health staff. Other recommendations included pilot testing programs and evaluating them for effectiveness; exploring the relationship between disease risk behaviors and criminality; determining disease progression among incarcerated and released populations; increasing focus on community corrections; directing funds for correctional research and training; and establishing an office of correctional health care. Williams noted that the final meeting report will be available on the CDC Web site this fall.

Andrew Margolis, MPH, a health services research officer for the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, spoke about HIV prevention efforts within correctional populations. Between 1998 and the present, the following efforts have been undertaken:

* HIV prevention intervention research including development of new interventions and adaptation of existing interventions;

* Jail-and prison-based HIV testing and linkage to care programs;

* Epidemiological investigation of HIV transmission within a state prison system; and

* Surveillance system to document sexual violence among prison inmates.

Margolis also gave an overview of Project START, which is an HIV, STD and hepatitis risk-reduction intervention trial. It was conducted at five sites between 1998 and 2005, and examined 522 young men being released from prison and returning to the community. The study compared a single-session intervention and a multisession intervention (two prerelease and four post-release). Overall, the multisession intervention reduced sexual risk after release. "Project START has been field-tested by nonre-search staff from community-based organizations for use with men and women of all ages in prisons or jails," Margolis said. Facilitator trainings are being conducted this year and intervention packages will be available for communities in summer 2010.


Other programs include Interventions for HIV-Positive Prisoners, which is now evaluating interventions to address HIV-risk-reduction service utilization and treatment adherence for HIV-positive prisoners released to the community. Project SAFE (sexual awareness for everyone) is a group-level motivational and skills-building intervention to reduce risky behaviors and STDs among minority women. Margolis said it has been adapted for HIV/STD prevention among incarcerated women in the rural South. SiHLE (Sisters Informing Healing, Living, Empowering) is a group-level training intervention to reduce risky sexual behavior among African-American adolescent females in youth detention centers. The Advancing HIV Prevention Initiative Jail-Based Rapid HIV Testing project funded four health departments to conduct demonstration projects between 2004 and 2006. Margolis said 33,211 jail inmates were tested for HIV. Additionally, in 2007, CDC joined a three-year national HIV testing and linkage to care initiative that funded 25 health departments and jurisdictions. By September 2008, approximately 42,200 HIV tests had been conducted among inmates and 408 HIV-infected offenders had been identified.

Margolis noted that earlier this year CDC released Centers for Disease Control and Prevention: HIV Testing Implementation Guidance for Correctional Settings, a report that was developed by CDC and external consultants including departments of correction, health departments, medical providers and researchers. "It recommends routine opt-out screening during medical evaluation, confidentiality and privacy," he said. In closing, Margolis outlined a data collection surveillance system to ascertain indicators of injuries that might be associated with sexual violence and rape among inmates. CDC has worked on this with the Bureau of Justice Statistics. It will be pilot tested in 10 jails and 25 prisons beginning in 2010.

Following Margolis, Charlotte Kent, Ph.D., chief of the Health Services Research and Evaluation Branch, Division of Sexually Transmitted Disease Prevention at CDC, spoke about the importance of chlamydia and gonorrhea screening in corrections. Screening, according to Kent, provides an opportunity to identify and treat infections and prevent potential health complications such as pelvic inflammatory disease, chronic pelvic pain, infertility, ectopic pregnancy, and increased risk for HIV transmission and acquisition. Kent noted that the prevalence of chlamydia and gonorrhea in women under 25 is greater in adult jails than in juvenile facilities. "It's an opportunity to treat a lot more infections than you would see in juvenile facilities because there are so many young women incarcerated in jails."

Kent also spoke about targeted screening. She noted that an STD surveillance report shows that in some states and cities prevalence of chlamydia in jails is lower than in family planning settings among women. This, Kent said, is because of universal screening in jails versus targeted screening by age in family planning settings. She said that it is necessary to compare universal screening with the cost of screening among low prevalence, low-yield populations. "You do not have to detect and treat every infection to make a difference," Kent said, noting that pilot testing is essential in determining screening criteria.

Kent pointed out that based on San Francisco data and national prevalence data, priority for screening in detention should be girls in detention, women 18-30 years old in jails, followed by men 18-25 years old in jails. She said it is feasible to treat more than 80 percent of infections detected in correctional settings. Obtaining results as soon as possible and standardizing a treatment procedure is essential to increasing treatment, according to Kent. In order to increase post-release treatment Kent said it is important to collaborate with local health departments, use field-delivered therapy and implement alerts in correctional and STD clinic medical records so infected individuals are treated if they return. Finally, she noted that the field is beginning to accumulate information on best practices for establishing screening programs, determining who to screen and how to increase treatment.


The final workshop speaker was Reid who noted that CDC funds health departments and therefore it is important for correctional systems to forge relationships with their local health departments in order to access CDC funding and programming. She summarized the CDC's Adult Hepatitis B Vaccination Initiative. A strategy to eliminate hepatitis B virus (HBV) transmission involves preventing perinatal HBV transmission, implementing universal infant vaccination at birth, catching up vaccinations of all children and adolescents under 19 years old, and vaccinating adults in high-risk groups. CDC activities to promote vaccination of high-risk adults include releasing updated adult hepatitis B vaccination recommendations (2006), encouraging state programs to purchase hepatitis B vaccine for high-risk adults (2006), and implementing the Adult Hepatitis B Vaccination Initiative using earmarked CDC Section 317 Immunization Grant Program funds to vaccinate at-risk adults (2007 and 2008). Reid said it is now recommended that all unvaccinated at-risk adults receive the vaccine, as well as all adults seeking protection. Vaccination strategies have been developed for settings with a high proportion of at-risk adults including correctional facilities.

Reid discussed CDC's Hepatitis B Vaccine Initiative to Reach At-Risk Adults (Nov., 1, 2007-Dec. 31, 2008). The goal was to improve vaccination in settings with high proportions of at-risk adults. In fiscal year 2007, $20 million was given to 51 grantees and in fiscal year 2008, $16 million was given to 48 grantees. A program evaluation was conducted at the end of the first year. In the first year, 275,445 doses were administered.

In summary, Reid said substantial progress has been made in eliminating HBV transmission. Since 1990, hepatitis B rates in children have declined more than 95 percent and hepatitis B rates in adults have declined more than 75 percent. However, Reid noted that the burden of new infections remains with about 43,000 new infections in 2007. She concluded, "There is a time-limited opportunity to accelerate the elimination of HBV transmission by increasing hepatitis B vaccine coverage among at-risk adults."
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Title Annotation:WORKSHOPS
Author:Clayton, Susan
Publication:Corrections Today
Geographic Code:1USA
Date:Oct 1, 2009
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