ResearchPad - criminal-justice-system https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[A systematic review and meta-analyses on initiation, adherence and outcomes of antiretroviral therapy in incarcerated people]]> https://www.researchpad.co/article/elastic_article_15746 Incarcerated people are at increased risk of human immunodeficiency virus (HIV) infection relative to the general population. Despite a high burden of infection, HIV care use among prison populations is often suboptimal and varies among settings, and little evidence exists explaining the discrepancy. Therefore, this review assessed barriers to optimal use of HIV care cascade in incarcerated people.MethodsQuantitative and qualitative studies investigating factors affecting linkage to care, ART (antiretroviral therapy) initiation, adherence and/or outcomes among inmates were systematically searched across seven databases. Studies published in English language and indexed up to 26 October 2018 were reviewed. We performed a narrative review for both quantitative and qualitative studies, and meta-analyses on selected quantitative studies. All retrieved quantitative studies were assessed for risk of bias. Meta-analyses were conducted using RevMan-5 software and pooled odds ratios were calculated using Mantel-Haenszel statistics with 95% confidence interval at a p<0.05. The review protocol has been published at the International Prospective Register of Systematic Reviews (PROSPERO; Number: CRD42019135502).ResultsOf forty-two studies included in the narrative review, eight were qualitative studies. Sixteen of the quantitative studies were eligible for meta-analyses. The narrative synthesis revealed structural factors such as: a lack of access to community standard of HIV care, particularly in resource limited countries; loss of privacy; and history of incarceration and re-incarceration as risk factors for poor HIV care use in prison populations. Among social and personal characteristics, lack of social support, stigma, discrimination, substance use, having limited knowledge about, and negative perception towards ART were the main determinants of suboptimal use of care in incarcerated people. In the meta-analyses, lower odds of ART initiation was noticed among inmates with higher baseline CD4 count (CD4 ≥500celss/mm3) (OR = 0.37, 95%CI: 0.14–0.97, I2 = 43%), new HIV diagnosis (OR = 0.07, 95%CI: 0.05–0.10, I2 = 68%), and in those who lacked belief in ART safety (OR = 0.32, 95%CI: 0.18–0.56, I2 = 0%) and efficacy (OR = 0.31, 95%CI: 0.17–0.57, I2 = 0%). Non-adherence was high among inmates who lacked social support (OR = 3.36, 95%CI: 2.03–5.56, I2 = 35%), had low self-efficiency score (OR = 2.50, 95%CI: 1.64,-3.80, I2 = 22%) and those with depressive symptoms (OR = 2.02, 95%CI: 1.34–3.02, I2 = 0%). Lower odds of viral suppression was associated with history of incarceration (OR = 0.40, 95%CI: 0.35–0.46, I2 = 0%), re-incarceration (OR = 0.09, 95%CI: 0.06–0.13, I2 = 64%) and male gender (OR = 0.55, 95%CI: 0.42–0.72, I2 = 0%). Higher odds of CD4 count <200cells/mm3 (OR = 2.01, 95%CI: 1.62, 2.50, I2 = 44%) and lower odds of viral suppression (OR = 0.20, 95%CI: 0.17–0.22, I2 = 0%) were observed during prison entry compared to those noticed during release.ConclusionGiven the high HIV risk in prison populations and rapid movements of these people between prison and community, correctional facilities have the potential to substantially contribute to the use of HIV treatment as a prevention strategy. Thus, there is an urgent need for reviewing context specific interventions and ensuring standard of HIV care in prisons, particularly in resource limited countries. ]]> <![CDATA[Medications for opioid use disorder among pregnant women referred by criminal justice agencies before and after Medicaid expansion: A retrospective study of admissions to treatment centers in the United States]]> https://www.researchpad.co/article/elastic_article_15710 There has been a 4-fold increase in the number of pregnant women with opioid use disorder (OUD). Medications such as methadone and buprenorphine are standard of care for OUD and are recommended during pregnancy, but only 50% of pregnant women receive such medication.Pregnant women with OUD who are involved in the criminal justice system are at high risk of poor outcomes, but data regarding the use of medications for OUD in this population are limited.What did the researchers find?From 1992 to 2017, pregnant women in the US who were referred to treatment for OUD by a criminal justice agency (versus other referral sources) were half as likely to receive medication as part of their treatment plan.After implementation of the Affordable Care Act’s Medicaid expansion, medication for OUD increased significantly more among pregnant women referred to treatment by criminal justice agencies in Medicaid expansion states compared with nonexpansion states.What do these findings mean?Pregnant women referred to treatment for OUD by criminal justice agencies were consistently less likely to receive evidence-based treatment, which increases their risk of overdose and poor maternal and neonatal outcomes.Improving access to Medicaid for justice-involved individuals may increase the rate at which pregnant women receive evidence-based treatment for OUD. ]]> <![CDATA[Punishing the privileged: Selfish offers from high-status allocators elicit greater punishment from third-party arbitrators]]> https://www.researchpad.co/article/elastic_article_14606 Individuals high in socioeconomic status (SES) are often viewed as valuable members of society. However, the appeal of high-SES people exists in tension with our aversion to inequity. Little experimental work has directly examined how people rectify inequitable distributions between two individuals varying in SES. The objective of the present study was to examine how disinterested third parties adjudicate inequity in the context of concrete financial allocations between a selfish allocator and a recipient who was the victim of the allocator’s selfish offer. Specifically, this study focused on whether knowing the SES of the victim or the allocator affected the participant’s decisions to punish the selfish allocator. In two experiments (N = 999), participants completed a modified third-party Ultimatum Game in which they arbitrated inequitable exchanges between an allocator and a recipient. Although participants generally preferred to redistribute inequitable exchanges without punishing players who made unfair allocations, we observed an increased preference for punitive solutions as offers became increasingly selfish. This tendency was especially pronounced when the victim was low in SES or when the perpetrator was high in SES, suggesting a tendency to favor the disadvantaged even among participants reporting high subjective SES. Finally, punitive responses were especially likely when the context emphasized the allocator’s privileged status rather than the recipient’s underprivileged status. These findings inform our understanding of how SES biases retributive justice even in non-judicial contexts that minimize the salience of punishment.

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<![CDATA[Impact of law enforcement and increased traffic fines policy on road traffic fatality, injuries and offenses in Iran: Interrupted time series analysis]]> https://www.researchpad.co/article/N9254ca97-b759-40e9-8001-23227e05911a

Background

Road traffic law enforcement was implemented on 1st April 2011 (the first intervention) and traffic ticket fines have been increased on 1st March 2016 (the second intervention) in Iran. The aim of the current study was to evaluate the effects of the law enforcement on reduction in the incidence rate of road traffic fatality (IRRTF), the incidence rate of road traffic injuries (IRRTI) and the incidence rate of rural road traffic offenses (IRRRTO) in Iran.

Methods

Interrupted time series analysis was conducted to evaluate the impact of law enforcement and increased traffic tickets fines. Monthly data of fatality on urban, rural and local rural roads, injuries with respect to gender and traffic offenses namely speeding, illegal overtaking and tailgating were investigated separately for the period 2009–2016.

Results

Results showed a reduction in the incidence rate of total road traffic fatality (IRTRTF), the incidence rate of rural road traffic fatality (IRRRTF) and the incidence rate of urban road traffic fatality (IRURTF) by –21.44% (–39.3 to –3.59, 95% CI), –21.25% (–31.32 to –11.88, 95% CI) and –26.75% (–37.49 to –16, 95% CI) through the first intervention which resulted in 0.383, 0.255 and 0.222 decline in casualties per 100 000 population, respectively. Conversely, no reduction was found in the incidence rate of local rural road traffic fatality (IRLRRTF) and the IRRTI. Second intervention was found to only affect the IRURTF with –26.75% (–37.49 to –16, 95% CI) which led to 0.222 casualties per 100 000 population. In addition, a reduction effect was observed on the incidence rate of illegal overtaking (IRIO) and the incidence rate of speeding (IRS) with –42.8% (–57.39 to –28.22, 95% CI) and –10.54% (–21.05 to –0.03, 95% CI which implied a decrease of 415.85 and 1003.8 in monthly traffic offenses per 100 000 vehicles), respectively.

Conclusion

Time series analysis suggests a decline in IRTRTF, IRRRTF, and IRURTF caused by the first intervention. However, the second intervention found to be only effective in IRURTF, IRIO, and IRS with the implication that future initiatives should be focused on modifying the implementation of the traffic interventions.

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<![CDATA[Optimizing predictive performance of criminal recidivism models using registration data with binary and survival outcomes]]> https://www.researchpad.co/article/5c8c193ed5eed0c484b4d25f

In a recidivism prediction context, there is no consensus on which modeling strategy should be followed for obtaining an optimal prediction model. In previous papers, a range of statistical and machine learning techniques were benchmarked on recidivism data with a binary outcome. However, two important tree ensemble methods, namely gradient boosting and random forests were not extensively evaluated. In this paper, we further explore the modeling potential of these techniques in the binary outcome criminal prediction context. Additionally, we explore the predictive potential of classical statistical and machine learning methods for censored time-to-event data. A range of statistical manually specified statistical and (semi-)automatic machine learning models is fitted on Dutch recidivism data, both for the binary outcome case and censored outcome case. To enhance generalizability of results, the same models are applied to two historical American data sets, the North Carolina prison data. For all datasets, (semi-) automatic modeling in the binary case seems to provide no improvement over an appropriately manually specified traditional statistical model. There is however evidence of slightly improved performance of gradient boosting in survival data. Results on the reconviction data from two sources suggest that both statistical and machine learning should be tried out for obtaining an optimal model. Even if a flexible black-box model does not improve upon the predictions of a manually specified model, it can serve as a test whether important interactions are missing or other misspecification of the model are present and can thus provide more security in the modeling process.

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<![CDATA[Workplace burnout and health issues among Colombian correctional officers]]> https://www.researchpad.co/article/5c6c75e7d5eed0c4843d047c

Introduction

Correctional employees typically work under adverse conditions that may enhance the occurrence of different negative psychological states. Burnout constitutes a high-risk phenomenon that may affect people’s physical/mental health and welfare, especially in vulnerable occupational groups.

Objectives

The aim of this study was to characterize the burnout profile of correctional officers, and to associate their burnout profile with health issues and lifestyle factors.

Methods

The full sample was composed of 219 Colombian correctional officers with a mean age of 30.18 years. A questionnaire composed of three sections was employed: demographic data, burnout, and health information.

Results

A high proportion of participants reported burnout indicators, also significantly correlated to their health indicators and lifestyle factors. Cluster analyses were used in order to characterize the burnout/age (model A) and burnout/age/psychological disturbance (model B) profiles of correctional officers. Furthermore, significant differences were found when comparing frequencies of alcohol consumption and physical exercise (lifestyle indicators) and perceived social support of officers depending on their profile.

Conclusions

the discussion focused on the negative impact of burnout on health, and on the importance of strengthening occupational programs aimed at reducing the impact of hazardous working conditions that contribute to the development of burnout, and to the arise different mid and long-term health complains among correctional workers.

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<![CDATA[Adolescent offenders' current whereabouts predict locations of their future crimes]]> https://www.researchpad.co/article/5c5b529fd5eed0c4842bcce5

Knowing where crime is likely to happen can help prevent it. Here I investigate whether two basic mechanisms of human mobility—preferential return and spatial exploration—explain and predict where offenders commit future crimes. A sample of 843 adolescents reported their hourly whereabouts during four days. In line with findings from other sources and populations, their locations were concentrated and predictable. During the subsequent four years, 70 of the 843 were apprehended for committing one or more crimes. Compared to others, these 70 future offenders had visited slightly more different locations. However, their action radius and the predictability of their whereabouts had been very similar to those who would not become offenders. The offenders perpetrated most of their crimes around places they had visited before, including places where they previously offended. These findings show that the predictability of human mobility applies to offending and to offenders as well, and helps us understand and forecast where they will commit future crimes. They may prove particularly useful in criminal investigations, as they suggest that police should generally prioritize suspects who are familiar with the location of the crime and its environs, either because of their legal routine activities or because of their prior offences.

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<![CDATA[Active and latent tuberculosis among inmates in La Esperanza prison in Guaduas, Colombia]]> https://www.researchpad.co/article/5c6448ebd5eed0c484c2f1cf

Introduction

Active tuberculosis (TB) and latent tuberculosis infection (LTBI) are a public health threat in prisons around the world. The objectives of the study were to estimate the prevalence of LTBI and TB as well as to investigate TB transmission inside one prison, in Colombia.

Methods

A Cross-sectional study was conducted in inmates who agreed to participate. Inmates with respiratory symptoms (RS) of any duration underwent to medical evaluation and three sputum samples were taken for smear microscopy and culture for TB diagnosis. Drug susceptibility was analyzed using BACTEC MGIT 960 and GenoType MTBDRplus. Molecular genotyping of Mycobacterium tuberculosis isolates was performed by 24-Locus MIRU-VNTR and spoligotyping. LTBI was evaluated according to the result of the tuberculin skin test (TST). Close contact investigation was conducted inside the prison for inmates that shared the cell with the index TB case.

Results

Among 301/2,020 (15%) inmates with RS of any duration, 8% were diagnosed with active TB. The prevalence of active TB was 1,026 cases/100,000 inmates. We isolated M. tuberculosis in 19/24 (79%) TB cases, 94.7% were susceptible to first line drugs and only one was monoresistant to isoniazid. The most prevalent sub-lineage was Haarlem (68.4%), followed by LAM (26.3%) and T superfamily (5.3%). 24-Locus MIRU-VNTR typing results alone or in combination with spoligotyping identified three clusters containing two isolates each. Two clusters corresponded to inmates that shared the same cell, but each one was located in different blocks of the prison. Inmates from the last cluster were in the same block in nearby cells. TST reading was performed in 95.6% inmates, and 67.6% had a positive reaction.

Conclusions

The prevalence of LTBI and TB was higher in prison than in the general population. Molecular genotyping suggests that TB in this prison is mainly caused by strains imported by inmates or endogenous reactivation.

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<![CDATA[Compensate a little, but punish a lot: Asymmetric routes to restoring justice]]> https://www.researchpad.co/article/5c40f811d5eed0c484386f86

Most people have a desire to live in a just world, a place where good things happen to good people and bad things happen to bad people. And yet, injustices do occur: good things happen to bad people and bad things happen to good people. Across four experiments, we show that people respond quite differently to correct these two types of injustices. When bad things happen to good people, individuals are eager to compensate a good person’s losses, but only do so to a small degree. In contrast, when a good thing happens to a bad person, because the only perceived appropriate act of punishment is to fully strip the bad actor of all his or her illegitimate gains, few people choose to punish in this costly way. However, when they do, they do so to very large degrees. Moreover, we demonstrate that differential psychological mechanisms drive this asymmetry.

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<![CDATA[Does a history of sexual and physical childhood abuse contribute to HIV infection risk in adulthood? A study among post-natal women in Harare, Zimbabwe]]> https://www.researchpad.co/article/5c390bb2d5eed0c48491ddfa

Background

Sexual and physical abuse in childhood creates a great health burden including on mental and reproductive health. A possible link between child abuse and HIV infection has increasingly attracted attention. This paper investigated whether a history of child physical and sexual abuse is associated with HIV infection among adult women.

Methods

A cross sectional survey was conducted among 2042 postnatal women (mean age = 26y) attending six public primary health care clinics in Harare, Zimbabwe within 6 weeks post-delivery. Clinic records were reviewed for mother’s antenatal HIV status. Participants were interviewed about childhood abuse including physical or sexual abuse before 15 years of age, forced first sex before 16, HIV risk factors such as age difference at first sex before age 16. Multivariate analyses assessed the associations between mother’s HIV status and child physical and sexual abuse while controlling for confounding variables.

Results

More than one in four (26.6%) reported abuse before the age of 15: 14.6% physical abuse and 9.1% sexual abuse,14.3% reported forced first sex and 9.0% first sex before 16 with someone 5+ years older. Fifteen percent of women tested HIV positive during the recent antenatal care visit. In multivariate analysis, childhood physical abuse (aOR 3.30 95%CI 1.58–6.90), sexual abuse (3.18 95%CI: 1.64–6.19), forced first sex (aOR 1.42, 95%CI: 1.00–2.02), and 5+ years age difference with first sex partner (aOR 1.66 95%CI 1.09–2.53) were independently associated with HIV infection.

Conclusion

This study highlights that child physical and/or sexual abuse may increase risk for HIV acquisition. Further research is needed to assess the pathways to HIV acquisition from childhood to adulthood. Prevention of child abuse must form part of the HIV prevention agenda in Sub-Saharan Africa.

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<![CDATA[Doubling down on forensic twin studies]]> https://www.researchpad.co/article/5c25454bd5eed0c48442c452 ]]> <![CDATA[Estimation of HIV incidence and its trend in three key populations in Iran]]> https://www.researchpad.co/article/5c2400bbd5eed0c484098d34

In Iran, People Who Inject Drugs (PWID), Female Sex Workers (FSW), and prisoners are the main key populations at risk of HIV infection. This study aimed to evaluate the trend of HIV incidence among PWID, FSW and prisoners as an impact measure of HIV harm reduction and prevention efforts in Iran. Data were obtained from the two rounds of national bio-behavioral surveillance surveys among FSW (2010 (n = 872), 2015 (n = 1339)), PWID (2010 (n = 2417), 2014 (n = 2307)), and prisoners (2009 (n = 4536), 2013 (n = 5390)) through facility-based (FSW and PWID surveys) and cluster sampling (prisoner surveys). Time-at-risk was calculated assuming the age at first sex or drug injection as the beginning of the at-risk period and the age at the time of the interview or date when they received a positive HIV test result as the end of this period, adjusted for interval censoring. HIV incidence among PWID in 2014 was 5.39 (95% CI 4.71, 6.16) per 1,000 person-years (PY), significantly lower than in 2009 (17.07, 95% CI 15.34, 19.34). Similarly, HIV incidence was 1.12 (95% CI 0.77, 1.64) per 1,000 PY among FSW in 2015, a significant drop from 2010 (2.38, 95% CI 1.66, 3.40). Also, HIV incidence decreased among prisoners from 1.34 (95% CI: 1.08, 1.67) in 2009 to 0.49 (95% CI: 0.39, 0.61) per 1,000 PY in 2013. Our findings suggest that after an increase in the 2000s, the HIV incidence may have been decreased and stabilized among key populations in Iran.

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<![CDATA[The health care utilization of people in prison and after prison release: A population-based cohort study in Ontario, Canada]]> https://www.researchpad.co/article/5b6dda14463d7e7491b405ed

Background

Many people experience imprisonment each year, and this population bears a disproportionate burden of morbidity and mortality. States have an obligation to provide equitable health care in prison and to attend to care on release. Our objective was to describe health care utilization in prison and post-release for persons released from provincial prison in Ontario, Canada in 2010, and to compare health care utilization with the general population.

Methods

We conducted a population-based retrospective cohort study. We included all persons released from provincial prison to the community in 2010, and age- and sex-matched general population controls. We linked identities for persons released from prison to administrative health data. We matched each person by age and sex with four general population controls. We examined ambulatory care and emergency department utilization and medical-surgical and psychiatric hospitalization, both in prison and in the three months after release to the community. We compared rates with those of the general population.

Results

The rates of all types of health care utilization were significantly higher in prison and on release for people released from prison (N = 48,861) compared to general population controls (N = 195,444). Comparing those released from prison to general population controls in prison and in the 3 months after release, respectively, utilization rates were 5.3 (95% CI 5.2, 5.4) and 2.4 (95% CI 2.4, 2.5) for ambulatory care, 3.5 (95% CI 3.3, 3.7) and 5.0 (95% CI 4.9, 5.3) for emergency department utilization, 2.3 (95% CI 2.0, 2.7) and 3.2 (95% CI 2.9, 3.5) for medical-surgical hospitalization, and 21.5 (95% CI 16.7, 27.7) and 17.5 (14.4, 21.2) for psychiatric hospitalization. Comparing the time in prison to the week after release, ambulatory care use decreased from 16.0 (95% CI 15.9,16.1) to 10.7 (95% CI 10.5, 10.9) visits/person-year, emergency department use increased from 0.7 (95% CI 0.6, 0.7) to 2.6 (95% CI 2.5, 2.7) visits/person-year, and hospitalization increased from 5.4 (95% CI 4.8, 5.9) to 12.3 (95% CI 10.1, 14.6) admissions/100 person-years for medical-surgical reasons and from 8.6 (95% CI 7.9, 9.3) to 17.3 (95% CI 14.6, 20.0) admissions/100 person-years for psychiatric reasons.

Conclusions

Across care types, health care utilization in prison and on release is elevated for people who experience imprisonment in Ontario, Canada. This may reflect high morbidity and suboptimal access to quality health care. Future research should identify reasons for increased use and interventions to improve care.

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<![CDATA[Risk of Violent Crime in Individuals with Epilepsy and Traumatic Brain Injury: A 35-Year Swedish Population Study]]> https://www.researchpad.co/article/5989db27ab0ee8fa60bd0755

Seena Fazel and colleagues report findings from a longitudinal follow-up study in Sweden that evaluated the risks of violent crime subsequent to hospitalization for epilepsy, or traumatic brain injury. The researchers control for familial confounding with sibling controls. The analyses call into question an association between epilepsy and violent crime, although they do suggest that there may be a relationship between traumatic brain injury and violent crime.

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<![CDATA[Do Characteristics of Faces That Convey Trustworthiness and Dominance Underlie Perceptions of Criminality?]]> https://www.researchpad.co/article/5989da71ab0ee8fa60b94ce7

Background

This study tested whether the 2D face evaluation model proposed by Oosterhof and Todorov can parsimoniously account for why some faces are perceived as more criminal-looking than others. The 2D model proposes that trust and dominance are spontaneously evaluated from features of faces. These evaluations have adaptive significance from an evolutionary standpoint because they indicate whether someone should be approached or avoided.

Method

Participants rated the emotional state, personality traits, and criminal appearance of faces shown in photographs. The photographs were of males and females taken under naturalistic conditions (i.e., police mugshots) and highly controlled conditions. In the controlled photographs, the emotion display of the actor was systematically varied (happy expression, emotionally neutral expression, or angry expression).

Results

Both male and female faces rated high in criminal appearance were perceived as less trustworthy and more dominant in police mugshots as well as in photographs taken under highly controlled conditions. Additionally, emotionally neutral faces were deemed as less trustworthy if they were perceived as angry, and more dominant if they were morphologically mature. Systematically varying emotion displays also affected criminality ratings, with angry faces perceived as the most criminal, followed by neutral faces and then happy faces.

Conclusion

The 2D model parsimoniously accounts for criminality perceptions. This study extends past research by demonstrating that morphological features that signal high dominance and low trustworthiness can also signal high criminality. Spontaneous evaluations regarding criminal propensity may have adaptive value in that they may help us to avoid someone who is physically threatening. On the other hand, such evaluations could inappropriately influence decision making in criminal identification lineups. Hence, additional research is needed to discover whether and how people can avoid making evaluations regarding criminality from a person’s facial appearance.

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<![CDATA[The Risk Behaviors and Mental Health of Detained Adolescents: A Controlled, Prospective Longitudinal Study]]> https://www.researchpad.co/article/5989db0aab0ee8fa60bc9da1

Background

To assess the behavioral risk factors and mental health needs of adolescents in juvenile detention centers (JDC).

Method

A total of 238 boys aged 12–17 years was surveyed who had been admitted to a detention center and compared them with boys from the community (n = 238) matched for sex and age. We assessed behavioral risk factors and mental health problems by using the Youth Risk Behavior Survey questionnaire (YRBS) and the Youth Self-Report questionnaire (YSR).

Results

Young offenders had significantly higher YRBS scores than controls for drug use (odds ratio (OR) 5.16, 95% CI 2.27–7.84), sexual intercourse (OR, 2.51; 95% CI 1.55–2.90), irregular diet (4.78, 2.11–7.51), suicide attempts (1.96, 1.32–5.85), and physical fighting behavior (3.49, 1.60–7.07), but not for tobacco use, alcohol use, and high–risk cycling. Young offenders at the time of admission (6.61, 2.58–15.2), at 6 months (3.12, 1.81–10.1), and at 12 months (5.29, 1.98–13.3) reported statistically higher levels of total mental health problems than adolescents in a community sample.

Conclusions

Young offenders have a high rate of mental and behavioral disorders. In the detention period, aggressive behavior, self–destructive/identity, and externalizing of problems improved while withdrawn, anxious or depressed, and internalizing of problems worsened.

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<![CDATA[Gender Differences in HIV Care among Criminal Justice-Involved Persons: Baseline Data from the CARE+ Corrections Study]]> https://www.researchpad.co/article/5989dad8ab0ee8fa60bb8eb0

Background

HIV-infected individuals recently released from incarceration have suboptimal linkage and engagement in community HIV care. We conducted a study to evaluate an information and communication technology intervention to increase linkage to community care among HIV-infected persons recently involved in the criminal justice (CJ) system. Baseline characteristics including risk behaviors and HIV care indicators are reported and stratified by gender.

Methods

We recruited HIV-infected individuals in the District of Columbia jail and persons with a recent history of incarceration through community and street outreach. Participants completed a baseline computer-assisted personal interview regarding HIV care and antiretroviral treatment (ART) adherence, substance use, and sexual behaviors. CD4 and HIV plasma viral load testing were performed at baseline or obtained through medical records. Data were analyzed for the sample overall and stratified by gender.

Results

Of 110 individuals, 70% were community-enrolled, mean age was 40 (SD = 10.5), 85% were Black, and 58% were male, 24% female, and 18% transgender women. Nearly half (47%) had condomless sex in the three months prior to incarceration. Although drug dependence and hazardous alcohol use were highly prevalent overall, transgender women were more likely to have participated in drug treatment than men and women (90%, 61%, and 50% respectively; p = 0.01). Prior to their most recent incarceration, 80% had an HIV provider and 91% had ever taken ART. Among those, only 51% reported ≥90% ART adherence. Fewer women (67%) had received HIV medications during their last incarceration compared to men (96%) and transgender women (95%; p = 0.001). Although neither was statistically significant, transgender women and men had higher proportions of baseline HIV viral suppression compared to women (80%, 69%, and 48.0% respectively, p>0.05); a higher proportion of women had a CD4 count ≤200 compared to men and transgender women (17%, 8% and 5% respectively; p>0.05).

Conclusions

In this study, HIV-infected persons with recent incarceration in Washington, DC reported important risk factors and co-morbidities, yet the majority had access to HIV care and ART prior to, during, and after incarceration. Self-reported ART adherence was sub-optimal, and while there were not statistically significant differences, CJ-involved women appeared to be at greatest risk of poor HIV outcomes.

Trial registration

Registered on ClinicalTrials.gov on 10/16/2012. Reference number: NCT01721226.

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<![CDATA[Absence of Antiretroviral Therapy and Other Risk Factors for Morbidity and Mortality in Malaysian Compulsory Drug Detention and Rehabilitation Centers]]> https://www.researchpad.co/article/5989d9fdab0ee8fa60b72a05

Background

Throughout Asia, people who use drugs are confined in facilities referred to as compulsory drug detention and rehabilitation centers. The limited transparency and accessibility of these centers has posed a significant challenge to evaluating detainees and detention conditions directly. Despite HIV being highly prevalent in this type of confined setting, direct evaluation of detainees with HIV and their access to medical care has yet to be reported in the literature.

Methods

We evaluated the health status of 100 adult male detainees with HIV and their access to medical care in the two largest Malaysian compulsory drug detention and rehabilitation centers holding HIV-infected individuals.

Results

Approximately 80% of all detainees with HIV were surveyed in each detention center. Most participants reported multiple untreated medical conditions. None reported being able to access antiretroviral therapy during detention and only 9% reported receiving any HIV-related clinical assessment or care. Nearly a quarter screened positive for symptoms indicative of active tuberculosis, yet none reported having been evaluated for tuberculosis. Although 95% of participants met criteria for opioid dependence prior to detention, none reported being able to access opioid substitution therapy during detention, with 86% reporting current cravings for opioids and 87% anticipating relapsing to drug use after release. Fourteen percent of participants reported suicidal ideation over the previous two weeks.

Conclusion

We identified a lack of access to antiretroviral therapy in two of the six compulsory drug detention and rehabilitation centers in Malaysia designated to hold HIV-infected individuals and found significant, unmet health needs among detainees with HIV. Individuals confined under such conditions are placed at considerably high risk for morbidity and mortality. Our findings underscore the urgent need for evidence-based drug policies that respect the rights of people who use drugs and seek to improve, rather than undermine, their health.

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<![CDATA[The Prison Economy of Needles and Syringes: What Opportunities Exist for Blood Borne Virus Risk Reduction When Prices Are so High?]]> https://www.researchpad.co/article/5989da3dab0ee8fa60b8888f

Aim

A formal Needle and Syringe Program (NSP) is not provided in Australian prisons. Injecting equipment circulates in prisons as part of an informal and illegal economy. This paper examined how this economy generates blood-borne virus (BBV) risk and risk mitigation opportunities for inmates.

Method

The HITS-p cohort recruited New South Wales inmates who had reported ever injecting drugs and who had a negative HCV serological test within 12 months prior to enrolment. For this study, qualitative interviews were conducted with 30 participants enrolled in HITS-p. Participants included 10 women and were incarcerated in 12 prisons.

Results

A needle/syringe was nominated as being typically priced in the ‘inside’ prison economy at $100-$150, with a range of $50-$350. Purchase or hire of equipment was paid for in cash (including transactions that occurred outside prison) and in exchange for drugs and other commodities. A range of other resources was required to enable successful needle/syringe economies, especially relationships with visitors and other prisoners, and violence to ensure payment of debts. Strategies to mitigate BBV risk included retaining one needle/syringe for personal use while hiring out others, keeping drug use (and ownership of equipment) “quiet”, stealing used equipment from the prison health clinic, and manufacture of syringes from other items available in the prison.

Conclusions

The provision of prison NSP would disrupt the inside economies built around contraband needles/syringes, as well as minimise BBV risk. However, any model of prison NSP should be interrogated for any unanticipated markets that could be generated as a result of its regulatory practices.

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<![CDATA[Bringing state-of-the-art diagnostics to vulnerable populations: The use of a mobile screening unit in active case finding for tuberculosis in Palawan, the Philippines]]> https://www.researchpad.co/article/5989db50ab0ee8fa60bdc1f5

Background

Globally, case detection of tuberculosis (TB) has stabilized in recent years. Active case finding (ACF) has regained an increased attention as a complementary strategy to fill the case detection gap. In the Philippines, the DetecTB project implemented an innovative ACF strategy that offered a one-stop diagnostic service with a mobile unit equipped with enhanced diagnostic tools including chest X-ray (CXR) and Xpert®MTB/RIF (Xpert). The project targeted the rural poor, the urban poor, prison inmates, indigenous population and high school students.

Methods

This is a retrospective review of TB screening data from 25,103 individuals. A descriptive analysis was carried out to compare screening and treatment outcomes across target populations. Univariate and multivariate analyses were performed to identify predictors of TB for each population. The composition of bacteriologically-confirmed cases by smear and symptom status was further investigated.

Results

The highest yield with lowest number needed to screen (NNS) was found in prison (6.2%, NNS: 16), followed by indigenous population (2.9%, NNS: 34), the rural poor (2.2%, NNS: 45), the urban poor (2.1%, NNS: 48), and high school (0.2%, NNS: 495). The treatment success rate for all populations was high with 89.5% in rifampicin-susceptible patients and 83.3% in rifampicin-resistant patients. A relatively higher loss to follow-up rate was observed in indigenous population (7.5%) and the rural poor (6.4%). Only cough more than two weeks showed a significant association with TB diagnosis in all target populations (Adjusted Odds Ratio ranging from 1.71 to 6.73) while other symptoms and demographic factors varied in their strength of association. The urban poor had the highest proportion of smear-positive patients with cough more than two weeks (72.0%). The proportion of smear-negative (Xpert-positive) patients without cough more than two weeks was the highest in indigenous population (39.3%), followed by prison inmates (27.7%), and the rural poor (22.8%).

Conclusions

The innovative ACF strategy using mobile unit yielded a substantial number of TB patients and achieved successful treatment outcomes. TB screening in prison, indigenous population, and urban and rural poor communities was found to be effective. The combined use of CXR and Xpert largely contributed to increased case detection.

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