Abstract
BACKGROUND: Release from prison or jail is a high-risk time for HIV acquisition, yet prior efforts to expand access to pre-exposure prophylaxis (PrEP) and other HIV prevention services for people releasing from jail or prison have faced substantial implementation barriers. OBJECTIVE: Characterize the implementation landscape for HIV prevention for people releasing from prison or jail in Washington State, gathering input from staff at carceral institutions and community-based organizations to inform implementation of evidence-based HIV prevention strategies. DESIGN: Qualitative study. PARTICIPANTS: Healthcare and reentry staff in prisons and jails (n = 15) and staff at community-based organizations that may serve people releasing from jail or prison (n = 20), selected through chain referral sampling. APPROACH: Semi-structured qualitative interviews were conducted to theoretical saturation, then coded using a mixed inductive-deductive approach, based on the Consolidated Framework for Implementation Research. KEY RESULTS: Carceral institutions had few programs aimed specifically at HIV prevention. Carceral institutions had PrEP available but did not offer it widely, focusing on behavioral health or acute medical needs. Some community-based organizations offered PrEP or other forms of HIV prevention, but many focused on meeting basic needs or building community. Five themes characterized the implementation landscape for HIV prevention: 1) primacy of basic needs means HIV prevention is lower priority, 2) adding HIV prevention programming would require new funding, 3) differences in culture and philosophy influence interest in providing PrEP, 4) disconnection between carceral institutions and providers in the community limits linkage to care, 5) organizations balance protecting confidentiality while coordinating care. CONCLUSION: Rather than directly focusing on HIV prevention, carceral institutions and community-based organizations often focused on substance use disorder treatment, and there are opportunities to integrate additional HIV prevention education and interventions into substance use care. Closer relationships between carceral institutions and community organizations may improve care coordination but would require staff capacity.