Try a new search

Format these results:

Searched for:



Total Results:


Linkage to hepatitis C care after incarceration in jail: a prospective, single arm clinical trial

Akiyama, Matthew J; Columbus, Devin; MacDonald, Ross; Jordan, Alison O; Schwartz, Jessie; Litwin, Alain H; Eckhardt, Benjamin; Carmody, Ellie
BACKGROUND:Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. METHODS:We conducted a single arm clinical trial of a combined transitional care coordination (TCC) and patient navigation intervention and assessed the linkage rate and factors associated with linkage to HCV care after incarceration. RESULTS:During the intervention, 84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years. Of those who returned to the community, 26 (31%) linked to HCV care within a median of 20.5 days; 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, 9 (11%) had a follow-up lab drawn to confirm sustained virologic response (SVR), and 7 (8%) had a documented SVR. Among those with follow-up labs the known SVR rate was (7/9) 78%. Expressing a preference to be linked to the participant's existing health system, being on methadone prior to incarceration, and feeling that family or a loved one were concerned about the participant's wellbeing were associated with linkage to HCV care. Reporting drinking alcohol to intoxication prior to incarceration was negatively associated with linkage to HCV care. CONCLUSION/CONCLUSIONS:We demonstrate that an integrated strategy with combined TCC and patient navigation may be effective in achieving timely linkage to HCV care. Additional multicomponent interventions aimed at treatment of substance use disorders and increasing social support could lead to further improvement. TRIAL REGISTRATION/ NCT04036760 July 30th, 2019 (retrospectively registered).
PMID: 31395019
ISSN: 1471-2334
CID: 4034412

Witnessed overdoses and naloxone use among visitors to Rikers Island jails trained in overdose rescue

Huxley-Reicher, Zina; Maldjian, Lara; Winkelstein, Emily; Siegler, Anne; Paone, Denise; Tuazon, Ellenie; Nolan, Michelle L; Jordan, Alison; MacDonald, Ross; Kunins, Hillary V
With the opioid overdose mortality rates rising nationally, The New York City Department of Health and Mental Hygiene (NYC DOHMH) has worked to expand overdose rescue training (ORT) and naloxone distribution. This study sought to determine rates of overdose witnessing and naloxone use among overdose rescue-trained visitors to the NYC jails on Rikers Island. We conducted a six-month prospective study of visitors to NYC jails on Rikers Island who received ORT. We collected baseline characteristics of study participants, characteristics of overdose events, and responses to witnessed overdose events, including whether the victim was the incarcerated individual the participant was visiting on the day of training. Bivariate analyses compared baseline characteristics of participants who witnessed overdoses to those who did not, and of participants who used naloxone to those who did not. Overall, we enrolled 283 participants visiting NYC's Rikers Island jails into the study. Six months after enrollment, we reached 226 participants for follow-up by phone. 40 participants witnessed 70 overdose events, and 28 participants reported using naloxone. Of the 70 overdose events, three victims were the incarcerated individuals visited on the day of training; nine additional victims were recently released from jail and/or prison. Visitors to persons incarcerated at Rikers Island witness overdose events and are able to perform overdose rescues with naloxone. This intervention reaches a population that includes not only those recently released, but also other people who experienced overdose.
PMID: 29175025
ISSN: 1873-6327
CID: 2890852

Linkage to HCV care and reincarceration following release from New York City jails [Meeting Abstract]

Akiyama, M.; Macdonald, R.; Jordan, A.; Columbus, D.; Schwartz, J.; Litwin, A.; Eckhardt, B.; Carmody, E.
ISSN: 0168-8278
CID: 5267622

Implementation and Evaluation of a Care Coordination Program for Patients with Hepatitis C Following Release from Jail [Meeting Abstract]

Akiyama, Matthew J; Macdonald, Ross; Jordan, Alison; Columbus, Devin; Litwin, Alain H; Echkardt, Bejamin; Carmody, Ellie
ISSN: 1527-3350
CID: 2746182

Medicine and Mass Incarceration: Education and Advocacy in the New York City Jail System

Giftos, Jonathan; Mitchell, Andreas; MacDonald, Ross
The United States incarcerates more people than any other country in the world. The scale of mass incarceration ensures that almost all practicing physicians will treat formerly incarcerated patients. Yet the majority of physicians receive little training on this topic. In this paper, we will outline the need for expanded education on the interface between incarceration and health, describe initiatives taking place within the New York City jail system and nationally, and describe future directions for curriculum development. We conclude by highlighting the important role health care workers can play in transforming our criminal justice system and ending mass incarceration.
PMID: 28905732
ISSN: 2376-6980
CID: 2701402

Correlates of Hepatitis C Virus Infection in the Targeted Testing Program of the New York City Jail System

Akiyama, Matthew J; Kaba, Fatos; Rosner, Zachary; Alper, Howard; Kopolow, Aimee; Litwin, Alain H; Venters, Homer; MacDonald, Ross
OBJECTIVE:The objective of this study was to understand predictors of hepatitis C virus (HCV) antibody positivity in a large urban jail system in New York City. METHODS:We examined demographic characteristics, risk behaviors, and HCV antibody prevalence among 10 790 jail inmates aged 16 to 86 who were screened from June 13, 2013, to June 13, 2014, based on birth cohort or conventional high-risk criteria. We used logistic regression analysis to determine predictors of HCV antibody positivity. RESULTS:Of the 10 790 inmates screened, 2221 (20.6%) were HCV antibody positive. In the multivariate analysis, HCV antibody positivity was associated most strongly with injection drug use (IDU; adjusted odds ratio [aOR] = 35.0; 95% confidence interval [CI], 28.5-43.0). Women were more likely than men to be infected with HCV (aOR = 1.3; 95% CI, 1.1-1.5). Compared with non-Hispanic black people, Hispanic (aOR = 2.1; 95% CI, 1.8-2.4) and non-Hispanic white (aOR = 1.7; 95% CI, 1.5-2.1) people were more likely to be infected with HCV. Non-IDU, recidivism, HIV infection, homelessness, mental illness, and lower education level were all significantly associated with HCV infection. The prevalence rate of HCV infection among a subset of inmates born after 1965 who denied IDU and were not infected with HIV was 5.6% (198 of 3529). Predictors of HCV infection among this group included non-IDU as well as being non-Hispanic white, Hispanic, recidivist, and homeless. CONCLUSION:These data reveal differences in HCV infection by sex, race/ethnicity, and socioeconomics in a large jail population, suggesting that a focused public health intervention is required and that universal screening may be warranted. Further sensitivity and cost-benefit analyses are needed to make this determination.
PMID: 28005477
ISSN: 1468-2877
CID: 4532962

Death After Jail Release

Alex, Byron; Weiss, David B; Kaba, Fatos; Rosner, Zachary; Lee, David; Lim, Sungwoo; Venters, Homer; MacDonald, Ross
The period immediately after release from prison or jail carries increased mortality risk. This study sought to better understand postrelease death by matching electronic health records from those incarcerated in New York City jails between 2011 and 2012 with vital statistics records. The in-jail and 6-week postrelease mortality rates were estimated to be 1.39 and 5.89 per 1,000 person-years, respectively. Of 59 deaths occurring within 6 weeks of release from jail, the causes included opioid overdose (37.3%), other drugs (8.5%), chronic disease (25.4%), assaultive trauma (20.3%), and other trauma (8.5%). These data confirm that overdose death accounts for the most frequent cause of postrelease death. Matching between correctional health systems and vital statistics can inform quality improvement efforts in jail health care delivery.
PMID: 28040993
ISSN: 1940-5200
CID: 4532972

The Rikers Island Hot Spotters: Exploring the Needs of the Most Frequently Incarcerated

Harocopos, Alex; Allen, Bennett; Glowa-Kollisch, Sarah; Venters, Homer; Paone, Denise; Macdonald, Ross
A cohort of frequently incarcerated individuals in the New York City jail system was identified through "hot spotting" analysis. This group demonstrated higher levels of substance use, mental illness, and homelessness than the general jail population, and was typically incarcerated on minor criminal charges. To understand this population better, in-depth interviews (n = 20) were conducted at three Rikers Island correctional facilities with people who had entered the jail system at least 18 times in a six-year period. Findings showed that life circumstances, chronic homelessness, mental illness, and substance use resulted in repeated institutionalization across multiple settings. Participants described an "institutional circuit" that promoted a state of permanent instability characterized by rotating involvement with custodial institutions. Exiting the institutional circuit requires the ability to navigate complex bureaucratic systems; however, without structural reorganization in social service delivery and an emphasis on permanent housing, participants in this group are unlikely to break the cycle.
PMID: 29176106
ISSN: 1548-6869
CID: 2890842

Head Trauma in Jail and Implications for Chronic Traumatic Encephalopathy in the United States: Case Report and Results of Injury Surveillance in NYC Jails

Siegler, Anne; Rosner, Zachary; MacDonald, Ross; Ford, Elizabeth; Venters, Homer
Because there is no standard reporting of injuries in jails and prisons, the national burden of head trauma during incarceration is unclear. We report on a case of repeated head trauma in the New York City (NYC) jail system, data on the incidence of head trauma and mild traumatic brain injury (mTBI), and compare those findings with national estimates. The case report revealed 64 injurious events over two years, 44% resulting in a head injury and 25% resulting in emergency hospitalization. During the 42 months of this analysis, 10,286 incidents of head trauma occurred in the NYC jail system. Mild TBI occurred in 1,507 of these instances. The rate of head trauma and mTBI was 269.0 and 39.4 per 1,000 person-years, respectively. The lack of reporting head trauma in correctional settings means that national prevalence estimates of these critical health outcomes miss the vulnerable cohort of incarcerated individuals.
PMID: 28804076
ISSN: 1548-6869
CID: 4532992

Feasibility of Treating Hepatitis C in a Transient Jail Population

MacDonald, Ross; Akiyama, Matthew J; Kopolow, Aimee; Rosner, Zachary; McGahee, Wendy; Joseph, Rodrigue; Jaffer, Mohamed; Venters, Homer
Jails represent a critical component of the public health response to HCV elimination. We report on outcomes of 104 patients receiving HCV treatment from January 1, 2014 to June 30, 2016 in a large urban jail setting. Our data demonstrate that treatment in jails is feasible, but many barriers remain.
PMID: 28852680
ISSN: 2328-8957
CID: 4533002