Transnational Trans Woman Inspires and Informs Evidence-Informed Interventions.

Transitional Care Coordination is an evidence-informed model program developed by New York City Correctional Health Services as a Health Resources and Services Administration Special Projects of National Significance Correctional Health Linkage Intervention. Using implementation science under this and subsequent demonstration projects, interventions were adapted and enhanced to address the transitional needs of people of Puerto Rican ancestry and to expand the network of care across the islands of Puerto Rico. These interventions were informed, in part, by a transnational trans woman of color of Puerto Rican ancestry living with HIV.

HIV Care Engagement Among Justice-Involved and Substance Using People of Puerto Rican Origin Who are Living with HIV.

Persons living with diagnosed HIV (PLWDH) are overrepresented in correctional settings, as are Latinx including those of Puerto Rican (PR) origin. Little is known about this population's HIV care engagement after incarceration. Semi-structured interviews were conducted with 23 PLWDH of PR origin incarcerated in NYC jails using the Behavioral Model for Vulnerable Populations as the theoretical basis.

Client Outcomes From a Multilevel Intervention to Support Persons Living With HIV and Returning to the Community After Incarceration in Puerto Rico.

The twin epidemics of HIV and incarceration impact Puerto Rico, which has limited resources to address the social and structural determinants of health in incarcerated populations. A Special Programs of National Significance grant supported a Puerto Rican community-based organization to implement the evidence-informed Transitional Care Coordination intervention among incarcerated persons living with HIV, targeting changes at the individual, organization, and systems levels. After implementation (November 2015-July 2018; = 69), 93.

Patterns of homelessness and implications for HIV health after release from jail.

This empirical study examines the association between substance abuse, mental illness, health behaviors and different patterns of homelessness among recently released, HIV-infected jail detainees. Using longitudinal data from a 10-site study, we examine correlates of homelessness, transitions to and from stable housing and the effect of housing on HIV treatment outcomes. Based on our analysis, we found evidence that the transitions from homelessness are closely associated with a reduction in the use of alcohol and illicit drugs, a decline in drug addiction severity, and an improvement in mental health.

Linkage to HIV care for jail detainees: findings from detention to the first 30 days after release.

Of people living with HIV in the US, ~16 % or over 150,000 individuals passed through a correctional facility in 2006. Given the enormous impact of HIV within incarcerated populations, facilitating continuity of care from jails to the community is particularly important in reducing morbidity and mortality for releasees. Grantees participating in the Enhancing Linkages to HIV Primary Care in Jail Settings Initiative developed models for identifying HIV-positive detainees during incarceration and linking them to care following release.

Correlates of retention in HIV care after release from jail: results from a multi-site study.

Retention in care is key to effective HIV treatment, but half of PLWHA in the US are continuously engaged in care. Incarcerated individuals are an especially challenging population to retain, and empiric data specific to jail detainees is lacking. We prospectively evaluated correlates of retention in care for 867 HIV-infected jail detainees enrolled in a 10-site demonstration project.

Transitional care coordination in New York City jails: facilitating linkages to care for people with HIV returning home from Rikers Island.

New York City (NYC) jails are the epicenter of an epidemic that overwhelmingly affects Black and Hispanic men and offer a significant opportunity for public health intervention. The NYC Department of Health and Mental Hygiene instituted population based approaches to identify the HIV-infected, initiate discharge planning at jail admission, and facilitate post-release linkages to primary care. Using a caring and supportive 'warm transitions' approach, transitional care services are integral to continuity of care.