ID: HR23-7
Presenting author: Barry Zack

Presenting author biography:

Since 1986, Barry has been working in the program/service community along with conducting research in collaboration with academic, governmental, and prison partners in prison/detention health; he has consulted with projects in 15 countries and in 30 U.S. states. Barry’s current efforts are focused on prison linkage and continuity of care.

Prison Linkage to Community Care: An Effective Harm Reduction Model

Barry Zack, Apinun Aramrattana
Incarceration provides access to a population with an increased burden of disease. In a 10-year literature search, researchers estimated that of the 10.2 million people incarcerated world-wide, 15.1% have HCV, 4.8% have chronic HBV, 3.8% have HIV and 2.8% have active TB. Covid presented additional challenges, with an increased burden of disease among people incarcerated. Project START+ (PS+) is an evidenced-based prison reentry harm reduction intervention for people with health conditions that require linkage to medical care. Its model (and adaptations) has been implemented in multiple countries in Central Asia, and in Haiti, Kenya, South Africa and in the United States.

To assess capacity to pilot-test PS+ in a provincial prison in Thailand. Objectives include 1) how to identify people who require post-release medical care; 2) how to assess their post-release medical and reentry needs before they are released from prison; 3) to identify clinics at the Primary Care Units (PCU) within the Provincial or District Hospitals and 4) formalizing the link between the prison and the PCU.

We conducted informal interviews with prison and PCU staff, people in prison and people recently released from prison; health conditions surveyed included HCV, HIV, TB as well as asthma, diabetes and hypertension.

Within the Thai medical system, weekly care clinics are offered at the district/provincial PCU. Preliminary data documented support from the provincial prison, the PCU staff and people about to be released.
In pilot testing the intervention model, a significant proportion of participants received medications and were linked to community care after release.

The Project START+ model is an effective and feasible intervention to recruit and link people into community care after release from prison or remand. By using a harm reduction approach, identifying competing priorities to support an individual’s linkage to community care is critical.