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SPNS Initiative: SURE Housing Initiative (2022-2026)
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Pay it Forward Transitional Care Coordination
One Stop Career Center of Puerto Rico (OSCC-PR) implemented Pay it Forward to increase workforce capacity to connect Puerto Ricans with HIV to community-based HIV care and social supports following release from jail. Pay it Forward included training of OSCC-PR staff in the Transitional Care Coordination model. Eighty percent of clients who were supported by Pay it Forward in Puerto Rico were still in HIV care 12 months after release.Resource from the RWHAP Best Practices Compilation updated on 05/07/2024
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Beyond the Walls: Building Foundation for Jail Linkage Programs
Effective models and best practices for connection to care for justice-involved individuals.Resource updated 05/15/2024
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Transitional Care Coordination: From Jail Intake to Community HIV Care Intervention
Transitional Care Coordination (TCC) connects people with HIV who are incarcerated with a transitional care coordinator to facilitate access to HIV primary care and other community-based services and supports, following their transition from jail back to the community. TCC aims to establish vital linkages between jail-based and community-based HIV care, and may be implemented by community-based organizations, clinics, health departments, or jails.Resource from the RWHAP Best Practices Compilation updated on 02/02/2024
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Maricopa County: Expanding Jail Services & Improving Health for Incarcerated People with HIV
The Maricopa County Jail Project was implemented by five jails and uses a nurse practitioner to manage service access and case management across the jail system.Resource updated 10/13/2023
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LINK LA
LINK LA is a 12-session, 24-week peer navigation intervention for people with HIV who are scheduled to be released from incarceration. LINK LA peer navigators focus on behavioral changes that promote medication adherence and retention in care, while providing social support and facilitating communication with medical providers. LINK LA showed improvements in linkage to and retention in HIV care and viral suppression among people with HIV re-entering the community after incarceration.Resource from the RWHAP Best Practices Compilation updated on 01/03/2024
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Maricopa County Jail Project: Providing HIV Service to People Who Are Incarcerated
Partnership between jail staff and public health prevention staff created new data communication systems and bundled services for clients upon release.Resource updated 05/15/2024
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Navigator Case Management for People Leaving Jail
The Navigator Case Management intervention helps people with HIV who are incarcerated and are leaving to return to the community. The intervention uses harm reduction, case management, and motivational interviewing techniques to promote healthy behaviors. Enhanced case management including peer support and connection to other needed services both immediately before and after release supports increased linkage to and retention in HIV care for people transitioning to the community from jail.Resource from the RWHAP Best Practices Compilation updated on 01/19/2024
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Telemedicine to Achieve HIV Viral Suppression in Incarcerated People in Tennessee – 9-year retrospective (2010 – 2018)
In collaboration with Tennessee Department of Corrections, we developed and implemented a stepwise HIV telemedicine program to optimize viral suppression in the state prisons during 2010-2018. Clinic attendance increased from 50 percent to 90 percent during full implementation. Viral suppression increased from 30 percent in 2010 to 90 percent in 2018.
Resource (Conference Presentation) updated 09/14/2023
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Corrections and community for continuity of HIV care upon re-entry
Development of a referral processes for persons re-entering the community from incarceration (in SOAR program), with referrals prior to release, resulting in higher rate of first appointments within 30-days; challenges for linkage to care through SOAR remain after release.
Resource (Conference Presentation) updated 09/14/2023
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Correctional Health Linkage Interventions Toolkit
Training materials and a curriculum on implementing a project to enhance HIV health services between community and jail settings, based on insights from the SPNS initiative, Enhancing Linkages to HIV Primary Care & Services in Jail Settings.Informational updated 05/16/2024
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HRSA HAB Program Letter on Expungement Services for People with HIV Who Have Had Legal System Involvement
Dear Ryan White HIV/AIDS Program Colleagues,
News Article updated on 06/07/2024 -
Innovative Approaches to Engaging Hard-to-Reach Populations Living with HIV/AIDS into Care: Training Manual
Manual to help health care providers adapt SPNS models addressing how to engage hard-to-reach people with HIV (PWH) into care within their current operations.
Curriculum updated on 01/01/2013 -
Ryan White HIV Care and Black/African American People
A significant proportion of African Americans living with HIV/AIDS get care from HRSA's Ryan White HIV/AIDS Program.
Blog updated 03/29/2024
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Creating a Jail Linkage Program Training Manual: Introduction
Objectives of training manual for enhancing continuity of care for HIV-positive prisoners returning to community settings, along with an overview of incarceration in the U.S. Manual based on insights from the SPNS Enhancing Linkages to HIV Primary Care & Services in Jail Settings Initiative.
Curriculum updated on 09/01/2013 -
Innovative Approaches to Engaging Hard-to-Reach Populations Living with HIV/AIDS into Care: Training Manual
Training manual for health care providers on adapting SPNS models addressing how to engage hard-to-reach people with HIV into their current operations.
Resource updated 03/12/2024
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Innovative Approaches to Engaging Hard-to-Reach Populations Living with HIV/AIDS into Care: Curriculum
Curriculum on how to replicate models of care developed to engage and retain hard-to-reach populations into HIV medical care. Document can also serve as a quality improvement tool.
Resource updated 03/13/2024
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Why a Jail Intervention?
Rationale for providing continuity of care for HIV-positive prisoners returning to community settings, in Creating a Jail Linkage Program training manual, based on insights from the SPNS Enhancing Linkages to HIV Primary Care & Services in Jail Settings Initiative.
Curriculum updated on 09/01/2013 -
Getting Started with a Jail Linkage Program
Elements of a continuity of care program for HIV-positive prisoners returning to community settings, in Creating a Jail Linkage Program training manual, based on insights from the SPNS Enhancing Linkages to HIV Primary Care & Services in Jail Settings Initiative.
Curriculum updated on 09/01/2013