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      Development of an intervention to increase health service utilisation in ex-prisoners

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          Abstract

          The world prison population is growing at a rate well in excess of general population growth, with more than 10 million adults currently in custody around the world and around 30 million moving through prison systems each year. There is increasing recognition of the complex and chronic health needs of incarcerated populations, but evidence-based responses to these needs remain elusive. Most prisoners return to the community after a relatively short period of time in custody, however few transitional interventions for prisoners have been subjected to rigorous evaluation. This paper details the process of developing a service brokerage intervention for ex-prisoners in Queensland, Australia, and describes the resultant intervention. The intervention could be adapted for use in other settings and is amenable to methodologically rigorous evaluation. The collaborative design and development process involved extensive consultation with ex-prisoners and key government, community and consumer stakeholders. The intervention evolved considerably during the process of consultation, as we came to better understand the needs and priorities of our target population, and of the community organisations that served them. We consider genuine consultation with consumers, in a safe and supportive environment, to be an integral part of intervention research in this area. Given the poor outcomes experienced by many people after release from prison, evidence-based interventions developed in the way described here are urgently required.

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          The online version of this article (doi:10.1186/2194-7899-2-4) contains supplementary material, which is available to authorized users.

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          HIV in prison in low-income and middle-income countries.

          High prevalence of HIV infection and the over-representation of injecting drug users (IDUs) in prisons combined with HIV risk behaviour create a crucial public-health issue for correctional institutions and, at a broader level, the communities in which they are situated. However, data relevant to this problem are limited and difficult to access. We reviewed imprisonment, HIV prevalence, and the proportion of prisoners who are IDUs in 152 low-income and middle-income countries. Information on imprisonment was obtained for 142 countries. Imprisonment rates ranged from 23 per 100,000 population in Burkina Faso to 532 per 100,000 in Belarus and Russia. Information on HIV prevalence in prisons was found for 75 countries. Prevalence was greater than 10% in prisons in 20 countries. Eight countries reported prevalence of IDUs in prison of greater than 10%. HIV prevalence among IDU prisoners was reported in eight countries and was greater than 10% in seven of those. Evidence of HIV transmission in prison was found for seven low-income and middle-income countries. HIV is a serious problem for many countries, especially where injection drug use occurs. Because of the paucity of data available, the contribution of HIV within prison settings is difficult to determine in many low-income and middle-income countries. Systematic collection of data to inform HIV prevention strategies in prison is urgently needed. The introduction and evaluation of HIV prevention strategies in prisons are warranted.
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            Randomized experiments in criminology: What have we learned in the last two decades?

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              Mortality from overdose among injecting drug users recently released from prison: database linkage study.

              To assess whether injecting drug users have a higher than usual risk of death from overdose in the 2 weeks after release from prison. Soundex coding of surnames and information on date of birth were used to link entry and release dates from the local prison between 1983 and 1994 with clinical data from Edinburgh City Hospital's cohort of male injecting drug users who are infected with HIV. Edinburgh City Hospital and Edinburgh Prison. 316/332 male injecting drug users infected with HIV in the City Hospital HIV cohort; 16 were excluded because they were enrolled after developing AIDS or because their precise date of death was not available. Relative risk of dying from overdose before developing AIDS and relative risk of dying of all causes before developing AIDS during the 2 weeks after release from prison; this was compared with relative risks of death during other time at liberty. 238/316 (75%) injecting drug users served time in the prison between 1983 and 1994. 33 out of 316 injecting drug users who were infected with HIV died before developing AIDS during 517,177 days at risk. 20 of these men died of an overdose; 6 of these deaths occurred within 2 weeks of release during 5903 days at risk. Death rates from overdose before the development of AIDS were 1.02/1000 days during the 2 weeks after release (recently released) and 0.029/1000 days during other times of liberty. The relative risk of death from overdose became 7.7 (1.5 to 39.1) after temporal matching (when the comparison was limited to the first 2 weeks after release v the next 10 weeks). The crude relative risk in an analysis combining stratified prison term and the 2 weeks after release was 4.5 (1.7 to 11.7) for death from overdose. After temporal matching these risks became 1.8 (0.4 to 9.2). Prisons should evaluate interventions to reduce the risk of death from overdose after release.
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                Author and article information

                Contributors
                s.kinner@unimelb.edu.au
                k.vandooren@uq.edu.au
                f.boyle@sph.uq.edu.au
                marie.longo@health.sa.gov.au
                n.lennox@uq.edu.au
                Journal
                Health Justice
                Health Justice
                Health & Justice
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                2194-7899
                19 March 2014
                19 March 2014
                December 2014
                : 2
                : 4
                Affiliations
                [1 ]GRID grid.1008.9, ISNI 000000012179088X, Melbourne School of Population and Global Health, , The University of Melbourne, ; 207 Bouverie Street, Carlton, VIC 3010 Australia
                [2 ]GRID grid.1003.2, ISNI 0000000093207537, School of Medicine, , The University of Queensland, ; 288 Herston Road, Herston, QLD 4006 Australia
                [3 ]GRID grid.1002.3, ISNI 0000000419367857, School of Public Health and Preventive Medicine, , Monash University, ; 99 Commercial Road, Melbourne, VIC 3004 Australia
                [4 ]GRID grid.1058.c, ISNI 000000009442535X, , Murdoch Children’s Research Institute, ; 50 Flemington Road, Parkville, VIC 3052 Australia
                [5 ]GRID grid.1003.2, ISNI 0000000093207537, Queensland Centre for Intellectual and Developmental Disability, , School of Medicine, The University of Queensland, ; Raymond Terrace, South Brisbane, QLD 4010 Australia
                [6 ]GRID grid.1003.2, ISNI 0000000093207537, School of Population Health, , The University of Queensland, ; Herston Road, Herston, QLD 4006 Australia
                [7 ]Drug and Alcohol Services South Australia, 60 Marryatt Street, Port Adelaide, SA 5015 Australia
                Article
                4
                10.1186/2194-7899-2-4
                5151804
                a403c611-c348-4a39-ae31-4e82aa12fc08
                © Kinner et al.; licensee Springer. 2014

                This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 August 2013
                : 12 February 2014
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2014

                prisoner,transition,re-entry,randomised controlled trial,service brokerage,case management,intervention

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