Fortune Society

BACKGROUND:Criminal legal system-involved individuals face barriers to care after release from carceral settings. Elevated SARS-CoV-2 risk while incarcerated, together with living in congregate settings post-incarceration, increase the risk of respiratory viral infection transmission. This study evaluated a community health worker-led point-of-care SARS-CoV-2 testing and education intervention in a re-entry-focused community-based organisation compared with standard referrals. METHODS:This non-blinded, parallel group, randomised controlled trial, conducted in partnership with a community-based organisation in New York City (NYC), NY, USA, enrolled clients who were released from incarceration in the previous 90 days, fluent in English or Spanish, and residing within NYC for the study duration. Participants were randomly assigned (1:1) via computer-generated randomisation to onsite point-of-care testing and education or standard of care referral to offsite testing sites over 12 months. All participants were advised to test every 3 months. The study was not masked due to the nature of the intervention. The primary outcome was the proportion of patients with at least one SARS-CoV-2 test performed with results received during the 12-month period. Primary analyses were done by intention-to-treat using logistic or Poisson regression modelling. This trial was registered with ClinicalTrials.gov, NCT04878328, and is completed. FINDINGS:Between April 14, 2022, and May 22, 2024, 572 formerly incarcerated individuals were assessed for study eligibility. After the exclusion of 247 individuals, and a further 75 who did not attend enrolment, 250 participants were randomly assigned to the two study groups (125 to onsite point-of-care testing and education and 125 to standard of care). 216 (86%) participants were cisgender men, 30 (12%) were cisgender women, two (1%) were transgender women, and two (1%) were non-binary; 120 (48%) were Black and 82 (33%) were Hispanic; mean age was 42·0 years (SD 11·8). 109 (87%) of the 125 participants in the onsite point-of-care testing and education group and 67 (54%) of 125 participants in the standard of care group had at least one complete SARS-CoV-2 test (odds ratio 5·9 [95% CI 3·1-11·1]; p<0·0001). The absolute difference was 34 percentage points (95% CI 23-44; p<0·0001). The incidence rate ratio of complete SARS-CoV-2 tests was 2·4 times (95% CI 1·9-3·0, p<0·0001) as high among participants in the intervention group versus those in the standard of care group. No serious adverse events occurred. INTERPRETATION:Community-health worker-led testing and education at a re-entry-focused community-based organisation could potentially increase uptake of SARS-CoV-2 testing among formerly incarcerated individuals. Although further, larger trials are required, trusted community health workers can provide onsite point-of-care testing and health education, which has relevance for respiratory viral infections such as SARS-CoV-2 and might potentially be applicable to other infectious diseases such as HIV and hepatitis C virus. FUNDING:US National Institutes of Health.

People with HIV (PWH) are disproportionately impacted by the criminal legal system. While carceral settings can provide transient stability for HIV and other chronic conditions, incarceration frequently disrupts continuity of care. HIV care engagement and antiretroviral therapy (ART) concordance are impacted after incarceration by multiple factors including substance use disorder (SUD), limited social support, and structural factors such as housing and economic instability. Peer navigators can improve linkage to and retention in HIV care during the reentry period, and technology-enhancements may increase engagement in existing peer navigation services. We conducted a qualitative study with criminal legal-involved (CLSI) PWH who had recently been released from incarceration and were enrolled in a pilot study that integrated mobile directly observed therapy (mDOT) with peer navigation. The interview guide and thematic analysis were informed by Social Cognitive Theory. Semi-structured interviews focused on understanding barriers to and facilitators of ART concordance and engagement in HIV care among CLSI PWH, and experiences with this peer navigator-led intervention. Fifteen of 18 pilot study participants completed qualitative interviews. Their mean age was 50.3 (SD 10.92), 14 identified as cisgender men and 1 identified as a transgender woman. Just over half of participants identified as Black (n = 8), one third identified as Hispanic (n = 5), one individual as White (n = 1), and one as Biracial (n = 1). Greater than half reported currently experiencing homelessness (n = 8), and two-thirds reported living in a group setting such as a shelter (n = 10). There were 4 overarching themes: (1) Structural barriers complicated engagement in HIV care; (2) Social support was important for engagement in HIV care; (3) Participants highly valued peer navigation; and (4) mDOT assisted with ART concordance for some participants while others had challenges with smartphone and application use. Participants faced several barriers to care in the post-incarceration period. Participants valued social support and expressed appreciation for both the peer navigator and mDOT application; however, the intervention was not “one-size-fits-all” as some participants found it challenging to use the smartphone and mDOT application. Overall, the intervention appears acceptable, but some participants may need technological support and structural barriers will continue to complicate post-incarceration linkage to HIV care.

Background:The National HIV/AIDS Strategy for the United States 2022-2025 emphasized carceral settings for the first time in the national strategy. Centering impacted people can take many forms and is critical to improving the HIV care continuum among people with carceral system involvement (CSI) to meet national Ending the HIV Epidemic goals.Methods:We provide a narrative synthesis of the barriers and facilitators of including people with CSI in different aspects of the research process across 5 Ending the HIV Epidemic studies. Data were collected from each team using a data collection form with open-ended questions. A qualitative thematic analysis identified strategies, barriers, and facilitators across studies.Findings:Major barriers to including people with CSI in research included institutional policies surrounding participant compensation and hiring practices, as well as a misalignment between the study objectives and the perceived needs of participants. Successful strategies for including people with CSI as part of the research team included providing training, support, and space for emotional processing and self-care to aid in managing the vicarious trauma and boundary setting that are unavoidable parts of this work. Successful strategies for including people with CSI as research participants include flexible research protocols and providing material support for participants in addition to cash payments for participation.Conclusions:It is imperative to create sustainable and equitable, community-engaged research practices that continue to center CSI populations during their involvement in all aspects of HIV-related research studies.

Traumatic brain injury (TBI) is common among legally-impacted adults and has also been linked to negative outcomes throughout the criminal legal system. Despite this, relatively limited TBI research has focused on or even included legally-impacted adults. Existing literature in this population has used heterogeneous TBI definitions, populations, and measures when studying outcomes. This study therefore investigates the feasibility and acceptability of telephone-administered TBI common data elements (CDEs) and the Rehabilitation Needs Survey (RNS) in 85 legally-impacted community-dwelling adults. Regarding feasibility, completion rates across measures were high (88-100%), and noncompletion was most commonly due to participants declining to continue. Regarding acceptability, data collectors were able to administer and code most measures with relative ease. Reported difficulties related to measures requiring detailed data collector training to administer and code, such as the Brain Injury Screening Questionnaire (BISQ) and Brief Test of Adult Cognition by Telephone, or challenges inherent to self-report tests in general. In addition, data collectors recommended adding specific questions to the BISQ to query head injuries experienced during or as a result of their exposure to the criminal legal system. Overall, results support the use of telephone-administered TBI CDEs and the RNS in legally-impacted adults, and underscore the need for culturally-responsive training and technical assistance for TBI researchers engaging with this population.