Pilot to Transition Incarcerated HIV+/- Opiate Users to the Community

Jacqueline Peterson-Tulsky, UC-San Francisco
HIV/AIDS Policy & Health Care Financing

The decrease in risky sexual and injection drug use behaviors has been the primary focus of prevention efforts against the spread of theHIV. Foropioidaddicts, abundant datahasshownthereduction in risky behavior when treatment is offered with opioid replacement therapy. For more than three decades Methadone, administered in a structured strictly prescribed program, was the only treatment available until the release of Buprenorphine. California laws have restricted opioid replacement therapy options in many communities, and this has made it virtually impossible for jails to begin opioid replacement therapy on incarcerated opioid addicts. Physicians can now prescribe effective opioid replacement therapy for opioid dependent persons using Buprenorphine, including persons who are incarcerated. In San Francisco, leadership in public health and in the sheriff 's department has been supportive of providing opioid replacement therapy to HIV+ and HIV-addicts, but the program in the jail has been slow to be implemented.

Buprenorphine is viewed as an effective, economical and viable alternative to methadone, especially in a jail setting where the complex rules of methadone licensing may be difficult to implement. But, Buprenorphine has yet to be fully utilized in a jail-based setting as opiate replacement. Initially, the San Francisco Jail Health Services program for treating opiate dependent incarcerated persons was administered to opiate dependent individuals undergoing opioid withdrawal in jail. Upon release, each individual was referred to the San Francisco Department of Public Health's Induction Clinic (OBIC), located in the Mission District of San Francisco. However, a simple referral to OBIC has not been effective for linking released inmates to ongoing Buprenorphine care.

Medication adherence and treatment outcomes are optimized when linked with substance abuse treatment. The largest challenge is to stabilize peoples'lives so that they can consistently access care and to provide comprehensive, quality care to those whose lives remain chaotic. As Ryan White-funded primary care providers, the PHP clinic provides substance abuse counseling and has access to substance abuse treatment for its patients through multiple community linkages and collaborations. Substance abuse services are coordinated by five full-time social workers. Services include on-site substance abuse counseling, referrals to inpatient and outpatient substance abuse treatment programs, and a strong linkage to OTOP on the hospital campus.

Concurrent studies of this population in San Francisco indicate that a lack of ongoing effective opiate replacement therapy carries a direct correlation with high rates of progression from HIV to AIDS diagnosis and death, recidivism, risky behavior and subsequent spread of infectious diseases such as HIV and HCV. This study is designed to evaluate linkages between opiate replacement therapy in jails and community healthcare. Our research goals for this pilot are: (1.) to document the implementation of a program to induce and maintain HIV positive and negative inmates on Buprenorphine while in jail, (2.) to implement a transition program for jail inmates on Buprenorphine into the community, and (3.) to describe the characteristics ofHIV positive persons, including changes in reported HIV risk behavior, who continue on Buprenorphine after release from jail.