Washington, D.C. suffers from the most devastating HIV epidemic in the United States, with 3 percent of the general population and 6 percent of prison inmates being infected. Now, researchers from Yale, along with colleagues from George Mason and Howard Universities in the Washington area, have received a $4.2 million grant from the National Institute on Drug Abuse (NIDA) to study access and adherence to HIV treatment among infected drug users involved with the criminal justice system in the nation's capital.
In the United States and many countries around the world, HIV and concurrent substance disorder rates are extremely high among prison populations. The study aims to identify, treat and retain HIV-infected persons involved in the front and back ends of the criminal justice system — from time of arrest to parole — where defendants are supervised in community settings. Transition times like this, and after release from prison, are when inmates are most vulnerable to abandoning treatment.
As part of this study, pre-trial and adjudicated defendants who are opioid dependent will for the first time be offered immediate access to supervised withdrawal, sometimes called "detox," using the replacement medication buprenorphine. During this period they will also be tested for HIV, other infections and mental illness, and offered treatment.
"Criminal justice systems have not adopted and in most situations not even allowed medication-assisted treatments for opioid dependence like buprenorphine, methadone or even extended-release naltrexone to be used while defendants are under supervision," said principal investigator Frederick L. Altice, M.D., professor of medicine at Yale School of Medicine and Director of Clinical and Community Research.
"In addition to addressing the HIV and substance abuse treatment outcomes in this highly vulnerable population, this study allows us to examine what happens as HIV-infected individuals move between being in pre-trial services, jail, prison, probation and parole. These moves are likely to result in adverse treatment outcomes and perpetuate the HIV epidemic, and have untold consequences on public safety," states co-principal investigator Faye S. Taxman, Ph.D. of George Mason University in Fairfax, Virginia.
The nation's capital is home to the country's worst HIV epidemic, primarily among people of color. "This study will contribute greatly to easing the continuing health disparities among racial and ethnic minorities who are disproportionately impacted by substance use disorders and HIV/AIDS," says site principal investigator William B. Lawson, M.D., PhD, Professor and Chair of Psychiatry and Behavioral Sciences at Howard University in Washington, D.C.
Other investigators are Sandra A. Springer, M.D., of Yale University, and Cecilia Maxwell, M.D. of Howard University.