Alison Jordan - Academia.edu (original) (raw)
Papers by Alison Jordan
APHA 2021 Annual Meeting and Expo, Oct 24, 2021
AIDS Education and Prevention, 2020
The twin epidemics of HIV and incarceration impact Puerto Rico, which has limited resources to ad... more The twin epidemics of HIV and incarceration impact Puerto Rico, which has limited resources to address the social and structural determinants of health in incarcerated populations. A Special Programs of National Significance grant supported a Puerto Rican community-based organization to implement the evidence-informed Transitional Care Coordination intervention among incarcerated persons living with HIV, targeting changes at the individual, organization, and systems levels. After implementation (November 2015–July 2018; n = 69), 93.1% of eligible clients were linked to community-based HIV care, 86.3% remained in care for 6 months, and 78.6% remained for 12 months. A greater proportion reported consistent HIV care, ART adherence, food security, and transportation to access care. Integrating HIV case management with housing and employment services, and developing buy-in and collaboration from partners across systems of care, including after a natural disaster, led to positive client o...
Journal of Immigrant and Minority Health, 2021
Persons living with diagnosed HIV (PLWDH) are overrepresented in correctional settings, as are La... more Persons living with diagnosed HIV (PLWDH) are overrepresented in correctional settings, as are Latinx including those of Puerto Rican (PR) origin. Little is known about this population’s HIV care engagement after incarceration. Semi-structured interviews were conducted with 23 PLWDH of PR origin incarcerated in NYC jails using the Behavioral Model for Vulnerable Populations as the theoretical basis. Most participants described a fragile connection to HIV care and inconsistent antiretroviral therapy adherence due to issues including substance use, poverty (e.g. homelessness), and other factors. Most were satisfied with their current communitybased providers and reported that their PR ethnicity and transnational ties to PR did not impact their HIV care, although some preferred Spanish-speaking providers. Greater access to stable housing and HIV care that is convenient to substance use treatment and other services appear to be the greatest needs of PLWDH of PR origin leaving jail.
Facilities 12 jails: 9 on Rikers Island (1 female facility, 1 adolescent facility), 3 borough hou... more Facilities 12 jails: 9 on Rikers Island (1 female facility, 1 adolescent facility), 3 borough houses, public hospital inpatient unit Average Daily Population~10,800 (2014) Annual Admissions 60,000 (2014) Community Releases* 60,000 / year Length of Stay mean=37 days; median~7d Electronic Health Record
Public Health Behind Bars, 2021
PLOS ONE, 2020
Introduction While U.S. jails are critical sites for engagement in HCV care, short lengths-of-sta... more Introduction While U.S. jails are critical sites for engagement in HCV care, short lengths-of-stay often do not permit treatment in jail. Therefore, linkage to HCV care after incarceration is crucial. However, little is known about HCV treatment acceptability among justice-involved individuals in U.S. jails. The goal of this study was to understand knowledge, attitudes, and acceptability of HCV treatment among people living with HCV in the New York City (NYC) jail system. Methods We recruited 36 HCV-antibody-positive individuals in the NYC jails using clinical data reports and performed semi-structured interviews to explore participants’ attitudes toward HCV treatment in jail and following return to the community. We continued interviews until reaching thematic saturation and analyzed interviews using an inductive, thematic approach. Results Participants were mostly male, Latina/o, with a mean age of 40 years. Nearly all were aware they were HCV antibody-positive. Two thirds of part...
Background: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HC... more Background: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. Methods: We conducted a single arm clinical trial to assess the rate and factors associated with linkage to HCV care after incarceration associated with a combined transitional care coordination (TCC) and patient navigation intervention. Results: During the intervention, n=84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years (SD=12). Of those who returned to the community, 26 (31%) linked to HCV care within a mean of 29 days (SD=25); 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, and 7 (8%) had documentation of sustained virol...
Journal of Hepatology, 2018
ABSTRACT The HRSA Special Projects of National Significance grant for Enhancing Linkages to Care ... more ABSTRACT The HRSA Special Projects of National Significance grant for Enhancing Linkages to Care for People Leaving Jails with HIV included ten demonstration sites. The program enhancement grants of up to $400,000 each year were awarded to ten sites including three major urban areas, Chicago, New York City and Philadelphia. Using similar approaches, the local areas instituted public health approaches to identify the HIV-infected, initiate discharge planning in jails, and facilitate post-release linkages to primary care. Tracking and sharing outcome data and conducting program evaluations led to program improvements and helped build sustainable programs. In NYC, the Ryan White Planning Council prioritized case management programs for those leaving jails. A robust effort to disseminate findings led to over a dozen published papers and policy briefs and local evaluation findings were presented at APHA 2012, the International AIDS Conference 2012 and the National Commission on Correctional Healthcare Conference. This widespread dissemination led to interest from those in other jurisdictions locally and globally, who were seeking ways to improve access and engagement in care. As a result, other community programs are interested in replicating the model including those implementing patient-centered Medical Homes and substance use treatment programs. Demonstration projects with timely dissemination can enhance awareness and opportunities to identify potential collaborators and funders for program sustainability and replication.
Addictive Behaviors
With the opioid overdose mortality rates rising nationally, The New York City Department of Healt... more With the opioid overdose mortality rates rising nationally, The New York City Department of Health and Mental Hygiene (NYC DOHMH) has worked to expand overdose rescue training (ORT) and naloxone distribution. This study sought to determine rates of overdose witnessing and naloxone use among overdose rescue-trained visitors to the NYC jails on Rikers Island. We conducted a six-month prospective study of visitors to NYC jails on Rikers Island who received ORT. We collected baseline characteristics of study participants, characteristics of overdose events, and responses to witnessed overdose events, including whether the victim was the incarcerated individual the participant was visiting on the day of training. Bivariate analyses compared baseline characteristics of participants who witnessed overdoses to those who did not, and of participants who used naloxone to those who did not. Overall, we enrolled 283 participants visiting NYC's Rikers Island jails into the study. Six months after enrollment, we reached 226 participants for follow-up by phone. 40 participants witnessed 70 overdose events, and 28 participants reported using naloxone. Of the 70 overdose events, three victims were the incarcerated individuals visited on the day of training; nine additional victims were recently released from jail and/or prison. Visitors to persons incarcerated at Rikers Island witness overdose events and are able to perform overdose rescues with naloxone. This intervention reaches a population that includes not only those recently released, but also other people who experienced overdose.
Background: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HC... more Background: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. Methods: We conducted a single arm clinical trial of a combined transitional care coordination (TCC) and patient navigation intervention and assessed the linkage rate and factors associated with linkage to HCV care after incarceration. Results: During the intervention, 84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years. Of those who returned to the community, 26 (31%) linked to HCV care within a median of 20.5 days; 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, 9 (11%) had a follow-up lab drawn to confirm sustained virologi...
Journal of Community Health
Young men who have sex with men (YMSM), especially African American and Latinx YMSM, accounted fo... more Young men who have sex with men (YMSM), especially African American and Latinx YMSM, accounted for the highest proportion of new HIV diagnoses in 2016. Minorities and persons living with HIV are over-represented in correctional settings. To influence risk behaviors of incarcerated YMSM who are living with HIV, New York City Health + Hospitals adapted, implemented, and evaluated an evidence-based intervention (EBI)-Personalized Cognitive Counseling-as a pilot program for YMSM, aged 20-29 in New York City jails from May 2015 to July 2016. Thirty-four participants recalled a memorable episode of unprotected anal intercourse (UAI), discussed the episode and resulting thoughts and feelings, identified the self-justifications that facilitated the episode, and discussed possible behavior modifications when presented with similar situations in the future. The top endorsed self-justifications for UAI included that they already had UAI with this person, condomless sex feels more natural, not wanting to lose the opportunity for sex, that substance use influenced their thinking, and not wanting to think about HIV transmission. HIV knowledge improved slightly, as measured by the 18 item HIV-KQ-18 HIV Knowledge Questionnaire, from a pre-intervention average of 15.17 (SD = 3.05) to post-intervention average of 16.48 (SD = 1.64) (p < 0.05). Learning the self-justifications that justice-involved MSM have for having UAI is beneficial for targeting future health promotion interventions. Despite challenges inherent in the jail setting, HIV behavioral EBIs are feasible and they can improve HIV knowledge and encourage exploration of self-justifications for risky behavior.
AIDS Education and Prevention
To address HIV-risk among justice-involved minority men, New York City Health + Hospitals Correct... more To address HIV-risk among justice-involved minority men, New York City Health + Hospitals Correctional Health Services implemented a modified version of Choosing Life: Empowerment, Action Results (CLEAR), an evidence-based intervention to influence behavior. A total of 166 young (i.e., 20–29 years old) minority (e.g., non-Hispanic Black or Latinx) men at risk for HIV and incarcerated in New York City jails completed the adapted group-format intervention and corresponding evaluation assessments. Participants showed significantly improved HIV knowledge on the 18-item HIV-KQ-18 scale (mean increase = 3.11 correct, from 13.23 [SD = 3.80] pre-intervention to 16.34 [SD = 2.29] post-intervention). Similarly, participant summary scores for substance use risk, sexual risk, and health promotion improved significantly. At 90 days after jail release, participants reported improved “CLEAR thinking,” reduced risk behaviors and improved health-promoting behaviors. Health and HIV-prevention educati...
Puerto Rico health sciences journal, 2017
Campus, moderated the event with insight and experience from his years working with both people w... more Campus, moderated the event with insight and experience from his years working with both people with HIV and incarcerated populations. The conference brought together 100 people representing 42 organizations dedicated to providing health services, education, housing, and other re-entry services. A list of the organizations represented in the meeting is included in Table 1. In PR, as in the contiguous continental United States, gaps in the HIV continuum of care have been identified, as well as its adverse effects on both the individual and community health (2). There is evidence that professional and institutional development from a collaborative approach can improve the quality of care and the health outcomes of people with HIV (3). A collaborative multisectoral practice can improve health outcomes in people with HIV who are released from correctional facilities to their communities (4,5).
International Journal of Prisoner Health
Purpose Patient navigation is an evidence-based approach for enhancing medical and support servic... more Purpose Patient navigation is an evidence-based approach for enhancing medical and support service co-ordination and ensuring linkage to medical care for people living with HIV released from jail. The paper aims to discuss this issue. Design/methodology/approach This brief describes the benefits of patient navigation and issues to consider when implementing a navigator program. The authors use process data to describe the type and amount of navigation services delivered as part of a randomized study, the “The San Francisco Navigator Project.” Findings Navigation programs are able to accommodate a range of service needs; most clients required multiple types of services, particularly during the first two months after release. Originality/value Navigation programs should be prioritized because they provide unique and essential support for people leaving jail during the particularly vulnerable time immediately after release navigation plays a crucial role in retaining individuals in car...
Open Forum Infectious Diseases
APHA 2021 Annual Meeting and Expo, Oct 24, 2021
AIDS Education and Prevention, 2020
The twin epidemics of HIV and incarceration impact Puerto Rico, which has limited resources to ad... more The twin epidemics of HIV and incarceration impact Puerto Rico, which has limited resources to address the social and structural determinants of health in incarcerated populations. A Special Programs of National Significance grant supported a Puerto Rican community-based organization to implement the evidence-informed Transitional Care Coordination intervention among incarcerated persons living with HIV, targeting changes at the individual, organization, and systems levels. After implementation (November 2015–July 2018; n = 69), 93.1% of eligible clients were linked to community-based HIV care, 86.3% remained in care for 6 months, and 78.6% remained for 12 months. A greater proportion reported consistent HIV care, ART adherence, food security, and transportation to access care. Integrating HIV case management with housing and employment services, and developing buy-in and collaboration from partners across systems of care, including after a natural disaster, led to positive client o...
Journal of Immigrant and Minority Health, 2021
Persons living with diagnosed HIV (PLWDH) are overrepresented in correctional settings, as are La... more Persons living with diagnosed HIV (PLWDH) are overrepresented in correctional settings, as are Latinx including those of Puerto Rican (PR) origin. Little is known about this population’s HIV care engagement after incarceration. Semi-structured interviews were conducted with 23 PLWDH of PR origin incarcerated in NYC jails using the Behavioral Model for Vulnerable Populations as the theoretical basis. Most participants described a fragile connection to HIV care and inconsistent antiretroviral therapy adherence due to issues including substance use, poverty (e.g. homelessness), and other factors. Most were satisfied with their current communitybased providers and reported that their PR ethnicity and transnational ties to PR did not impact their HIV care, although some preferred Spanish-speaking providers. Greater access to stable housing and HIV care that is convenient to substance use treatment and other services appear to be the greatest needs of PLWDH of PR origin leaving jail.
Facilities 12 jails: 9 on Rikers Island (1 female facility, 1 adolescent facility), 3 borough hou... more Facilities 12 jails: 9 on Rikers Island (1 female facility, 1 adolescent facility), 3 borough houses, public hospital inpatient unit Average Daily Population~10,800 (2014) Annual Admissions 60,000 (2014) Community Releases* 60,000 / year Length of Stay mean=37 days; median~7d Electronic Health Record
Public Health Behind Bars, 2021
PLOS ONE, 2020
Introduction While U.S. jails are critical sites for engagement in HCV care, short lengths-of-sta... more Introduction While U.S. jails are critical sites for engagement in HCV care, short lengths-of-stay often do not permit treatment in jail. Therefore, linkage to HCV care after incarceration is crucial. However, little is known about HCV treatment acceptability among justice-involved individuals in U.S. jails. The goal of this study was to understand knowledge, attitudes, and acceptability of HCV treatment among people living with HCV in the New York City (NYC) jail system. Methods We recruited 36 HCV-antibody-positive individuals in the NYC jails using clinical data reports and performed semi-structured interviews to explore participants’ attitudes toward HCV treatment in jail and following return to the community. We continued interviews until reaching thematic saturation and analyzed interviews using an inductive, thematic approach. Results Participants were mostly male, Latina/o, with a mean age of 40 years. Nearly all were aware they were HCV antibody-positive. Two thirds of part...
Background: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HC... more Background: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. Methods: We conducted a single arm clinical trial to assess the rate and factors associated with linkage to HCV care after incarceration associated with a combined transitional care coordination (TCC) and patient navigation intervention. Results: During the intervention, n=84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years (SD=12). Of those who returned to the community, 26 (31%) linked to HCV care within a mean of 29 days (SD=25); 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, and 7 (8%) had documentation of sustained virol...
Journal of Hepatology, 2018
ABSTRACT The HRSA Special Projects of National Significance grant for Enhancing Linkages to Care ... more ABSTRACT The HRSA Special Projects of National Significance grant for Enhancing Linkages to Care for People Leaving Jails with HIV included ten demonstration sites. The program enhancement grants of up to $400,000 each year were awarded to ten sites including three major urban areas, Chicago, New York City and Philadelphia. Using similar approaches, the local areas instituted public health approaches to identify the HIV-infected, initiate discharge planning in jails, and facilitate post-release linkages to primary care. Tracking and sharing outcome data and conducting program evaluations led to program improvements and helped build sustainable programs. In NYC, the Ryan White Planning Council prioritized case management programs for those leaving jails. A robust effort to disseminate findings led to over a dozen published papers and policy briefs and local evaluation findings were presented at APHA 2012, the International AIDS Conference 2012 and the National Commission on Correctional Healthcare Conference. This widespread dissemination led to interest from those in other jurisdictions locally and globally, who were seeking ways to improve access and engagement in care. As a result, other community programs are interested in replicating the model including those implementing patient-centered Medical Homes and substance use treatment programs. Demonstration projects with timely dissemination can enhance awareness and opportunities to identify potential collaborators and funders for program sustainability and replication.
Addictive Behaviors
With the opioid overdose mortality rates rising nationally, The New York City Department of Healt... more With the opioid overdose mortality rates rising nationally, The New York City Department of Health and Mental Hygiene (NYC DOHMH) has worked to expand overdose rescue training (ORT) and naloxone distribution. This study sought to determine rates of overdose witnessing and naloxone use among overdose rescue-trained visitors to the NYC jails on Rikers Island. We conducted a six-month prospective study of visitors to NYC jails on Rikers Island who received ORT. We collected baseline characteristics of study participants, characteristics of overdose events, and responses to witnessed overdose events, including whether the victim was the incarcerated individual the participant was visiting on the day of training. Bivariate analyses compared baseline characteristics of participants who witnessed overdoses to those who did not, and of participants who used naloxone to those who did not. Overall, we enrolled 283 participants visiting NYC's Rikers Island jails into the study. Six months after enrollment, we reached 226 participants for follow-up by phone. 40 participants witnessed 70 overdose events, and 28 participants reported using naloxone. Of the 70 overdose events, three victims were the incarcerated individuals visited on the day of training; nine additional victims were recently released from jail and/or prison. Visitors to persons incarcerated at Rikers Island witness overdose events and are able to perform overdose rescues with naloxone. This intervention reaches a population that includes not only those recently released, but also other people who experienced overdose.
Background: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HC... more Background: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. Methods: We conducted a single arm clinical trial of a combined transitional care coordination (TCC) and patient navigation intervention and assessed the linkage rate and factors associated with linkage to HCV care after incarceration. Results: During the intervention, 84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years. Of those who returned to the community, 26 (31%) linked to HCV care within a median of 20.5 days; 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, 9 (11%) had a follow-up lab drawn to confirm sustained virologi...
Journal of Community Health
Young men who have sex with men (YMSM), especially African American and Latinx YMSM, accounted fo... more Young men who have sex with men (YMSM), especially African American and Latinx YMSM, accounted for the highest proportion of new HIV diagnoses in 2016. Minorities and persons living with HIV are over-represented in correctional settings. To influence risk behaviors of incarcerated YMSM who are living with HIV, New York City Health + Hospitals adapted, implemented, and evaluated an evidence-based intervention (EBI)-Personalized Cognitive Counseling-as a pilot program for YMSM, aged 20-29 in New York City jails from May 2015 to July 2016. Thirty-four participants recalled a memorable episode of unprotected anal intercourse (UAI), discussed the episode and resulting thoughts and feelings, identified the self-justifications that facilitated the episode, and discussed possible behavior modifications when presented with similar situations in the future. The top endorsed self-justifications for UAI included that they already had UAI with this person, condomless sex feels more natural, not wanting to lose the opportunity for sex, that substance use influenced their thinking, and not wanting to think about HIV transmission. HIV knowledge improved slightly, as measured by the 18 item HIV-KQ-18 HIV Knowledge Questionnaire, from a pre-intervention average of 15.17 (SD = 3.05) to post-intervention average of 16.48 (SD = 1.64) (p < 0.05). Learning the self-justifications that justice-involved MSM have for having UAI is beneficial for targeting future health promotion interventions. Despite challenges inherent in the jail setting, HIV behavioral EBIs are feasible and they can improve HIV knowledge and encourage exploration of self-justifications for risky behavior.
AIDS Education and Prevention
To address HIV-risk among justice-involved minority men, New York City Health + Hospitals Correct... more To address HIV-risk among justice-involved minority men, New York City Health + Hospitals Correctional Health Services implemented a modified version of Choosing Life: Empowerment, Action Results (CLEAR), an evidence-based intervention to influence behavior. A total of 166 young (i.e., 20–29 years old) minority (e.g., non-Hispanic Black or Latinx) men at risk for HIV and incarcerated in New York City jails completed the adapted group-format intervention and corresponding evaluation assessments. Participants showed significantly improved HIV knowledge on the 18-item HIV-KQ-18 scale (mean increase = 3.11 correct, from 13.23 [SD = 3.80] pre-intervention to 16.34 [SD = 2.29] post-intervention). Similarly, participant summary scores for substance use risk, sexual risk, and health promotion improved significantly. At 90 days after jail release, participants reported improved “CLEAR thinking,” reduced risk behaviors and improved health-promoting behaviors. Health and HIV-prevention educati...
Puerto Rico health sciences journal, 2017
Campus, moderated the event with insight and experience from his years working with both people w... more Campus, moderated the event with insight and experience from his years working with both people with HIV and incarcerated populations. The conference brought together 100 people representing 42 organizations dedicated to providing health services, education, housing, and other re-entry services. A list of the organizations represented in the meeting is included in Table 1. In PR, as in the contiguous continental United States, gaps in the HIV continuum of care have been identified, as well as its adverse effects on both the individual and community health (2). There is evidence that professional and institutional development from a collaborative approach can improve the quality of care and the health outcomes of people with HIV (3). A collaborative multisectoral practice can improve health outcomes in people with HIV who are released from correctional facilities to their communities (4,5).
International Journal of Prisoner Health
Purpose Patient navigation is an evidence-based approach for enhancing medical and support servic... more Purpose Patient navigation is an evidence-based approach for enhancing medical and support service co-ordination and ensuring linkage to medical care for people living with HIV released from jail. The paper aims to discuss this issue. Design/methodology/approach This brief describes the benefits of patient navigation and issues to consider when implementing a navigator program. The authors use process data to describe the type and amount of navigation services delivered as part of a randomized study, the “The San Francisco Navigator Project.” Findings Navigation programs are able to accommodate a range of service needs; most clients required multiple types of services, particularly during the first two months after release. Originality/value Navigation programs should be prioritized because they provide unique and essential support for people leaving jail during the particularly vulnerable time immediately after release navigation plays a crucial role in retaining individuals in car...
Open Forum Infectious Diseases