Formerly Incarcerated Transitions for Pre-Exposure Prophylaxis (FIT for PrEP)

Background

The HIV prevalence among the prison population is 3-5 times greater than the non-incarcerated population. Prisoners disproportionately come from groups with the highest rates of HIV (e.g. people who use drugs, racial-ethnic minorities, lower socioeconomic status individuals). Further, people in prison are more likely to have engaged in high risk activities such as commercial sex work and injection drug use. Therefore, people leaving prison may benefit from evidence-based bio-behavioral HIV prevention such as pre-exposure prophylaxis (PrEP). However, few prisons offer PrEP at release and, after prison release, uptake among the highest risk groups (e.g. people who use drugs, racial-ethnic minorities) has been poor. There is a critical need to implement programs to improve PrEP uptake among the prison population, particularly in the immediate post-release period.

Objective

This study integrated PrEP with the formerly incarcerated transitions (FIT) program linking people recently released from prison to primary care. In the FIT program, soon-to-be-released individuals are moved to prisons located in their release counties. A local peer community health worker (CHW) employed by the community health center meets with the individual prior to release and the CHW and the prisoner establish a re-entry plan. The CHW presents the plan for access to services post-release to the local re-entry resource center. The CHW then accompanies the person who has been recently released to their medical appointments. Participants in this program have been shown to have early engagement in primary care after release.

To improve access to PrEP among recently released prisoners, the program linked them to PrEP care after release. The next step was to explore the feasibility of the program, FIT for PrEP, among the target population and key stakeholders.

Outcomes

A major aim of this project was to explore the feasibility (acceptability and demand) of a FIT for PrEP program among the target population. The proposed research conducted semi-structured interviews with current male and female FIT program participants (N=40) to explore the extent and ways in which the new program FIT for PrEP is attractive and in demand for men and women recently released from prison.

A second aim was to explore the feasibility (acceptability, integration, and expansion) of a FIT for PrEP program among key stakeholders: community health center staff, prison transition site social workers, and criminal justice re-entry council members. The proposed research conducted semi-structured interviews among community health center staff (n=11) including community health workers, prison social workers (N=5), and criminal justice re-entry council members (N=5). The program’s purpose was to explore the attractiveness and potential of the FIT for PrEP program for key stakeholders. The research also explored among stakeholders the extent and ways in which PrEP can be integrated into the existing FIT program and/or the extent that the FIT program can be expanded to include PrEP. The anticipated outcome of this supplement was the identification of a set of strategies to make the FIT for PrEP program successful. These strategies informed the refinement of the program prior to an initial roll-out. The research then tested other aspects of the feasibility of the refined program in a pilot study funded by NIH clinical trial planning grant (R34). Subsequently, the efficacy of the program is being evaluated in a large-scale clinical trial (NIH R01).

Benefits

The FIT for PrEP program could significantly contribute to eliminating the disparity in PrEP access for underserved criminal justice involved populations in order to reduce HIV acquisition and racial- ethnic disparities in HIV. Further, the program’s proposed multi-disciplinary collaboration could provide a framework for implementation of other programs including linkages for HIV or hepatitis subspecialty care. Both the FIT for PrEP program and the encompassing multi-disciplinary process hold the potential to be replicated in criminal justice settings across the country.

Study Team/Roles

Becky White, MD, MPH, Assistant Professor (UNC-CH), PI
Lauren Brinkley-Rubinstein, PhD, Assistant Professor (UNC-CH), Co-PI
Sharon Parker, MSW, MS, Assistant Professor (NC A&T), Co-Investigator
Andrea Knittel, MD, PhD, FACOG, Assistant Professor (UNC-CH), Co-Investigator
Evan Ashkin, MD, Professor (UNC-CH), Co-Investigator

Funding Organization

The funding organization is the UNC Center for AIDS Research, through their CFAR Supplement.

The grant lasted for one year from 2018-2019.

Contact

Lauren Brinkley-Rubinstein | Lauren_Brinkley@med.unc.edu

333 S. Columbia St.

341b MacNider Hall

Chapel Hill, NC 27599

Learn More

Formerly Incarcerated Transition program webpage

Last updated: 7/28/2020