Addressing risk through Community Treatment for Infectious disease and Opioid use disorder Now (ACTION) among Justice-involved Populations


Purpose: ACTION is a 5-year randomized controlled trial comparing the effectiveness of a patient navigation model versus a mobile health unit (MHU) model to link individuals during re-entry from incarceration to healthcare services, with emphasis on prevention and treatment for HIV, hepatitis C, opioid use disorder. The current study examined secondary outcomes, comparing the type of referrals made (treatment vs ancillary services) at the initial MHU visit and the correlation between the number of MHU visits during the first six weeks of the intervention and having a primary care physician (PCP) prior to incarceration (before joining ACTION).

Methods: Participants (N=34) who attended at least one in-person MHU visit within the first six weeks of the intervention were included in the analysis. Demographics, PCP status, and referral type were collected from RealTime, an electronic health records system used on the TCU MHU and confirmed in the main study database. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) and Microsoft Excel.

Results: At the initial MHU visit, 97% of participants were given referrals for medical/health needs, 94% were given referrals for socio-economic needs, and 91% received referrals for both medical/health and socio-economic needs. Top medical/health referrals made were dental (71%), general medical care (53%), vision (41%), mental health (35%), and specialty care (26%).

Participants with a PCP prior to joining ACTION attended a mean of 0.97 MHU visits, while those who did not have a PCP attended an average 1.32 visits. Having a PCP prior to joining the study was negatively correlated to MHU visits (r = - 0.24). 46.2% of females (n=13) reported having a PCP, compared to 19% of males (n=21). Females averaged fewer MHU visits than males during the first six weeks of the intervention.

Conclusions: More participants received referrals at the initial MHU visit for health-related needs compared to socio-economic needs such as housing, transportation, and identification documents. The negative correlation between having a PCP prior to incarceration and frequency of MHU visits suggests that participants without a PCP are likely to attend more MHU visits. Future research should examine if individuals with a PCP experience trust issues with the healthcare system (compared to those without a PCP), experiences that could impact healthcare-seeking behavior. Females averaged fewer visits to the MHU than did males, and females were more likely than males to have previously had a PCP. These findings are preliminary and based on a small sample size but suggest interesting directions for future analysis on women’s health issues.