CIRA Affiliated Project

Transitions is a novel demonstration program for managing HIV+ clients as they transition from the jail to the community setting. Rapid HIV testing will be enhanced within this setting to improve diagnostic screening for HIV. The Transitions intervention is based on three evidence-based components that will be adapted for jail-release settings. 1) buprenorphine maintenance therapy (BMT) for opioid dependence; 2) intensive case management (ICM) with elements of assertive community treatment; and 3) money management (MM) that utilized an assigned payee to manage financial resources to reduce social instability, homelessness, substance abuse and mental illness. A randomized controlled trial of MM will be conducted to determine if this added contribution may lead to previously unattained outcomes. Year 1 activities include finalizing the intervention protocol and assessment plan, hiring and training staff anc working closely with the Evaluation Center. Subjects will be recruited and assessed for HIV, substance abuse, mental illness and social stability outcomes during Years 2-4.

HIV+ inmates of the New Haven jail (catchment area New Haven and Waterbury) will be recruited. New Haven County has one of the highest per capita rates of HIV/AIDS and is one of 15 cities impacted by markedly high rates of IDU (the majority being opioid dependence), mental illness, and poverty. Transitions will be feasible through the collaboration between the Yale University AIDS Program, the Waterbury Hospital ID Clinic and the Connecticut Department of Correction. Both of the community-based programs are experienced with provision of HIV care and BMT and are embedded within a nexus of care provision services within the Ryan White Consortium.

The goals of this program are: 1) to increase routine HIV testing within the jail setting; 2) develop a unique jail-release model utilizing a jail-based referrals coordinator, community-based case managers, opiate substitution therapy and community outreach that results in improved HIV treatment, substance abuse, and social services outcomes; 3) to adapt a Money Management program for inmates being released from jail; 4) to determine the acceptability of MM services for released HIV+ jail detainees; and 5) to compare the HIV, substance abuse and social services outcomes for those who receive vs. not receive MM services.

TRANSITIONS is likely to be a successful program due to the ; 1) high unmet needs of jail-inmates in New Haven County 2) collective experience between the Yale University AIDS Program, Waterbury Hospital, the Connecticut Department of Correction; 3) collective expertise of Yale University in development and testing of novel interventions for released prisoners with co-occurring substance use disorder and mental illness; 4) creative integration of diverse, but evidence-based interventions for a population of jail-detainees with HIV/AIDS; 5) novelty of providing opiate substitution therapy, as physician-prescribed buprenorphine before and continuously after release to the community; 6) novelty of adapting ICM and MM interventions for released prisoners; and 7) likelihood that the intervention will be sustainable through the efforts of the investigators through their dissemination at national meetings and within peer-reviewed journals.

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