JMIR Publications

ABSTRACT

Background:

HIV disproportionately impacts criminal justice (CJ)-involved individuals, including men who experience incarceration. Men make up the vast majority of those experiencing incarceration as well as those newly diagnosed with HIV infection. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention that significantly reduces the risk of HIV acquisition. However, implementation in CJ-systems is limited. Little is known about effective PrEP implementation and use in this unique public health context.

Objective:

This article describes a PrEP care continuum for men experiencing incarceration who are at increased risk of HIV acquisition, which can help conceptualize approaches to evaluating PrEP implementation.

Methods:

Men incarcerated in the Rhode Island Department of Corrections, a correctional system composed of all of the state's sentenced and awaiting trial population, are screened for HIV acquisition risk during the course of routine clinical care. Those identified at high risk for HIV acquisition are referred for evaluation for PrEP initiation and enrollment in this study. Individuals who express interest in initiating PrEP and consent to the study are then followed in a prospective longitudinal cohort.

Results:

The outlined study will enroll 100 men experiencing incarceration at high risk for HIV acquisition prior to release into the community. The goal is to initiate PrEP prior to incarceration and link individuals to PrEP providers in the community, capturing barriers and facilitators to PrEP use during this uniquely vulnerable time period for HIV acquisition.

Conclusions:

Based on the proposed care continuum and what is known about HIV risk and prevention efforts in the CJ-context, we outline key future research efforts to better understand effective approaches to preventing HIV infection among this vulnerable population. The described approach presents a powerful public health opportunity to help end the HIV epidemic.