How Can HIV Care Transition Be Improved When U.S. Immigration and Customs Enforcement Repatriates Detained Aliens to Mexico?

Abstract

ABSTRACT Alyson Rose-Wood: How Can HIV Care Transition Be Improved When U.S. Immigration and Customs Enforcement Repatriates Detained Aliens to Mexico? (Under the direction of Sandra Greene) Given the seriousness of HIV infection, the clinical implications of interrupted antiviral therapy, and the availability of free HIV treatment in Mexico, continuity of care for HIV-infected aliens detained by U.S. Immigration and Customs Enforcement (ICE) who are repatriated to Mexico is important. While ICE provides opt-in HIV screening and treatment for aliens during detention, a major gap exists in the care transition for HIV-infected detainees once they are repatriated from the United States. A convergent mixed-methods design was used to address how care transition of HIV-infected aliens repatriated to Mexico could be improved. The number of HIV-infected aliens repatriated to Mexico annually was estimated using data on HIV prevalence rates among aliens in ICE detention from the Texas Department of State Health Services. U.S.-based key informants were interviewed about HIV care transition and the factors facilitating or hindering its success. Bardach’s eightfold path was used to identify policy solution(s). Kingdon’s multiple streams model was used to develop policy advocacy recommendations to take advantage of “windows of opportunity” to reach identified policy goals. Secondary data analysis found that while likely an underestimate, every two weeks ICE is repatriating 2-3 (avg) HIV-infected aliens to Mexico. Ways to improve care transition suggested by key informants included ensuring that U.S. and Mexican health authorities are included in the removal of HIV-infected aliens in ICE custody and addressing three challenges for binational HIV medical record sharing (access, confidentiality, and patient consent). The policy analysis found that the most impactful long-term option for improving HIV care transition is to develop a binational continuity of care program that includes a platform for sharing medical information. A short-term step is to ensure implementation of extant ICE standards for HIV care transition. The multiple streams model suggested possible avenues to promote program implementation such as engaging with advisory committees that advise the U.S. government on HIV care. The most impactful option for improving HIV care transition is the development of a binational platform for sharing of HIV data and medical records. Opportunities to move this policy onto the formal government agendas need to be sought.Doctor of Public Healt