Barriers and facilitators to implementing status-neutral HIV care in an urban jail system.

IF 2.8 Q1 CRIMINOLOGY & PENOLOGY

Health and Justice Pub Date : 2026-03-05 DOI:10.1186/s40352-026-00402-7

Brindet Socrates, Amy M LeClair, Kaitlyn Jaffe, Linnea Evans, Abigail W Batchelder, Emily Moner, Denise Daudelin, Whitney Irie, Yvane Ngassa, Yoelkys Morales, Julie Levison, Elizabeth A Evans, Alysse G Wurcel

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Abstract

BACKGROUND: People who use drugs face barriers to accessing HIV prevention tools. The status-neutral model for HIV care starts with the HIV test and offers linkage to HIV treatment if the person tests positive and linkage to pre-exposure prophylaxis (PrEP) if the person tests negative. The goal of this study was to evaluate barriers and facilitators impacting the implementation of a status-neutral HIV model of care in the jail setting. METHODS: Between June and August 2024, we recruited people working in and incarcerated in the jails operated by the Suffolk County Sheriff’s Department (Jail and House of Correction) for in-depth interviews. The Consolidated Framework for Implementation Research (CFIR) 2.0 guided interview development. Interviews were recorded, transcribed, coded, and analyzed using rapid thematic analysis (RTA) methods. Relevant themes were mapped onto CFIR domains. RESULTS: We conducted 28 interviews: 13 with correctional and clinical staff and 15 with incarcerated people. Clinical and administrative staff members indicated that strong relationships with state and local agencies and the state’s proactive approach to preventative carceral healthcare helped facilitate HIV treatment and prevention pathways. Incarcerated individuals identified issues in the system used to report health needs and unreliable test result delivery mechanisms as major barriers. Staff also identified barriers, including understaffing, but overwhelmingly endorsed the jails’ existing systems of accessing and delivering care. CONCLUSIONS: Findings identified multiple potential intervention targets to enhance a status-neutral approach to HIV testing and treatment in jail settings, including leveraging existing partnerships, and educational opportunities for staff. Strategies that reinforce a patient-centered institutional culture (with a focus on incarcerated individuals’ health), improve care continuity for transitions into and out of jail, and highlight gaps in healthcare delivery are critical for successful implementation of status-neutral HIV care in jails.

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在城市监狱系统中实施身份中立艾滋病毒护理的障碍和促进因素。

背景：吸毒者在获得艾滋病毒预防工具方面面临障碍。艾滋病毒护理中性状态模式从艾滋病毒检测开始，如果检测呈阳性，则与艾滋病毒治疗联系起来，如果检测呈阴性，则与暴露前预防联系起来。本研究的目的是评估影响在监狱环境中实施状态中性艾滋病毒护理模式的障碍和促进因素。方法：在2024年6月至8月期间，我们招募了萨福克县治安部门（监狱和惩教所）管理的监狱中的工作人员和在押人员进行深度访谈。实施研究综合框架（CFIR） 2.0指导了访谈的发展。访谈记录、转录、编码并使用快速主题分析（RTA）方法进行分析。将相关主题映射到CFIR域。结果：我们进行了28次访谈，其中13次是矫正和临床工作人员，15次是在押人员。临床和行政工作人员指出，与州和地方机构的密切关系以及国家预防性护理的积极做法有助于促进艾滋病毒的治疗和预防途径。被监禁的个人认为，报告健康需求的系统和不可靠的检测结果传递机制存在问题，这是主要障碍。工作人员也发现了障碍，包括人员不足，但绝大多数人支持监狱现有的获取和提供护理的系统。结论：研究结果确定了多个潜在的干预目标，以加强监狱环境中艾滋病毒检测和治疗的地位中立方法，包括利用现有的伙伴关系和工作人员的教育机会。加强以患者为中心的机构文化（重点关注在押人员的健康）、改善进出监狱过渡期间的护理连续性以及突出医疗保健服务方面的差距的战略，对于在监狱中成功实施身份中立的艾滋病毒护理至关重要。

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来源期刊

Health and Justice Social Sciences-Law

CiteScore

4.10

自引率

8.60%

发文量

审稿时长

13 weeks

期刊介绍： Health & Justice is open to submissions from public health, criminology and criminal justice, medical science, psychology and clinical sciences, sociology, neuroscience, biology, anthropology and the social sciences, and covers a broad array of research types. It publishes original research, research notes (promising issues that are smaller in scope), commentaries, and translational notes (possible ways of introducing innovations in the justice system). Health & Justice aims to: Present original experimental research on the area of health and well-being of people involved in the adult or juvenile justice system, including people who work in the system; Present meta-analysis or systematic reviews in the area of health and justice for those involved in the justice system; Provide an arena to present new and upcoming scientific issues; Present translational science—the movement of scientific findings into practice including programs, procedures, or strategies; Present implementation science findings to advance the uptake and use of evidence-based practices; and, Present protocols and clinical practice guidelines. As an open access journal, Health & Justice aims for a broad reach, including researchers across many disciplines as well as justice practitioners (e.g. judges, prosecutors, defenders, probation officers, treatment providers, mental health and medical personnel working with justice-involved individuals, etc.). The sections of the journal devoted to translational and implementation sciences are primarily geared to practitioners and justice actors with special attention to the techniques used.