# Leveraging Big Data to understand and improve continuity of care among HIV-positive jail inmates

> **NIH NIH R01** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2020 · $600,807

## Abstract

In the US only 30% of all HIV-infected (HIV+) persons are engaged in HIV care and on ART. Accordingly,
key to addressing the US HIV epidemic is to identify out-of-care HIV+ persons and to link them into sustainable
care. Criminal justice involvement (CJI) is endemic to communities most affected by the HIV epidemic and it
creates barriers to HIV care. On the other hand, CJI—and specifically incarceration—presents opportunities to
identify out-of-care HIV+ persons and facilitate their return to care. Most incarcerations occur in jails: county- or
municipal-operated facilities that house pretrial detainees and inmates sentenced to ≤ 1 year. Research
examining continuity of care among jail inmates has been limited to large urban jails, predominantly in the
Northeast. Little HIV research among jail inmates has been conducted in the South, a region with small and
mid-sized rural jails and a disproportionately high number of HIV deaths. As a result, a substantial gap exists
in elucidating the epidemiology of HIV in jails and identifying opportunities to maintain and re-establish care in
this setting. Statewide repositories of jail medical records could facilitate the analysis of HIV care across
representative samples of jails, but given jails’ local, independent operation, such repositories do not exist.
 In response, we propose a Big Data solution: creation of a de-identified database integrating 1) individual-
level, inmate records published daily on jail websites and retrieved using a web-scraping program that
automates data collection and 2) confidential HIV diagnosis and care records maintained by the state
department of public health (DPH). The integrated data will be used to assess the burden of HIV among jail
inmates and their continuity of HIV care as they transition between jail and the community. Beyond population-
level surveillance, a real-time version of our database that retains personal identifiers could be used by DPH to
identify HIV+ jail inmates not engaged in care prior to or during incarceration, and state disease specialists
could then intervene to coordinate receipt of HIV care in jail and linkage to community care at release.
However, use of a surveillance database with identifiers raises several ethical considerations.
 Accordingly, for HIV+ inmates incarcerated in southern state with a large and heterogeneous array of jails,
we will: 1) Develop a highly novel, de-identified database combining jail and state HIV records; 2) Use the de-
identified database to examine burden of known HIV in county jails, assess inmates’ use of HIV services
before, during and after incarceration, and identify inmate and facility factors associated with (dis)continuity of
care; and 3) Explore HIV+ inmates’, jailors’, and other stakeholders’ perspectives on the use of inmates’
anonymized data for HIV surveillance and the potential use of their identifiable data to enhance receipt of care
during incarceration and after release. Our proposed Big Data p...

## Key facts

- **NIH application ID:** 9933797
- **Project number:** 5R01AI129731-04
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** DAVID L ROSEN
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $600,807
- **Award type:** 5
- **Project period:** 2017-06-20 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9933797

## Citation

> US National Institutes of Health, RePORTER application 9933797, Leveraging Big Data to understand and improve continuity of care among HIV-positive jail inmates (5R01AI129731-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9933797. Licensed CC0.

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