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Joseph Bick MD

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Joseph Bick MD. Chief Medical Officer. California Medical Facility ... of the release date or precipitous release by the courts can challenge ... – PowerPoint PPT presentation

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Title: Joseph Bick MD


1
Joseph Bick MD Chief Medical Officer California
Medical Facility California Department Of
Corrections and Rehabilitation
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HIV-infected prisoners, U.S. HIV in Prisons,
2004 BOJ Statistics
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States with largest HIV-infected prisoner
populations 2004 BOJ Statistics
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HIV prevalence by gender 2004 BOJ Statistics
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of population with confirmed AIDS 2004 BOJ
Statistics
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AIDS-related deaths in state prisons 2004 BOJ
Statistics
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Deaths of state prisoners 2004 BOJ Statistics
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HIV testing of prisoners, U.S. 2004 BOJ
Statistics
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HIV testing of inmates 2004 BOJ Statistics
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California Department of Corrections
  • 172,000 inmates
  • 33 prisons
  • HIV prevalence 1.5-2.5 (2500-4300)
  • Identified HIV population at any given time
    1500-1800

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HIV prevalence, CDCR 1999 Ruiz et al, DHS OOA
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CDCR 1758 HIV-infected inmates 5/07
  • CMF 530
  • CMC 400
  • CIM 247
  • COR 124
  • CCWF 95
  • NKSP 65
  • SQ 49
  • LAC 47
  • RJD 46
  • SAC 33
  • WSP 33
  • CCI 25
  • CIW 22
  • DVI 20
  • CRC 8
  • SOL 5
  • SVSP 3
  • ASP 2
  • CTF 2
  • FOL 1
  • KVSP 1

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HIV testing of prisoners, California
  • If clinically indicated
  • Upon inmate request
  • If exposure incident
  • By court order

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The Effect of Various Counseling and Testing
Methods on the Rate of HIV Testing Among Male
Prisoners
  • J. Baham, J. Gavin, S. Mittal,
  • M. Kuniholm, D. Harriss, J. Ruiz, J. Bick
  • California Department of Corrections, Department
    of Health Services Office of AIDS

22
Purpose of Study
  • Evaluate how the rate of voluntary HIV testing at
    one prison was effected by
  • different counseling strategies
  • offering different testing methodologies
  • Evaluate how HIV risk factors, testing history,
    and testing attitudes influenced testing method
    preferences

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Results
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Choice of Testing Method
  • 40 chose oral fluid testing
  • Of those who reported fear of needles, 75 chose
    oral fluid
  • 60 chose blood testing
  • Some associated oral fluid testing with DNA
    collection
  • No one chose urine testing
  • Some associated urine testing with drug testing

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Interview results (n128)
  • 23 had never tested for HIV before
  • 30 said that they did not know where to get
    tested in free community
  • 35 said that they had wanted to get tested in
    past but didnt

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Interview results
  • 44 first tested at age gt30, in spite of the fact
    that
  • 37 of testers gave history of IDU
  • 57 of testers gave history of gt5 female sex
    partners over past ten years

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Conclusions
  • 11 counseling of all new arrivals doubled rate
    of HIV testing
  • There is a role for multiple testing modalities
    within corrections

29
Assembly Bill 66 (Dymally)
  • Amends penal code sections 7520 and 7521 and
    adds sections 7507 and 7507.5 relating to inmate
    HIV testing and disclosure
  • Requires that HIV testing be offered to all
    inmates who will be incarcerated for a period of
    at least one year
  • Testing to be routinely, universally offered
    twice within 30-60 days after entry, and at
    least 60 days prior to release
  • Testing would require patient consent and could
    be declined (opt-out)

30
AB 66 (HIV Testing)
  • Requires HIV care and treatment plans, referral
    to HIV care and treatment services, and
    notification of parole officers
  • Authorizes notification to spouse or domestic
    partner of potential HIV exposure
  • States that HIV status shall not be used to deny
    eligibility for and access to programs that are
    otherwise available
  • Requires the CDCR to report annually to the DHS
    and the Legislature on the prevalence HIV

31
Impact of AB 66
  • 12 reception centers HIV counseling and testing
    services for 70,000 new intakes per year
  • All facilities counseling and testing for
    65,000 inmates in the months prior to their
    release
  • Inmates inmates found to be HIV infected will
    require additional evaluation by clinical staff
  • Lab studies, radiographic exams, immunizations,
    medications, and specialty referrals

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Impact of AB 66
  • Most HIV infected inmates currently housed at a
    limited number of facilities
  • Current housing matrix may need to be revised to
    accommodate an increased number of identified HIV
    infected prisoners

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Impacts of AB 66
  • Will require additional clinicians who are
    knowledgeable in the treatment of HIV
  • Geographic isolation of prisons often makes it
    difficult to have an HIV specialist on-site
  • ? increased use of telemedicine
  • All primary providers and nursing personnel will
    require continuing education re medication side
    effects, drug-drug interactions, opportunistic
    infections and other issues related to HIV
    infection

34
Impacts of AB 66
  • Increased pharmaceutical expenditures
  • Antiretroviral agents will be needed at all
    facilities where HIV testing takes place
  • Will need to be able to dispense antiretroviral
    agents at all facilities at the time of release

35
Linkage to care at release
  • Uncertainty of the release date or precipitous
    release by the courts can challenge effective
    discharge planning
  • AB 66 will lead to the identification of a
    significant number of HIV infected inmates
    shortly before their scheduled release.
  • ADAP, SSA, Medicaid applications

36
Linkage to the Community
  • CDCR currently contracts with community based
    organizations to provide HIV associated discharge
    planning (Transitional Case Management Program,
    TCMP)
  • TCMP establishes linkages to medical care, and
    other re-entry needs such as housing, food,
    employment, mental health and substance abuse
    treatment and childcare
  • Will require a significant expansion of the
    current TCMP

37
Harm Reduction
  • Soon after release to the general community,
    HIV-infected inmates have a high rate of unsafe
    sex practices, especially with their regular
    partners
  • Pre-release risk reduction interventions as part
    of transitional care have been found to decrease
    high risk behaviors in the months post release
    and increase linkage to community resources.

38
Impacts of AB 66
  • Increased need for mental health services
  • Partner counseling and referral services
  • HIV/AIDS Case reporting requirements
  • Rapid vs. routine testing oral fluid, serum,
    urine

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Contact information
  • Joseph Bick
  • joseph.bick_at_cdcr.ca.gov
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