Identifying Opportunities to Reduce STI/HIV Disparities among Recent Offenders

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 DESCRIPTION (provided by applicant): Juvenile and adult offenders have high rates of sexually transmitted infections (STI) and incident HIV after arrest or release from prison, jail or juvenile facilities, though few studies have identified when and where this population presents for clinical care or are tested for STI/HIV. This now-identifiable population - i.e., those with a criminal record - may be targeted for increased STI and HIV surveillance. To date, however, there are few data to inform STI/HIV screening, treatment and prevention among these individuals because we do not know when and where they present for clinical care and whether they receive STI/HIV care in these settings. The long-term goal of this research is to develop informed interventions to improve the health of recent offenders in community and clinical settings, particularly by reducing the burden of STI and HIV. The purpose of this study is to investigate when and where offenders after arrest or release from incarceration are seen in the health system and, at points where they access clinical care, whether they are being screened for STI and HIV. The hypothesis is that offenders following arrest or release from incarceration have different patterns of clinical care encounters, including fewer routine preventive visits, and thus fewer STI/HIV screening tests compared to non-offenders. In collaboration with criminal justice, clinical and public health agencies serving Marion County (Indianapolis), Indiana, all individual-level arrest, juvenile detention, jail and prison records were linked with positive STI/HIV test results over a 9-year period. Building on this foundation of expertise and resources, this study will incorporate inpatient, emergency room and outpatient encounter data using the Indiana Network for Patient Care system, one of the most comprehensive clinical encounter data sets for a U.S. metropolitan area. The specific aims are to: (1) describe if, when, where and for what purposes recent offenders present for clinical care in the 1-year after arrest or release from incarceration, compared to the non-offender population during a 1-year period; and (2) assess the quality of STI/HIV care among recent offenders with at least 1 clinical encounter in the 1-year after arrest or release from incarceration. This project fits well within the scope of AHRQ's Prevention and Care Management Portfolio as it will result in STI/HIV screening recommendations for this vulnerable population to prevent disease among both offenders in the post-incarceration period as well as their communities.