The role of community health workers in re-entry of people with HIV and substance use disorder released from jail: a mixed methods evaluation of a pilot study
Abstract Background Incarcerated individuals face high rates of mental illness, substance use disorders and communicable diseases including HIV, with increased health complications and mortality in the early post-release period. Multiple re-entry interventions linking justice-involved individuals to...
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BMC
2024-11-01
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| Series: | Health & Justice |
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| Online Access: | https://doi.org/10.1186/s40352-024-00301-9 |
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| author | Afeefah Khazi-Syed Emily Hoff Maverick Salyards Laura Hansen Nicholas Campalans Zoe Pulitzer Christina Melton Crain Hue Nguyen Shira Shavit Robrina Walker Ank E. Nijhawan |
| author_facet | Afeefah Khazi-Syed Emily Hoff Maverick Salyards Laura Hansen Nicholas Campalans Zoe Pulitzer Christina Melton Crain Hue Nguyen Shira Shavit Robrina Walker Ank E. Nijhawan |
| author_sort | Afeefah Khazi-Syed |
| collection | DOAJ |
| description | Abstract Background Incarcerated individuals face high rates of mental illness, substance use disorders and communicable diseases including HIV, with increased health complications and mortality in the early post-release period. Multiple re-entry interventions linking justice-involved individuals to community resources via peer navigation have emerged, though limited data exist on the mechanics and personal impact of these approaches. This paper quantifies and evaluates a pilot study of a combined Community Health Worker (CHW)-re-entry intervention for individuals released from jail who use substances and have HIV to inform future large-scale applications. Methods A mixed-methods analysis of a CHW-re-entry intervention utilized in a pilot randomized controlled trial involving people with HIV who have a history of substance (stimulant, opioid or alcohol) use in Dallas, TX was conducted using an explanatory sequential design. Quantitative assessments of the intervention measured interaction types, time spent, and topics discussed and explored associations between the “dose” of intervention and patient outcomes. Qualitative analyses of CHW field notes and end-of-study participant interviews were triangulated with quantitative findings to elucidate the intervention’s impact. Results Of the 17/31 participants assigned to the intervention, 16 interacted with the CHW on at least one occasion, and 6 successfully completed a visit with the re-entry organization. Most CHW interactions occurred by phone (66%) or in person (28%). Frequently discussed topics included substance use, housing, and physical health. On average, participants spent 7.65 h (range 0-37.18, SD = 9.33) engaged with the intervention over 6 months. Intervention dose was associated with improved HIV control, decreased stimulant use, higher rates of recidivism, and improved clinical appointment show rate. Qualitative analyses revealed key intervention components, paralleling benefits of study participation alone: outreach, nonjudgmental approach, motivation and accountability. Conclusions A CHW-re-entry intervention, while resource-intensive, shows preliminary promise in improving HIV and some substance use outcomes. Frequent telephone and in-person contact, with an empathetic yet goal-oriented approach, fostered participant support and motivation to address HIV and substance use. Participants reported that engagement in research provided accountability and a sense of purpose. Future studies should focus on optimizing implementation of CHW-based interventions to enhance impact on vulnerable populations. |
| format | Article |
| id | doaj-art-e94f189e91fa4e1a84a38e2e3840b712 |
| institution | Kabale University |
| issn | 2194-7899 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
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| series | Health & Justice |
| spelling | doaj-art-e94f189e91fa4e1a84a38e2e3840b7122024-12-01T12:14:20ZengBMCHealth & Justice2194-78992024-11-0112111110.1186/s40352-024-00301-9The role of community health workers in re-entry of people with HIV and substance use disorder released from jail: a mixed methods evaluation of a pilot studyAfeefah Khazi-Syed0Emily Hoff1Maverick Salyards2Laura Hansen3Nicholas Campalans4Zoe Pulitzer5Christina Melton Crain6Hue Nguyen7Shira Shavit8Robrina Walker9Ank E. Nijhawan10University of Texas Southwestern Medical SchoolDepartment of Internal Medicine, Division of Infectious Diseases, Johns HopkinsDepartment of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas SouthwesternDepartment of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas SouthwesternDepartment of Internal Medicine, University of California San FranciscoDepartment of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas SouthwesternUnlocking Doors®Unlocking Doors®Department of Family and Community Medicine, University of California San FranciscoThe Emmes CompanyDepartment of Internal Medicine, Division of Infectious Diseases, Johns HopkinsAbstract Background Incarcerated individuals face high rates of mental illness, substance use disorders and communicable diseases including HIV, with increased health complications and mortality in the early post-release period. Multiple re-entry interventions linking justice-involved individuals to community resources via peer navigation have emerged, though limited data exist on the mechanics and personal impact of these approaches. This paper quantifies and evaluates a pilot study of a combined Community Health Worker (CHW)-re-entry intervention for individuals released from jail who use substances and have HIV to inform future large-scale applications. Methods A mixed-methods analysis of a CHW-re-entry intervention utilized in a pilot randomized controlled trial involving people with HIV who have a history of substance (stimulant, opioid or alcohol) use in Dallas, TX was conducted using an explanatory sequential design. Quantitative assessments of the intervention measured interaction types, time spent, and topics discussed and explored associations between the “dose” of intervention and patient outcomes. Qualitative analyses of CHW field notes and end-of-study participant interviews were triangulated with quantitative findings to elucidate the intervention’s impact. Results Of the 17/31 participants assigned to the intervention, 16 interacted with the CHW on at least one occasion, and 6 successfully completed a visit with the re-entry organization. Most CHW interactions occurred by phone (66%) or in person (28%). Frequently discussed topics included substance use, housing, and physical health. On average, participants spent 7.65 h (range 0-37.18, SD = 9.33) engaged with the intervention over 6 months. Intervention dose was associated with improved HIV control, decreased stimulant use, higher rates of recidivism, and improved clinical appointment show rate. Qualitative analyses revealed key intervention components, paralleling benefits of study participation alone: outreach, nonjudgmental approach, motivation and accountability. Conclusions A CHW-re-entry intervention, while resource-intensive, shows preliminary promise in improving HIV and some substance use outcomes. Frequent telephone and in-person contact, with an empathetic yet goal-oriented approach, fostered participant support and motivation to address HIV and substance use. Participants reported that engagement in research provided accountability and a sense of purpose. Future studies should focus on optimizing implementation of CHW-based interventions to enhance impact on vulnerable populations.https://doi.org/10.1186/s40352-024-00301-9Linkage to careRe-entryHIVSubstance useCommunity health workerIncarceration |
| spellingShingle | Afeefah Khazi-Syed Emily Hoff Maverick Salyards Laura Hansen Nicholas Campalans Zoe Pulitzer Christina Melton Crain Hue Nguyen Shira Shavit Robrina Walker Ank E. Nijhawan The role of community health workers in re-entry of people with HIV and substance use disorder released from jail: a mixed methods evaluation of a pilot study Health & Justice Linkage to care Re-entry HIV Substance use Community health worker Incarceration |
| title | The role of community health workers in re-entry of people with HIV and substance use disorder released from jail: a mixed methods evaluation of a pilot study |
| title_full | The role of community health workers in re-entry of people with HIV and substance use disorder released from jail: a mixed methods evaluation of a pilot study |
| title_fullStr | The role of community health workers in re-entry of people with HIV and substance use disorder released from jail: a mixed methods evaluation of a pilot study |
| title_full_unstemmed | The role of community health workers in re-entry of people with HIV and substance use disorder released from jail: a mixed methods evaluation of a pilot study |
| title_short | The role of community health workers in re-entry of people with HIV and substance use disorder released from jail: a mixed methods evaluation of a pilot study |
| title_sort | role of community health workers in re entry of people with hiv and substance use disorder released from jail a mixed methods evaluation of a pilot study |
| topic | Linkage to care Re-entry HIV Substance use Community health worker Incarceration |
| url | https://doi.org/10.1186/s40352-024-00301-9 |
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