In-facility HIV peer-based rehabilitation programs’ role in linkage to care among persons transitioning from correctional to community-based HIV care in South Africa

• DOI: https://doi.org/10.1108/IJPH-05-2021-0044
• Published date: 27 January 2022
• Date: 27 January 2022
• Pages: 473-482
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice
• Author: Nimasha B. Fernando,Daniel M. Woznica,Tonderai Mabuto,Christopher J. Hoffmann

In-facility HIV peer-based rehabilitation

programs’role in linkage to care among

persons transitioning from correctional to

community-based HIV care in South Africa

Nimasha B. Fernando, Daniel M. Woznica, Tonderai Mabuto and Christopher J. Hoffmann

Abstract

Purpose –This analysis aims to examine therole of pre-release, HIV-related, peer-based rehabilitation

programattendance on post-release linkageto community-based HIV care in South Africa.

Design/methodology/approach –During a post-release linkage-to-care prospective study,

participants from six correctional facilities who had an HIV-positive diagnosis and were taking anti-

retroviral medicationsat release (N= 351) self-reported rehabilitationprogram participation. Linkage-to-

care status90 days post-release was verifiedby medical chart review.

Findings –In a binomial regression model, HIV-related, peer-based rehabilitationprogram attendance

was insignificant(relative risk [RR] 1.1, 95% confidence interval[CI] [0.8, 1.4], p-value = 0.7), but short-/

long-term incarceration site (RR 1.5, 95% CI [1.0, 2.1], p-value = 0.04) and relationship status pre-

incarceration(RR 1.9, 95% CI [1.0, 3.6], p-value = 0.05) were significantly associated with linkageto HIV

care post-release.

Originality/value –Rehabilitation and peer-based HIV programs have had demonstrated benefit in

other settings.Assessment of current programsmay identify opportunitiesfor improvement.

Keywords HIV, South Africa, Prison, Incarceration, Reentry, Linkage to care

Paper type Research paper

Background

Community reentry has been consistently shown to be a high-risk period for disengagement

from human immunodeficiency virus (HIV) care (Fu et al.,2013;Iroh et al., 2015;Springer

et al.,2011

;Westergaard et al.,2013). During the reentry process, individuals encounter

multiple challenges including unstable housing (Springer et al.,2011), economic insecurity

(Iroh et al.,2015;Springer et al.,2011), substance abuse disorders (Iroh et al.,2015;

Springer et al., 2011;Westergaard et al., 2013), stigmatization (Iroh et al., 2015), poor

management of mental illness (Baillargeon et al.,2010;Iroh et al.,2015;Spaulding et al.,

2013;Springer et al.,2011) and limited ability to navigate social service systems including

health care (Westergaard etal.,2013).

Pre-release skill development and motivational enhancement programs have evidence of being

effective for promotion of post-release health behaviors, including linkage to care. Several

studies have found statistically significant associations between in-prison health education

sessions and post-release care engagement (Althoff et al., 2013;Booker et al., 2013),

particularly when included as part of multi-level interventions such as pre- and post-release

patient navigation with peer support and case management services (Myers et al., 2018). A

(Informationabout the

authorscan be found at the

end of this article.)

Received 5 July 2021

Revised 30 October 2021

12 December 2021

Accepted 13 December 2021

The authors appreciate the time

provided by all participants and

the clinical and correctional

service teams within the

South African Department of

Corrections Services. The

authors also thank the

Dr James A. Ferguson

Emerging Infectious Diseases

Research Initiatives for Student

Enhancement Fellowship

program, especially Dr Harolyn

Belcher, Dr Damani Piggott and

Dr Kathryn Van Eck, for

providing 2018 summer

research mentorship and sup-

port.

Funding: This journal article

was supported by the Grant or

Cooperative Agreement

Number, 1 NU50MN000004,

funded by the Centers for

Disease Control and

Prevention. Its contents are

solely the responsibility of the

authors and do not necessarily

represent the official views of

the Centers for Disease Control

and Prevention or the

Department of Health and

Human Services.

DOI 10.1108/IJPH-05-2021-0044 VOL. 18 NO. 4 2022,pp. 473-482, ©Emerald Publishing Limited, ISSN 1744-9200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 473