Beginning in early 2020, non-essential visits, including those conducted by linkage to care staff and community health workers, ceased in the Santa Clara Jail (SCC Jail) in response to COVID-19. These restrictions prompted the County of Santa Clara Public Health Department (SCCPHD) to evaluate how to best serve justice-involved individuals who were newly diagnosed HIV. It was particularly crucial to ensure engagement in community HIV care following release from jail when community clinics also had limited in-person services in response to COVID.  In order to provide HIV linkage services to those newly diagnosed with HIV, a telephonic visits program was created in collaboration SCCPHD and Adult Custody Health Services (ACHS) in January 2021. In our latest publication, “Telephonic Visits Program to Link Justice-Involved Individuals Diagnosed With HIV in Jail to Community HIV Care,” we describe this program in detail and report preliminary outcomes observed among participating individuals.

Read the Article in JPHMP

The telephonic visits program deployed trained social workers from SCCPHD to offer HIV education and short-term case management by contacting individuals with newly diagnosed HIV in the jail by telephone. During the telephone call, individuals were offered assistance with obtaining release medications and scheduling and attending their first HIV primary care appointment in the community. Through a routine HIV screening process that is offered to all individuals upon admission to the SCC Jail, those testing positive for HIV were offered the opportunity to enroll into the telephonic visits program. Jail medical staff offered this service at the initial medical visit where individuals were informed of their HIV diagnosis and initiated on HIV treatment. Individuals that agreed to participate in the program were scheduled for their first telephonic visit by a medical unit clerk.

The SCCPHD team of social workers, trained in cultural humility and trauma-informed care, performed outreach as part of the first telephone visit, to individuals in the jail by being sensitive to their needs, especially around privacy and confidentiality. During this telephonic visit, SCCPHD provided HIV education and assesses post-release needs to ensure that individuals received low-barrier access to services to meet those needs. Needs assessed include: (1) verifying patient medical insurance coverage, (2) patient ability to pick up HIV treatment prescriptions from pharmacy, and (3) other needs for support services such as housing navigation assistance or employment assistance. Individuals enrolled in the program received at least two telephonic appointments with SCCPHD; one while they are still in the jail and one following release.

What We Found

We found telephonic visits to be a convenient and low-barrier approach for patients to build a meaningful connection with social workers before release in order to enhance engagement in HIV care in the community; this mode of delivery of services not only ensures continuum of care along the HIV care cascade, but it was also seen to be was acceptable to patients as almost 60% of referred individuals agreed to participate in the program. For those newly diagnosed with HIV in jail, this approach can particularly be helpful in establishing a connection with linkage staff since without their support, these individuals may delay or not seek HIV care upon release from jail.

Another noteworthy reflection is that telephonic visits demonstrated the potential for decreased time from referral to first visit with a social worker since in-person visits do not need to be coordinated as closely as telephonic visits; this can be particularly important in a jail setting where length of stay can be short, thereby reducing the time available to plan for release. This can also be important to increase the ability of service providers to offer timely services overall because telephonic visits eliminate the need for security clearances and transit time for staff to arrive and be screened for entrance into the facility for in-person visits.

The planning process to launch a program like this required careful thought and coordination across multiple teams within our health system. The SCCPHD social worker team convened multiple internal meetings to discuss and establish a coordination workflow and also adapted existing case management templates to conduct the HIV needs assessment for individuals enrolling in the telephonic visits program. SCCPHD also considered other resource and compliance related factors such as fees for collect calls and maintaining patient privacy whilst providing services remotely while they are in the jail.

Collectively, these efforts greatly assisted patients in navigating an already complex health care delivery system following release to prevent any disruption to their HIV care. An intervention like the telephonic visits program could be instrumental in improving HIV linkage to care rates by addressing a range of barriers by providing justice involved individuals with a choice to receive linkage through telephonic or in-person appointments. To learn more, including specific implications for your practice, check out our full publication here.

Acknowledgements

We would like to thank our co-authors, Iliam Lopez and Rene Padilla, for their valuable contributions to this project which positively impacted the patients served by the telephonic visits program.

Kristin Walsh is an HIV specialist with Adult Custody Health Services for the Santa Clara County Jail, where she has led the HIV screening and treatment program since 2015.