1. To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection Florida Department of Health: Corrections Programs Florida Department of Health: Corrections Programs Prison Pre-Release Planning and Jail Linkage Prison Pre-Release Planning and Jail Linkage

2. Division of Disease Control and Health Protection Introduction HIV Care Continuum Prisons vs Jails Counseling and Testing Prevention and Linkage Collaboration and Challenges

3. Division of Disease Control and Health Protection HIV Care Continuum Cascade cascade source: www.aids.gov

4. Division of Disease Control and Health Protection Socioeconomic Factors and HIV Socioeconomic Factors and HIV Poverty Discrimination, stigma HIV Prevalence Undiagnosed/untreated STDs Language barriers Incarceration

5. Division of Disease Control and Health Protection Differences: Prisons vs Jails Differences: Prisons vs Jails Prisons Funded/operated by state Length of stay between 3 - 5 years Level of care similar to community standards

6. Division of Disease Control and Health Protection HIV-infected Inmates HIV/AIDS rates in corrections settings are 3 - 5 times higher than general population Over 95% of inmates will return to their communities Appx 100,000 inmates in FL prison system... about 3,000 have HIV/AIDS Appx 100 HIV-infected inmates leave prison each month

7. Division of Disease Control and Health Protection Pre-Release Planning Program (PRPP) DOC mandated to test for HIV within 60 days of inmate's release DOH contracts with DOC to provide PRPP services to HIV-infected inmates Contract totals $450,000 PRPP includes all DOC institutions and some transitional programs Funded by Ryan White Part B

8. Division of Disease Control and Health Protection Pre-Release Planning Program (PRPP) Five PRPP planners employed by DOC - divided among 5 regions Planner coordinates with CBO or medical providers to link inmate to care Inmates given copies of med record if requested and 30-day supply of meds

9. Division of Disease Control and Health Protection PRPP Inmates Served CY 2012-13 (n=1,618 thru Oct 2013) PRPP Inmates Served CY 2012-13 (n=1,618 thru Oct 2013)

10. Division of Disease Control and Health Protection PRP Map

11. Community Linkage Coordinators (CLC) More intensive services in Broward, Miami-Dade and Orange counties PRPP and CLC coordinate inmate appointments upon release from prison Medical appointment within one week of release Linkages to medical, SAMH, ADAP, case mgmt, housing, transportation, etc Up to six-month follow up with inmate after release Division of Disease Control and Health Protection

12. CLC Inmates Served CY 2012-13 (n=315 thru Oct 2013) CLC Inmates Served CY 2012-13 (n=315 thru Oct 2013) Division of Disease Control and Health Protection

13. Peer Education Training Program (PET) DOC program located at Central Florida Reception Center (CFRC) Provide peer education train-the- trainer sessions Education and prevention information Trainer supervises inmate peer educators as they conduct sessions

14. Division of Disease Control and Health Protection Peer Education Training Program (PET) 2012: 2 train-the trainer classes held 8 inmate peer educators trained 57 orientation sessions held 4,176 inmates attended sessions 2,977 (71.3%) requested HIV test after sessions

15. Differences: Prisons vs Jails Differences: Prisons vs Jails Jails Funded/operated by local govt Length of stay between 23 - 46 days, not more than 1 year Appx 50% released within 48 hours Division of Disease Control and Health Protection

16. Jail Linkage Program (JLP) Counties submitted proposals to provide services JLPs operate through CHD with no contracts Instead use MOAs JLP located in 16 jails Funding appx $1.2 million

17. Division of Disease Control and Health Protection JLP Inmates Tested CY 2012-13 (n=47,762 thru Sept 2013) JLP Inmates Tested CY 2012-13 (n=47,762 thru Sept 2013) 0.5% Positive 0.8% Positive 0.6% Overall Positive Rate

18. How to Use Navigation Division of Disease Control and Health Protection JLP Linkages CY 2012-13 (n=3,959 thru Sept 2013) JLP Linkages CY 2012-13 (n=3,959 thru Sept 2013)

19. Division of Disease Control and Health Protection JLP Annual Comparison Testing, Linkages, Positives 2008-2013 (thru Sept 2013) JLP Annual Comparison Testing, Linkages, Positives 2008-2013 (thru Sept 2013)

20. Division of Disease Control and Health Protection Jail Linkage Program (JLP) Bureau of Communicable Diseases Florida Department of Health JLP in 16 Counties: o 15 Counties funded by DOH o 1 County unfunded (Monroe)

21. Division of Disease Control and Health Protection Corrections Infections Workgroup HIV/AIDSEpidemiology Hepatitis Corrections Juvenile Justice Correctional Medical Authority Substance Abuse/Mental Health Education STD and TB

22. Division of Disease Control and Health Protection Funding Sequestration Round 1 - 2013 Sequestration Round 2 - 2014 Program evaluations/reviews "High-impact" prevention Challenges: The Future

23. How to Use Navigation Division of Disease Control and Health Protection www.floridahealth.gov

24. How to Use Navigation Division of Disease Control and Health Protection HIV Care Continuum Cascade + Literacy cascade source: www.aids.gov Overall: HIV+ more common with < HS education Almost half FL HIV+ inmates < HS education

25. How to Use Navigation Division of Disease Control and Health Protection HIV Care Continuum Cascade + Unemployed cascade source: www.aids.gov 88% FL HIV+ inmates with min-mod skills Overall: 45% are unemployed

26. How to Use Navigation Division of Disease Control and Health Protection Overall: 33% to 60% affected by depression HIV Care Continuum Cascade + Depression cascade source: www.aids.gov

27. How to Use Navigation Division of Disease Control and Health Protection Overall: 53% alcohol use in past month HIV Care Continuum Cascade + Alcohol and Other Drugs cascade source: www.aids.gov Overall: 50% drug use in past year Overall: 15% considered heavy drinkers 15% FL HIV+ inmates IDU 33% FL HIV+ inmates poly- drug users

28. How to Use Navigation Division of Disease Control and Health Protection HIV Care + Combination Prevention cascade source: www.aids.gov Combination Prevention: Services Integration

29. To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Division of Disease Control and Health Protection VANCE BURNS CORRECTIONS SPECIALIST HIV/AIDS AND HEPATITIS SECTION BUREAU OF COMMUNICABLE DISEASES (850) 245-4424, EXT 2565 vance.burns@flhealth.gov