Miriam Hospital receives NIH grants to improve HIV treatment for jail inmates

The Miriam Hospital received three of the 12 newly awarded grants from the National Institutes of Health (NIH) aimed at improving HIV prevention and treatment of prison and jail inmates. The awards, issued to only a handful of institutions nationwide, are part of Seek, Test, and Treat: Addressing HIV in the Criminal Justice System - NIH's largest research initiative to date to aggressively identify and treat HIV-positive inmates, parolees and probationers and help them continue care when they return to their home communities.

Currently, an estimated 1.1 million people in the United States are infected with HIV. Since the late 1990s, the number of new HIV infections has remained relatively stable, with approximately 56,000 new infections reported annually. Each year, an estimated one in seven individuals infected with HIV passes through a correctional facility, suggesting that there is a disproportionate number of HIV-positive individuals in the criminal justice system.

"Fighting the spread of HIV and AIDS among at-risk populations is a top public health priority," said U.S. Senator Sheldon Whitehouse. "These federal grants will fund vital research at institutions like Miriam Hospital, research that holds great promise for prevention, early detection, and appropriate treatment."

Over the past two decades, The Miriam Hospital, together with Brown University, their affiliated Center for Prisoner Health and Human Rights and the Rhode Island Department of Corrections (RIDOC), has emerged as a leader in the field of prison health, including HIV care in correctional facilities. Researchers have led a wide range of studies looking at everything from the benefit of routine, jail-based HIV testing for inmates to treating opiate drug addiction in prison settings.

The grants to Miriam researchers and their collaborators will fund the following projects:

• A Randomized Controlled Trial and Cohort Study of HIV Testing: Although there is a demonstrated link between incarcerated individuals and HIV, little is known about the prevalence of HIV risk behaviors (including injection drug use and unprotected sex) and infection among those on parole or probation. In this study, probationers and parolees from Providence and Baltimore, MD, will randomly receive HIV testing at either the probation/parole office or rapid HIV testing at a community health center. In a separate cohort study, all individuals with HIV identified at community corrections (probation and parole) will be offered enrollment into a one- year intervention study to help improve the connection to HIV care. Josiah Rich, MD, an infectious disease physician at The Miriam Hospital, is co-principal investigator of this study. 
• Improving Linkage to HIV Care Following Release from Incarceration: This study, led by Rich and co-principal investigator Liza Solomon, PhD, from Abt Associates, will focus on improving the link between HIV-positive inmates and HIV care following release from jail or prison. Researchers will design, implement and analyze a monitoring strategy for evaluating follow-up HIV medical care in the community after incarceration. To do so, they will link the new Ryan White HIV/AIDS Program dataset to corrections release data, and then apply this process across multiple states, correctional jurisdictions and care environments. The goal is to gain a better understanding of the elements influencing an inmate's linkage to HIV care in the community in order to improve systems and future interventions.

CARE Corrections: Technology for Jail HIV/HCV Testing, Linkage and Care (TLC): Jails and correctional facilities provide a unique opportunity to offer HIV testing and treatment to a high-risk population. However, given the short length of stay in jail incarceration, HIV screening and intervention needs to be conducted both efficiently and cost-effectively. In this study, co-principal investigator Curt Beckwith, MD, an infectious disease specialist at The Miriam Hospital, and colleagues at George Washington University and New York University will modify two interactive health communication tools, known as CARE and CARE+, which provide counseling and consent for rapid HIV testing in both clinical/community settings, for use within jails and prisons. The newly adapted tools will include additional content relevant and specific to inmates, including hepatitis C (HCV) infection and maintaining HIV treatment in the community following release, as well as text messaging capabilities. As part of the study, researchers will assess the feasibility and accessibility of these new tools among jail detainees in Rhode Island and Washington, DC, and will also analyze their cost-effectiveness.

The grants were awarded primarily by National Institute of Drug Abuse with additional support for Beckwith's study provided by the National Institute of Allergy and Infectious Diseases.

"The Miriam Hospital and our partners are proud to lend our collective expertise to this important initiative. Having the support of the NIH will go a long way toward our shared goal of improving HIV care and treatment in correctional facilities and ensuring HIV interventions continue after individuals are released from prison," said Timothy Flanigan, MD, director of infectious diseases at Rhode Island and The Miriam hospitals.