The 'Disastrous' State of Latin America's Prisons

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Blood-borne viral co-infections among HIV+ inmates

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A Budget Impact Analysis of Newly Available Hepatitis C Therapeutics and the Financial Burden on a State Correctional System

Hepatitis C virus (HCV) infection continues to disproportionately affect incarcerated populations. New HCV drugs present opportunities and challenges to address HCV in corrections. 

The goal of this study was to evaluate the impact of the treatment costs for HCV infection in a state correctional population through a budget impact analysis comparing differing treatment strategies. Electronic and paper medical records were reviewed to estimate the prevalence of hepatitis C within the Rhode Island Department of Corrections. 

Three treatment strategies were evaluated as follows: 

1. treating all chronically infected persons, 
2. treating only patients with demonstrated fibrosis, and 
3. treating only patients with advanced fibrosis. 

Budget impact was computed as the percentage of pharmacy and overall healthcare expenditures accrued by total drug costs assuming entirely interferon-free therapy. Sensitivity analyses assessed potential variance in costs related to variability in HCV prevalence, genotype, estimated variation in market pricing, length of stay for the sentenced population, and uptake of newly available regimens. 

Chronic HCV prevalence was estimated at 17% of the total population. Treating all sentenced inmates with at least 6 months remaining of their sentence would cost about $34 million-13 times the pharmacy budget and almost twice the overall healthcare budget. Treating inmates with advanced fibrosis would cost about $15 million. A hypothetical 50% reduction in total drug costs for future therapies could cost $17 million to treat all eligible inmates. 

With immense costs projected with new treatment, it is unlikely that correctional facilities will have the capacity to treat all those afflicted with HCV. Alternative payment strategies in collaboration with outside programs may be necessary to curb this epidemic. In order to improve care and treatment delivery, drug costs also need to be seriously reevaluated to be more accessible and equitable now that HCV is more curable.

Purchase full article at:   http://goo.gl/zB8WTD

By:  Nguyen JT1, Rich JD, Brockmann BW, Vohr F, Spaulding A, Montague BT.

• 1Brown University School of Public Health, Providence, RI, USA. 
• J Urban Health. 2015 Aug;92(4):635-49. doi: 10.1007/s11524-015-9953-4.

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The Role of Social Capital in African Americans' Attempts to Reduce and Quit Cocaine Use

BACKGROUND:

Research examining substance users' recovery has focused on individual-level outcomes while paying limited attention to the contexts within which individuals are embedded, and the social processes involved in recovery.

OBJECTIVES:

This paper examines factors underlying African American cocaine users' decisions to reduce or quit cocaine use and uses practice theory to understand how lifestyle changes and shifts in social networks facilitate access to the capital needed to change cocaine use patterns.

METHODS:

The study, an in-depth analysis of substance-use life history interviews carried out from 2010 to 2012, included 51 currently not-in-treatment African American cocaine users in the Arkansas Mississippi Delta region. A blended inductive and deductive approach to data analysis was used to examine the socio-cultural and economic processes shaping cocaine use and recovery.

RESULTS:

The majority of participants reported at least one lifetime attempt to reduce or quit cocaine use; motivations to reduce use or quit included desires to meet social role expectations, being tired of using, and incarceration. Abstinence-supporting networks, participation in conventional activities, and religious and spiritual practices afforded access to capital, facilitating cocaine use reduction and sobriety.

CONCLUSIONS:

Interventions designed to increase connection to and support from nondrug using family and friends with access to recovery capital (e.g., employment, faith community, and education) might be ideal methods to reduce substance use among minorities in low-income, resource-poor communities.

Purchase full article at:   http://goo.gl/tu8pcE

By:  Cheney AM¹, Booth BM², Borders TF³, Curran GM⁴.

¹ Center for Healthy Communities , University of California Riverside , Riverside , California , USA.

² Division of Health Services Research , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.

³ Department of Health Management and Policy , University of Kentucky , Lexington , Kentucky , USA.

⁴ Department of Pharmacy Practice , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.

Subst Use Misuse. 2016 Apr 20:1-11.

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The Path from Childhood Behavioural Disorders to Felony Offending: Investigating the Role of Adolescent Drinking, Peer Marginalization, and School Failure

Background

Although a pathway from childhood behavioural disorders to criminal offending is well-established, the aetiological processes remain poorly understood. Also, it is not clear if attention deficit hyperactivity disorder (ADHD) is predictive of crime in the absence of comorbid disruptive behaviour disorder (DBD).

Hypothesis

We examined two research questions: (1) Does ADHD have a unique effect on the risk of criminal offending, independently of DBD? (2) Is the effect of childhood behavioural disorders on criminal offending direct or mediated by adolescent processes related to school experience, substance misuse, and peers?

Method

Structural equation modelling, with latent variables, was applied to longitudinally collected data on 4,644 males from the 1986 Northern Finland Birth Cohort Study.

Results

Both ADHD and DBD separately predicted felony conviction risk. Most of these effects were mediated by adolescent alcohol use and low academic performance. The effect of DBD was stronger and included a direct pathway to criminal offending.

Conclusion

Findings were more consistent with the life course mediation hypothesis of pathways into crime, in that the effects of each disorder category were mediated by heavy drinking and educational failure. Preventing these adolescent risk outcomes may be an effective approach to closing pathways to criminal behaviour among behaviourally disordered children. However, as there was some evidence of a direct pathway from DBD, effective treatments targeting this disorder are also expected to reduce criminal offending.

Below:  Structural Equation Model (Standardised Path Estimates are Reported)

Full article at:   http://goo.gl/SoVWGH

  

By:  Jukka Savolainen, W. Alex Mason, Jonathan D. Bolen, Mary B. Chmelka, Tuula Hurtig, Hanna Ebeling, Tanja Nordström, and Anja Taanila

Jukka Savolainen, School of Criminology and CriminalJustice, University of Nebraska at Omaha, 321 Nebraska Hall, Lincoln, NE 68588-0561, USA, Phone 402-472-3677, FAX 402-472-6758

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Retrospective cohort study of cancer incidence and mortality by HIV status in a Georgia, USA, prisoner cohort during the HAART era

OBJECTIVE:

Non-AIDS-defining cancers (NADCs) have emerged as significant contributors to cancer mortality and morbidity among persons living with HIV (PLWH). Because NADCs are also associated with many social and behavioural risk factors that underlie HIV, determining the extent to which each of these factors contributes to NADC risk is difficult. We examined cancer incidence and mortality among persons with a history of incarceration, because distributions of other cancer risk factors are likely similar between prisoners living with HIV and non-infected prisoners.

DESIGN:

Registry-based retrospective cohort study.

PARTICIPANTS:

Cohort of 22 422 persons incarcerated in Georgia, USA, prisons on 30 June 1991, and still alive in 1998.

OUTCOME MEASURES:

Cancer incidence and mortality were assessed between 1998 and 2009, using cancer and death registry data matched to prison administrative records. Age, race and sex-adjusted standardised mortality and incidence ratios, relative to the general population, were calculated for AIDS-defining cancers, viral-associated NADCs and non-infection-associated NADCs, stratified by HIV status.

RESULTS:

There were no significant differences in cancer mortality relative to the general population in the cohort, regardless of HIV status. In contrast, cancer incidence was elevated among the PLWH. Furthermore, incidence of viral-associated NADCs was significantly higher among PLWH versus those without HIV infection (standardised incidence ratio=6.1, 95% CI 3.0 to 11.7, p<0.001).

CONCLUSIONS:

Among PLWH with a history of incarceration, cancer incidence was elevated relative to the general population, likely related to increased prevalence of oncogenic viral co-infections. Cancer prevention and screening programmes within prisons may help to reduce the cancer burden in this high-risk population.

Full article at:   http://goo.gl/bU7ddc

By:  Zlotorzynska M1, Spaulding AC1, Messina LC1, Coker D1, Ward K1, Easley K1, Baillargeon J2, Mink PJ3, Simard EP1.

• 1Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
• 2University of Texas Medical Branch, Galveston, Texas, USA.
• 3Rollins School of Public Health, Emory University, Atlanta, Georgia, USA Division of Applied Research, Allina Health, Minneapolis, Minnesota, USA.
• BMJ Open. 2016 Apr 11;6(4):e009778. doi: 10.1136/bmjopen-2015-009778. 

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New Mexico plaintiffs filing lawsuits against prison healthcare providers by year

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Extended-Release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders

BACKGROUND:

Extended-release naltrexone, a sustained-release monthly injectable formulation of the full mu-opioid receptor antagonist, is effective for the prevention of relapse to opioid dependence. Data supporting its effectiveness in U.S. criminal justice populations are limited.

METHODS:

In this five-site, open-label, randomized trial, we compared a 24-week course of extended-release naltrexone (Vivitrol) with usual treatment, consisting of brief counseling and referrals for community treatment programs, for the prevention of opioid relapse among adult criminal justice offenders (i.e., persons involved in the U.S. criminal justice system) who had a history of opioid dependence and a preference for opioid-free rather than opioid maintenance treatments and who were abstinent from opioids at the time of randomization. The primary outcome was the time to an opioid-relapse event, which was defined as 10 or more days of opioid use in a 28-day period as assessed by self-report or by testing of urine samples obtained every 2 weeks; a positive or missing sample was computed as 5 days of opioid use. Post-treatment follow-up occurred at weeks 27, 52, and 78.

RESULTS:

A total of 153 participants were assigned to extended-release naltrexone and 155 to usual treatment. During the 24-week treatment phase, participants assigned to extended-release naltrexone had a longer median time to relapse than did those assigned to usual treatment (10.5 vs. 5.0 weeks, P<0.001; hazard ratio, 0.49; 95% confidence interval [CI], 0.36 to 0.68), a lower rate of relapse (43% vs. 64% of participants, P<0.001; odds ratio, 0.43; 95% CI, 0.28 to 0.65), and a higher rate of opioid-negative urine samples (74% vs. 56%, P<0.001; odds ratio, 2.30; 95% CI, 1.48 to 3.54). At week 78 (approximately 1 year after the end of the treatment phase), rates of opioid-negative urine samples were equal (46% in each group, P=0.91). The rates of other prespecified secondary outcome measures--self-reported cocaine, alcohol, and intravenous drug use, unsafe sex, and reincarceration--were not significantly lower with extended-release naltrexone than with usual treatment. Over the total 78 weeks observed, there were no overdose events in the extended-release naltrexone group and seven in the usual-treatment group (P=0.02).

CONCLUSIONS:

In this trial involving criminal justice offenders, extended-release naltrexone was associated with a rate of opioid relapse that was lower than that with usual treatment. Opioid-use prevention effects waned after treatment discontinuation.

Purchase full article at:   http://goo.gl/GxwJ8D

By:  Lee JD1, Friedmann PD1, Kinlock TW1, Nunes EV1, Boney TY1, Hoskinson RA Jr1, Wilson D1, McDonald R1, Rotrosen J1, Gourevitch MN1, Gordon M1,Fishman M1, Chen DT1, Bonnie RJ1, Cornish JW1, Murphy SM1, O'Brien CP1.

• 1From the Departments of Population Health (J.D.L., R.M., M.N.G.), Medicine, Division of General Internal Medicine and Clinical Innovation (J.D.L.), and Psychiatry (J.R.), New York University, and the New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons (E.V.N.) - both in New York; the Division of General Internal Medicine, the Department of Medicine, Rhode Island Hospital and Alpert Medical School of Brown University, Providence (P.D.F., R.A.H., D.W.); Friends Research Institute (T.W.K., M.G., M.F.), the University of Baltimore, School of Criminal Justice (T.W.K.), and Maryland Treatment Centers (M.F.) - all in Baltimore; the University of Pennsylvania (T.Y.B., J.W.C., C.P.O.) and the Philadelphia Veterans Affairs Medical Center (J.W.C.) - both in Philadelphia; the Center for Biomedical Ethics and Humanities, School of Medicine (D.T.C.) and the School of Law (R.J.B.), University of Virginia, Charlottesville; and Washington State University, Spokane (S.M.M.). 
• N Engl J Med. 2016 Mar 31;374(13):1232-42. doi: 10.1056/NEJMoa1505409.

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Prevalence of Hepatitis C Virus in Brazil's Inmate Population: A Systematic Review

OBJECTIVE

To estimate the prevalence of hepatitis C virus infection in Brazil's inmate population.

METHODS

Systematic review on hepatitis C virus infection in the inmate population. Brazilian studies published from January 1, 1989 to February 20, 2014 were evaluated. The methodological quality of the studies was assessed using a scale of 0 to 8 points.

RESULTS

Eleven eligible studies were analyzed and provided data on hepatitis C virus infection among 4,375 inmates from seven states of Brazil, with a mean quality classification of 7.4. The overall hepatitis C virus prevalence among Brazilian inmates was 13.6% (ranging from 1.0% to 41.0%, depending on the study). The chances of inmates being seropositive for hepatitis C virus in the states of Minas Gerais (MG), Sergipe (SE), Mato Grosso do Sul (MS), Rio Grande do Sul (RS), Goiás (GO) and Espirito Santo (ES) were 84.0% (95%CI 0.06;0.45), 92.0% (95%CI 0.04;0.13), 88.0% (95%CI 0.09;0.18), 74.0% (95%CI 0.16;0.42), 84.0% (95%CI 0.08;0.31) and 89.0% (95%CI 0.01;0.05) respectively, lower than that observed in the Sao Paulo state (seroprevalence of 29.3%). The four studies conducted in the city of Sao Paulo revealed a lower prevalence in more recent studies compared to older ones.

CONCLUSIONS

The highest prevalence of hepatitis C virus infection in Brazil's inmate population was found in Sao Paulo, which may reflect the urban diversity of the country. Despite Brazilian studies having good methodological quality to evaluate the prevalence of the hepatitis C virus, they are scarce and lack data on risk factors associated with this infection, which could support decisions on prevention and implementation of public health policies for Brazilian prisons.

Prevalence of hepatitis C virus among inmate populations grouped into seven different states of Brazil.

State	Positive samples	Sample size	HCV sero-prevalence (%)	95%CI		OR	95%CI		p
				Lower	Upper		Lower	Upper
Sao Paulo	624	2,131	29.3	27.3	31.2	Ref.	–	–	< 0.001
Minas Gerais	4	63	6.3	0.3	12.4	0.16	0.06	0.45
Sergipe	13	422	3.1	1.4	4.7	0.08	0.04	0.13
Mato Grosso do Sul	33	686	4.8	3.2	6.4	0.12	0.09	0.18
Rio Grande do Sul	19	195	9.7	5.6	13.9	0.26	0.16	0.42
Goias	9	148	6.1	2.2	9.9	0.16	0.08	0.31
Espirito Santo	7	730	1.0	0.3	1.7	0.02	0.01	0.05
Total	709	4,375	16.2	15.1	17.3	–	–	–

Full article at:   http://goo.gl/tgGDws

By:  Magri MC1, Ibrahim KY2, Pinto WP2, França FO2, Bernardo WM3, Tengan FM2.

• 1Laboratório de Investigação Médica em Hepatologia por Vírus, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
• 2Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
• 3Centro de Desenvolvimento de Educação Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. 
• Rev Saude Publica. 2015;49:36. doi: 10.1590/S0034-8910.2015049005886. Epub 2015 Jul 31.

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The Need for Higher Standards in Correctional Healthcare to Improve Public Health

Over the last 40 years, the United States has experienced an “epidemic” of incarceration, in which millions of Americans have spent days to years of their lives in jails or prisons. During this time, correctional medicine has undergone major changes.^1,2 In 1976, the U.S. Supreme Court affirmed that failure to provide basic medical care to a prisoner violates the Eighth Amendment to the Constitution banning cruel and unusual punishment.³ Over the ensuing decades, additional litigation or threat of litigation has forced correctional institutions to provide a minimum community standard of healthcare to prisoners. In response, accreditation bodies such as the National Commission on Correctional Health Care have codified these minimum standards for prison and jail-based health systems to follow through voluntary accreditation. However, a minority of the 4,575 correctional institutions across the U.S. have volunteered to become accredited using these standards. As a result, litigation remains the mainstay of enforcing correctional healthcare standards,⁴and correctional healthcare improvements have transpired piecemeal, typically with a focus only on reaching the minimum standards that have been established.

While meeting minimum standards is critical in protecting against Eighth Amendment violations, we argue that higher standards in correctional healthcare are capable of improving individual and public health while controlling overall costs. With 2.2 million Americans behind bars, and 10 million cycling through correctional systems each year,⁵ U.S. correctional healthcare has provided medical care to 1 in 30 living American adults, the majority of whom are from impoverished communities, where poor healthcare access is the norm.^6–10 Since more than 95% of prisoners eventually return to the community, correctional healthcare has the opportunity, and the obligation, to transform care for persons and communities most in need.¹¹Moreover, given that incarcerated populations are disproportionately from traditionally underserved and/or disadvantaged backgrounds and have a high burden of disease, these goals also hold the promise of reducing health disparities.^6,8,12

We delineate three areas—screening and treatment for hepatitis C, improved mental health care, including treatment for addiction disorders, and attention to geriatric care—that exemplify the critical need for proactive, evidence-based correctional healthcare that reaches beyond minimum standards and integrates prisoner healthcare into mainstream medicine in order to improve the health of individuals and communities.

Below:  Number of U.S. Prisoners, 1925–2012

Below:  Prevalence of Substance Abuse among State and Federal Prisoners

Below:  Prevalence of Any Mental Illness among State and Federal Prisoners and Jail Inmates

Below:  Prevalence of Hepatitis C in State and Federal Prisoners and Jail Inmates

Full article at:  http://goo.gl/ryrbUv

By:  Rich JD1, Allen SA, Williams BA.

• 1Warren Alpert Medical School, Brown University, Providence, RI, USA, jrich@lifespan.org.
• J Gen Intern Med. 2015 Apr;30(4):503-7. doi: 10.1007/s11606-014-3142-0. Epub 2014 Dec 19. 

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Anxiety and Associated Factors among Prisoners in North West of Amhara Regional State, Ethiopia

BACKGROUND:

Mental illnesses are more common among the prison population than the general public. However, little attention is given to mental health service in low and middle income countries in general. The problem is more so for prisoners where the overall health care is poor. Therefore, the aim of this study was to assess the prevalence of anxiety and the associated factors among prisoners of North West Amhara, Ethiopia.

METHODS:

Institutional based cross-sectional study was employed from February to March 2015 by taking a sample of 700 prisoners. Simple random sampling method was employed to select three prisons out of 10 prisons found in the North West Amhara region. Generalized Anxiety Disorder 7-item (GAD-7) scale was used to assess prisoners' anxiety status. The receiver- operator characteristic (ROC) curve was used to determine the cutoff point with high sensitivity and specificity. Structured and pretested interviewer administered questionnaire was used for data collection. Data were checked, coded and entered into Epi Info version 7 and analyzed using R version 3.2.0. Bivariable and multivariable logistic regression analyses were carried out to identify factors associated with anxiety. Odds ratio with its 95 % confidence interval was used as a measure of association. Akaike's Information's Criterion (AIC) was used to check model fitness.

RESULTS:

A total of 649 prisoners were included in the analysis making the response rate 92.5 %. The prevalence of Anxiety was found to be 36.1 % (95 % CI: 32.7, 39.9). The odds of Anxiety was 2.49(95 % CI: 1.38, 4.55) times higher among prisoners who used to be unhappy in their life before imprisonment. Moreover, smokers were 2.6 (AOR = 2.6, 95 % CI: 1.08, 6.6) times more likely to have anxiety compared with non smokers. However, the odds of the odds of anxiety was 89% lower among Debre-Tabor prisoners (AOR = 0.11, 95 % CI: 0.06, 0.20) and 57 % lower among Gondar prisoners (AOR = 0.43, 95 % CI: 0.28, 0.67).

CONCLUSION:

The prevalence of anxiety is found to be very high among prisoners in North West Ethiopia. Anxiety was associated with current smoking and having had a dissatisfying life. Screening prisoners for common mental disorders and integrated health care is necessary.

Full article at:   http://goo.gl/MGOyGn

By:  Dadi AF1, Dachew BA2, Kisi T3, Yigzaw N4, Azale T5.

• 1Department of Epidemiology and Biostatistics, Institute of public Health, University of Gondar, Gondar, Ethiopia. Fekten@yahoo.com.
• 2Department of Epidemiology and Biostatistics, Institute of public Health, University of Gondar, Gondar, Ethiopia.
• 3Department of Public Health, College of health sciences, Arsi University, Arsi, Ethiopia.
• 4Department of Psychiatry, School of Medicine, University of Gondar, Gondar, Ethiopia.
• 5Department of Health Education and Behavioral Science, Institute of public Health, University of Gondar, Gondar, Ethiopia. 
• BMC Psychiatry. 2016 Mar 31;16(1):83.

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