Blood-borne viral co-infections among HIV+ inmates

Via:  http://goo.gl/mbSFE5

Criminality and Sexual Behaviours in Substance Dependents Seeking Treatment

The aim of this study was to investigate the link between violence, crime, and sexual behavior among patients with substance-related disorder admitted to a specialized inpatient care unit. 

This was a cross-sectional study using a questionnaire on socio-demographic characteristics, drug of choice (DOC), questions about sexual behavior, and instruments to evaluate the severity of dependence (SADD, DAST, FTND), level of impulsivity (BIS-11), and a screening sex addiction scale. 

The sample consisted of 587 adult subjects, of which 

• 82.3% were men, 
• 66.4% had used cocaine (sniffed and smoked) as their DOC, 
• 24.4% had a history with the criminal justice system, 
• 26.8% had committed crimes, 
• 19.3% had engaged in violent behavior, and 
• 12.2% had been involved in drug trafficking. 

In this sample, crime was strongly associated with various sexual behaviors and the severity of substance dependence

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

By:  Diehl A¹, Pillon SC², Dos Santos MA³, Rassool GH⁴, Laranjeira R⁵.

¹a National Institute of Alcohol and Drugs Policy (INPAD), Psychiatrist, Federal University of São Paulo (UNIFESP) , Psychiatric Department , São Paulo , Brazil.

²b Professor, University of São Paulo (USP) , Psychiatric Nursing and Human Science Department, Faculty of Nursing at Ribeirão Preto, Ribeirão Preto, Brazil; PAHO/WHO Collaborating Centre for Nursing Research Development , Ribeirão Preto , Brazil.

³c Associate Professor, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto , University of São Paulo, São Paulo , Brazil.

⁴d Professor and Executive Director, Sakina Counselling Institute , Port Louis , Republic of Mauritius.

⁵e Psychiatrist, Federal University of São Paulo (UNIFESP) , Psychiatric Department , São Paulo , Brazil.

J Psychoactive Drugs. 2016 Apr-Jun;48(2):124-134.

  

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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.

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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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Prompted to Treatment by the Criminal Justice System: Relationships with Treatment Retention & Outcome among Cocaine Users

BACKGROUND AND OBJECTIVES:

A substantial portion of individuals entering treatment for substance use have been referred by the criminal justice system, yet there are conflicting reports regarding treatment engagement and outcome differences compared to those not referred. This study examined baseline characteristic and treatment outcome differences among cocaine-dependent individuals participating in cocaine treatment randomized trials.

METHODS:

This secondary analysis pooled samples across five completed randomized controlled trials, resulting in 434 participants. Of these, 67 (15%) were prompted to treatment by the criminal justice system.

RESULTS:

This subsample of criminal justice prompted (CJP) individuals did not differ from those not prompted by the criminal justice system in terms of gender, race/ethnicity, marital status, or age. However, the CJP group reported more years of regular cocaine use, more severe employment and legal problems, as well as less readiness to change prior to treatment. Treatment outcomes did not differ significantly from those without a criminal justice prompt, and on some measures the outcomes for CJP group were better (e.g., percentage of days cocaine abstinent, number of therapy sessions attended).

DISCUSSION AND CONCLUSIONS:

These findings suggest that being prompted to treatment by the criminal justice system may not lead to poorer treatment engagement or substance use outcomes for individuals participating in randomized controlled treatment trials.

SCIENTIFIC SIGNIFICANCE:

Despite some baseline indicators of poorer treatment prognosis, individuals who have been prompted to treatment by the criminal justice system have similar treatment outcomes as those presenting to treatment voluntarily.

Within treatment outcomes according to criminal justice prompt

	Prompted by Criminal Justice System (CJP) N = 67	Not Prompted by Criminal Justice System (non-CJP) N = 367	Total N = 434
	Mean (SD)	Mean (SD)	Mean (SD)	X2 or F
Days retained in treatment protocol	55.4 (29.3)	53.4 (33.1)	53.7 (32.5)	0.22
Completed treatment period, n (%)	36 (53.7)	186 (51.0)	222 (51.4)	0.68
Percentage of cocaine positive urine specimens	55 (37)	62 (37)	61 (37)	1.43
Percentage of days abstinent from cocaine	83 (19)	74 (26)	76 (25)	6.27*
Maximum consecutive days abstinent	24 (20.6)	22.3 (24.9)	22.6 (24.2)	0.25
Maximum days of continuous abstinence during last two weeks of treatment	10 (4.0)	8.3 (4.7)	8.6 (4.6)	4.65*
3+ weeks of continuous abstinence, n (%)	31 (46.3)	149 (40.8)	180 (41.7)	0.69
‘Good Functioning’ = zero cocaine use, employment, or psychological problems last 28 days of treatment, n (%)a	4 (7.5)	48 (14.5)	52 (13.5)	1.89

*p<.05

**p<.01

***p<.001

asample size reduced due to missing data

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

By:  Kiluk BD1, Serafini K, Malin-Mayor B, Babuscio TA, Nich C, Carroll KM.

• 1Yale University School of Medicine, New Haven, Connecticut. 
• Am J Addict. 2015 Apr;24(3):225-32. doi: 10.1111/ajad.12208. Epub 2015 Mar 24.

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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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"Nowhere Line" - Voices from Manus Island, Where Australia Deports Asylum Seekers - Video

Nowhere Line: Voices from Manus Island from Lukas Schrank on Vimeo.

Via:  http://goo.gl/fm7xTm

A Longitudinal Study of Mental Health Symptoms in Young Prisoners: Exploring the Influence Of Personal Factors & the Correctional Climate

BACKGROUND:

Despite the high prevalence rate of mental health problems among young prisoners, little is known about the longitudinal course and covariates of their mental health symptoms during incarceration, especially the influence of the correctional climate. The current study aimed: (1) to examine changes in young prisoners' mental health symptoms during incarceration, (2) to identify personal factors associated with their mental health symptoms and perceptions of the correctional climate, and (3) to test the incremental effect of perceptions of the correctional climate on mental health symptoms.

METHODS:

Data were obtained from a sample of 75 youths (aged 17 to 22 years) detained in a Portuguese young offender prison. Data were gathered 1, 3, and 6 months after their admission in this facility. Socio-demographic, clinical and criminological variables were collected. Mental health symptoms and perceptions of the correctional climate were assessed through self-report assessment tools. Linear and logistic (multi-level) regressions and tests for differences between means were performed to analyze the data.

RESULTS:

Overall, mental health symptoms marginally declined by the sixth month in prison. Prisoners with a history of mental health treatment were more likely to have increased symptoms. Higher levels of mental health symptoms were associated with a history of mental health treatment, remand status, and a lower educational level. Better perceptions of the correctional climate were associated with Black race and participation in prison activities. A negative perception of the correctional climate was the strongest covariate of young prisoners' mental health symptoms and had incremental validity over that of personal variables.

CONCLUSIONS:

The results highlight that both characteristics of the prisoners and of the prison environment influence young prisoners' mental health. Prison management can try to reduce young prisoners' mental health problems by developing scientific procedures for their mental health assessment and creating a more beneficial correctional climate.

Level and Changes in Mental Health Symptoms over Time in Prison

	Month 1 (n = 70)	Month 3 (n = 58)	Month 6 (n = 49)
BSI Subscale	Mean (SD)	Mean (SD)	Mean (SD)	Mean difference/Contrast
Somatizationa	0.76 (0.82)	0.75 (0.74)	0.62 (0.70)	χ 2 = 6.70*
				M6 vs. M3*
Obsessive-compulsive	1.21 (0.70)	1.26 (0.81)	1.06 (0.78)	χ 2 = 6.97*
				M6 vs. M3*
Interpersonal sensitivitya	1.04 (0.83)	1.09 (0.77)	0.97 (0.86)	ns
Depression	1.28 (0.78)	1.26 (0.86)	1.12 (0.83)	ns
Anxietya	0.93 (0.79)	0.86 (0.72)	0.77 (0.71)	ns
Hostilitya	0.96 (0.69)	0.99 (0.89)	0.93 (0.74)	ns
Phobic anxietya	0.68 (0.67)	0.63 (0.67)	0.52 (0.65)	χ 2 = 5.88†
				M6 vs. M1†
Paranoid ideationa	1.25 (0.69)	1.34 (0.88)	1.31 (0.85)	ns
Psychoticisma	1.09 (0.78)	1.10 (0.77)	1.07 (0.89)	ns
GSIa	1.04 (0.63)	1.03 (0.65)	0.93 (0.65)	χ 2 = 5.87†
				M6 vs. M3†

Note. SD Standard deviation, M1 Month 1, M3 Month 3, M6 Month 6, ns not significant, BSI Brief Symptom Inventory, GSI Global Severity Index

a Distribution normalized through square root transformation. Descriptive statistics are based on the original data. Mean differences analyses are based on the transformed variables

† p < .10, * p < .05, two-tailed

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

By:  Gonçalves LC1, Endrass J2,3, Rossegger A1,4, Dirkzwager AJ5.

• 1Department of Mental Health Services, Office of Corrections, Canton of Zurich, Hohlstrasse 552, P.O. Box 8090, Zurich, Switzerland.
• 2Department of Mental Health Services, Office of Corrections, Canton of Zurich, Hohlstrasse 552, P.O. Box 8090, Zurich, Switzerland. Jerome.Endrass@uni-konstanz.de.
• 3Department of Psychology, University of Konstanz, Universitätsstrasse 10, 78464, Konstanz, Germany. Jerome.Endrass@uni-konstanz.de.
• 4Department of Psychology, University of Konstanz, Universitätsstrasse 10, 78464, Konstanz, Germany.
• 5Netherlands Institute for the Study of Crime and Law Enforcement, 71304, 1008 BH, Amsterdam, Netherlands. 
• BMC Psychiatry. 2016 Apr 6;16(1):91. doi: 10.1186/s12888-016-0803-z.

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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.

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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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Social Support Quality & Availability Affects Risk Behaviors in Offenders

Background

People involved in the justice system are at 2.5 times the risk of HIV infection compared to the general population, which is further complicated by substance abuse. The purpose of this study was to evaluate the role of social network quality and quantity on unprotected sex, criminal risk, and substance use.

Methods

We used data from 330 drug-involved offenders. Structural equation modeling (SEM) was used to model and test path directionality and magnitude between the latent constructs of social support quality and quantity on risky behaviors.

Results

The SEM indicated the latent construct of social support quality was significantly associated with reduced sexual risk behavior (β = −0.27), criminal risk (β = −0.26), and reduced substance use (β = −0.33). Additionally, the proposed model found that social support quantity was significantly positively associated with increased sexual risk behavior (β = 0.40) and substance use (β = 0.20).

Conclusions

Social support quality is an important predictor of risky behaviors; as the quality of an offender’s social support increases, engagement in risky behaviors decreases. Probationers who had broader social support availability also had increased substance use and unprotected sex. Probation systems may be able to reduce substance use and STD/HIV infection risk in offenders by strengthening the quality of social support networks.

Below:  Structural Model of Social Support Quality and Quantity on Risk Taking Behaviors

Full article at:   http://goo.gl/VmUAv0

By:  Stephanie A. Spohr, Sumihiro Suzuki, Brittany Marshall, Faye S. Taxman, and Scott T. Walters

University of North Texas Health Science Center, Fort Worth, USA

George Mason University, Fairfax, VA USA

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