The study, funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, through a Collaborative Network to End the HIV Epidemic and Address Addiction in the Criminal Justice System (CONNECT) grant to Dr. Alysse Wurcel, a physician and Infectious Disease consultant for the Massachusetts Sheriffs Association, and Dr. Elizabeth Evans, a public health professor in the UMass Amherst School of Public Health and Health Sciences – will design and assess an HIV testing and outreach intervention called ID-TOUCH (ID Testing OUtreach in Carceral Hubs).
"We know that incarceration is when HIV testing could be offered – we're trying to increase the number of incarcerated people who are tested and treated," said Dr. Wurcel. "Overall, people who are incarcerated are more likely to test positive than people who are not incarcerated. By the CDC guidelines, anyone in jail is at risk."
Those who test positive should be placed on treatment and those who test negative should be offered pre-exposure HIV medications to prevent the disease. Treatment and prevention while in jail involves taking medication each day, she said.
The ID-TOUCH intervention will be designed to strengthen jail-based HIV programming and integrate it with existing treatment, and program impacts will be rigorously assessed. "Our intervention is part of a national set of research and capacity-building projects designed to generate evidence to address the unique needs of individuals with HIV and substance use disorders as they transition between the criminal-legal system and the community," said Dr. Evans.
"We are one of seven academic regional research hubs funded by CONNECT, which also supports a patient engagement resource center, representing a timely and much-needed opportunity to conduct cutting-edge research in real-world settings. Results have the potential to save lives and improve health for incarcerated populations" Dr. Evans said.
In Massachusetts, the End HIV Epidemic (EHE) Toolkit recommends that jails offer low-barrier access to HIV testing, treatment, and prevention to people who inject opioids or other substances, but many justice-involved people with opioid use disorder do not know their HIV status and few access medications to prevent HIV. Suffolk County, the only EHE-designated jurisdiction in Massachusetts, had a recent HIV outbreak, occurring in formerly incarcerated people with opioid use disorder, that disproportionately impacted three communities (Boston, Chelsea and Revere). Improvements were made to increase carceral HIV prevention and care, but one year into implementation only about 10 percent were HIV tested and few were initiated on preventative medication.
As part of the study's first year, incarcerated individuals will be interviewed to learn more about why they might be currently refusing testing or medication to prevent HIV and also to increase their awareness that these steps are offered. Another step involves reviewing data that exists through the Massachusetts Department of Public Health about the number of people who enter Suffolk County jails that are tested for HIV. Also, 50 people will be recruited within the jail and researchers will track whether they are offered testing, receive testing, and how often. Results will be used to tailor the intervention to better meet the needs of the population before it is scaled up.
"This is one of the first times that the NIH has funded such a large research effort specific to HIV testing," said Dr. Wurcel. "It's a collaborative across Boston – almost every other health center in Boston is involved - along with the Massachusetts Department of Public Health and the Suffolk County Sheriff's Office, which is also an exciting opportunity to improve regional capacity for carceral HIV healthcare."
