Two-thirds of incarcerated persons meet the criteria for substance use disorder (SUD). HIV is also prevalent among this population, with many being unaware of their status. SUD has been shown to impede HIV prevention and care; thus, there is a high degree of co-occurrence. People involved in the criminal legal system experience significant barriers to evidence-based care for these conditions, resulting in substantial decrements to personal, public, and economic health.
An NIH funding opportunity, Ending the HIV Epidemic: Focus on Justice Populations with SUD, aims to identify strategies to improve HIV prevention and treatment for individuals with SUD who are involved in the criminal legal system. Dr. Sean Murphy, professor of population health sciences, is collaborating on two of the funded studies.
The first study, developed by the Massachusetts HIV/Justice Research Network, will explore outcomes and implementation of ID Testing Outreach in Carceral Hubs, or ID-TOUCH, designed to increase HIV testing and pre-exposure prophylaxis (PrEP) linkage. PrEP is the medication taken to prevent HIV and reduces the risk of getting HIV from injection drug use by at least 74 percent. This intervention will be evaluated in partnership with the Suffolk jail system in Massachusetts and community treatment partners.
The second study, led by faculty at the Albert Einstein College of Medicine, will evaluate the DEST2nation model: a Decentralized, Status neutral, Stakeholder-engaged, post-incarceration intervention for people with and at risk for HIV with SUD. The intervention involves peers with lived experience of incarceration to assist with linkage and engagement in medical care and SUD treatment, community-based organizations that can fulfill social needs, and decentralized medical care to address barriers to access. Both studies will inform new treatment options to end the HIV epidemic in individuals involved with the criminal legal system.
Dr. Murphy’s team will lead the economic evaluations of both studies, which will include evaluating the costs required to implement and sustain the interventions in a real-world setting and estimating their economic value according to the perspectives of important decision-makers for this population.
"Integrating care for HIV and SUD could offer an efficient method to address the dual crises of HIV and SUD in criminal-legal settings, given the interconnected challenges associated with these complex conditions," said Dr. Murphy. “Our primary objective is to guide the resource allocation decisions of policymakers and other stakeholders, in order to maximize access to care models that will not only improve health outcomes among this high-risk population, but also generate long-term economic benefits for our communities."
- Highlights