HIV & Drug Court: How do they fit? By Sockwell, Martel, Forsman, & Dusenge University of Arkansas for Medical Sciences

Transcription

1 HIV & Drug Court: How do they fit? By Sockwell, Martel, Forsman, & Dusenge University of Arkansas for Medical Sciences

2 Austin, Indiana

3 Austin, Indiana

4 Austin, Indiana

5 Austin, Indiana

6 Learning from Austin Rural areas are vulnerable too

7 Learning from Austin Rural areas are vulnerable too Needle exchanges aren t enough

8 Learning from Austin Rural areas are vulnerable too Needle exchanges aren t enough Building on existing infrastructure

9 Thinking about HIV

10 Rethinking HIV

11 HIV screening & education

12 HIV screening & education is a simple, low-cost, natural fit for drug courts

13 Today s roadmap

14 1. Preliminary data

15 1. Preliminary data 2. Pilot implementation & results

16 1. Preliminary data 2. Pilot implementation & results 3. Now what?

17 1. Preliminary data

18 UAMS Arkansas Population 2.9 million

19 New HIV/AIDS infections in Arkansas fell in 2015 but remain at six-year average

20 Our start UAMS UAMS Department of Family & Preventive Medicine Preliminary

21 Our start UAMS UAMS Department of Family & Preventive Medicine Northwest Arkansas drug courts Preliminary

22 Preliminary data IV drug use habits Preliminary

23 Preliminary data IV drug use habits Safe sex practices Preliminary

24 Tools used Preliminary

25 Tools used Government Performance Results Act (GPRA) Client Outcome Measures for Discretionary Program Preliminary

26 Tools used Government Performance Results Act (GPRA) Client Outcome Measures for Discretionary Program Addiction Severity Index (ASI) Preliminary

27 Tools used Government Performance Results Act (GPRA) Client Outcome Measures for Discretionary Program Addiction Severity Index (ASI) HIV Risk Assessment Preliminary

28 Preliminary Results: HIV risk in drug court clients Preliminary

29 Preliminary Results: HIV risk in drug court clients 275 preliminary clients Preliminary

30 Clients who had sex in the last 30 days often exhibited risky behaviors linked to contracting HIV. n =158

31 Clients who had sex in the last 30 days often exhibited risky behaviors linked to contracting HIV. Had unprotected sexual contact 81%

32 Clients who had sex in the last 30 days often exhibited risky behaviors linked to contracting HIV. Had unprotected sexual contact 81%...with someone who was high 15%

33 Clients who had sex in the last 30 days often exhibited risky behaviors linked to contracting HIV. Had unprotected sexual contact 81%...with someone who was high 15%...with an IV drug user I I n =158

34 30% of clients had either not been tested for HIV before or were unsure of their results Preliminary

35 Perceived barriers to getting tested Preliminary

36 Afraid to find out if I have HIV Preliminary

37 Afraid to find out if I have HIV 50% Preliminary

38 Too embarrassed to ask for a test Preliminary

39 Too embarrassed to ask for a test 52% Preliminary

40 I wouldn t know what to do if I tested positive Preliminary

41 I wouldn t know what to do if I tested positive 64% Preliminary

42 2. Pilot implementation & results

43 Designing the pilot Pilot

44 Designing the pilot UAMS-RED granted $5,000 for a six month pilot Pilot

45 Designing the pilot UAMS-RED granted $5,000 for a six month pilot HIV education and testing once a month Pilot

46 Designing the pilot UAMS-RED granted $5,000 for a six month pilot HIV education and testing once a month Pre/post given on HIV knowledge and PTS screening Pilot

47 Tools used Pilot

48 Tools used Expanded HIV questionnaire Pilot

49 Tools used Expanded HIV questionnaire Post-Traumatic Stress Disorder Checklist Civilian Version (PCL) Pilot

50 Tools used Expanded HIV questionnaire Post-Traumatic Stress Disorder Checklist Civilian Version (PCL) Pre/Post test and evaluation Pilot

51 Using outside contractors for HIV screening is critical Pilot

52 Using outside contractors for HIV screening is critical HIPPA protections Pilot

53 Using outside contractors for HIV screening is critical HIPPA protections Encourages honest self-reporting Pilot

54 Pilot

55 Pilot

56 Data collection Pilot

57 Data collection Washington & Madison Counties Pilot

58 Data collection Benton County Pilot

59 Pilot demographics Pilot

60 Pilot demographics 32% 67% n = 95 Pilot

61 Pilot demographics 32% 67% Overall HIV Risk level 1 = 83% level 2 = 67% level 3 = 42% n = 95 Pilot

62 Pilot demographics 32% 67% Overall HIV Risk level 1 = 83% level 2 = 67% level 3 = 42% n = 95 Pilot

63 Results Pilot

64 Pilot drug court clients were often at risk for contracting HIV from IV drug related behaviors.

65 Pilot drug court clients were often at risk for contracting HIV from IV drug related behaviors. Have used IV drugs 43%

66 Pilot drug court clients were often at risk for contracting HIV from IV drug related behaviors. Have used IV drugs 43% Have shared used IV needles 30%

67 Pilot drug court clients were often at risk for contracting HIV from IV drug related behaviors. Have used IV drugs 43% Have shared used IV needles 30% Have exchanged sex for drugs n =93, 39, 41

68 Pilot drug court clients often exhibited unsafe sex behaviors that put them at risk for contracting HIV.

69 Pilot drug court clients often exhibited unsafe sexbehaviors that put them at risk for contracting HIV. Never or only occasi onall y usecondoms 67%

70 Pilot drug court clients often exhibited unsafe sexbehaviors that put them at risk for contracting HIV. Never or only occasionally use condoms 67% Had sex with an injection drug user 50%

71 Pilot drug court clients often exhibited unsafe sexbehaviors that put them at risk for contracting HIV. Never or only occasi onall y usecondoms 67% Had sex with an injection drug user 50% Have multiple sexual partners 47%

72 Pilot drug court clients often exhibited unsafe sexbehaviors that put them at risk for contracting HIV. Never or only occasi onally use condoms 67% Had sex with an injection drug user 50% Have multiple sexual partners 47% Did not know the HIV status of their partner 21% n = 88, 90, 93, 92

73 Pilot drug court clients often exhibited unsafe sexbehaviors that put them at risk for contracting HIV. Never or only occasionall y use condoms 67% Had sex with an injection drug user 50% Have multiple sexualpartners 47% Did not know the HIV status of their partner 21% n = 88, 90, 93, 92

74 Pilot drug court clients often exhibited unsafe sexbehaviors that put them at risk for contracting HIV. Never or only occasionall y use condoms 67% Had sex with an injection drug user 50% Have multiple sexualpartners 47% Did not know the HIV status of their partner 21% n = 88, 90, 93, 92

75 Pilot drug court clients often exhibited unsafe sexbehaviors that put them at risk for contracting HIV. Never or only occasionall y use condoms 67% Had sex with an injection drug user 50% Have multiple sexualpartners 47% Did not know the HIV status of their partner 21% n = 88, 90, 93, 92

76 Trauma & HIV risk Pilot

77 Trauma & HIV risk No significant risk difference in low vs. moderate or high trauma Pilot

78 HIV knowledge Pilot

79 HIV knowledge Pilot

80 Quiz: Can HIV be spread though sharing needles? Pilot

81 Fact: HIV can be spread though sharing needles. 19% unaware Pilot

82 Quiz: Can HIV be spread though contact with blood of an HIV+ person? Pilot

83 Fact: HIV can be spread though contact with blood of an HIV+ person 13% unaware Pilot

84 Quiz: Can HIV be spread though contact with saliva of an HIV+ person? Pilot

85 Myth: HIV cannot be spread though contact with saliva of an HIV+ person 30% unaware Pilot

86 Quiz: Can HIV be spread though using the same toilet as an HIV+ person? Pilot

87 Myth: HIV cannot be spread though using the same toilet as an HIV+ person 7% unaware Pilot

88 HIV knowledge gain Pilot

89 HIV knowledge gain Pre ~1 in 4 incorrect Pilot

90 HIV knowledge gain Pre ~1 in 4 incorrect Post 1 in 20 incorrect n = 73 Pilot

91 What we learned: Implementation Pilot

92 What we learned: Implementation Drug court staff were extremely receptive to education and on-site testing Pilot

93 What we learned: Implementation Drug court staff were extremely receptive to education and on-site testing Logistics fit well in general Pilot

94 FJ105 What we learned: Implementation Drug court staff were extremely receptive to education and on-site testing Logistics fit well in general, though some challenges Discuss HIV and other STIs in tandem Pilot

95 Slide 94 FJ105 "Although there were some challenges we will discuss in a moment. FORSMAN, JOSEPH, 5/1/2017

96 Challenges faced Pilot

97 Challenges faced Scheduling and logistics Pilot

98 Challenges faced Scheduling and logistics Space for testing Pilot

99 Challenges faced Scheduling and logistics Space for testing Time Pilot

100 3. Now what?

101 HIV screening & education

102 HIV screening & education is a simple, low-cost, natural fit for drug courts

103 HIV screening & education is a simple, low-cost, natural fit for drug courts

104 HIV screening & education is a simple, low-cost, natural fit for drug courts

105 HIV screening & education is a simple, low-cost, natural fit for drug courts

106 Now what? Action

107 Now what? UAMS Action

108 Now what? Green light for statewide expansion UAMS Action

109 Now what? Green light for statewide expansion Adding HIV/STI testing in the future, pending new testing partnerships UAMS Action

110 Now what? Green light for statewide expansion Adding HIV/STI testing in the future, pending new testing partnerships UAMS Develop fidelity measures and monitoring process Action

111 How you can help Action

112 How you can help Contact your state legislators and city representatives Action

113 How you can help Contact your state legislators and city representatives Start a conversation, share what you learned Action

114 How you can help Contact your state legislators and city representatives Start a conversation, share what you learned Recommend partners or become one! Action

115 Contact us LaTunja Sockwell UAMS Family Medicine Community Research

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