Dr. Timothy Flanigan works at The Miriam Hospital on the East Side of Providence, where patients and visitors get valet parking, and the shabbiest rooms are nicer than the best in many hospitals. But that’s not the setting where Flanigan meets many of his patients.
Since 1992, Flanigan has been providing hands-on HIV care at the Adult Correctional Institutions in Cranston. He’s not alone; this is a group effort involving several doctors affiliated with Miriam and Brown University’s School of Medicine. But the team’s work is groundbreaking enough, it’s earned Flanigan an international award.
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Flanigan, who is co-director of the Immunology Center at Miriam and a professor of medicine at Brown, was chosen as the first recipient of the HIV Medicine Association’s Advocacy Award, which recognizes an HIVMA member “who has made important contributions to sound HIV/AIDS policy at the local, state, national or international levels in the arena of prevention, research or access to care.”
What the Miriam team has done is substantial.
First, when the ACI became one of only a few correctional systems to require HIV testing upon incarceration, program founder Dr. Charles Carpenter and his colleagues insisted that testing be tied to high-quality HIV treatment for the inmates, Flanigan said.
They started with women, then extended the program to men and to teenagers.
And they reached beyond the prison, too, providing continuous health care to inmates after their release and helping connect them with financial aid, social support and housing – which also helps reduce recidivism.
Flanigan also has worked to create a health care network for local residents and prison inmates who suffer from substance abuse, linking substance-abuse treatment with HIV therapy, an approach that is credited with improving adherence among HIV-infected substance abusers.
“The care of infectious diseases has to extend beyond the hospital walls into the communities that need it most,” Flanigan said in an interview. That means jail and prison inmates, substance abusers and residents of the poorest neighborhoods, he said, and that’s where the Miriam group has gone.
Flanigan and Dr. Josiah D. Rich not only provide care at the ACI, but also have a free HIV testing site and program to link people to care in South Providence, across from the Salvation Army. Dr. Karen T. Tashima, meanwhile, works with patients at Stanley Street Treatment & Resources (SSTAR), a detox and substance-abuse treatment program based in Fall River. Dr. Melissa M. Gaitanis brings her expertise to Thundermist Health Center in Woonsocket.
The patients even come to Miriam, where Flanigan said the Immunology Center treats about 1,200 patients per year, about 20 percent former inmates.
“We see that incarceration is just the beginning point, and once individuals leave, the care continues,” Flanigan said. “We’ve been fortunate to follow 80 percent of the individuals who are released at the Miriam Hospital. … We think it’s a very important program. It’s provided a tremendous amount of excellent care, and we’ve seen the death rate and illness related to AIDS plummet as a result.”
That’s a big reason behind the HIVMA award, Flanigan said. This program has been “a real success story,” and while there are other success stories around the country, this one has the potential to inspire other academic medical centers to reach out to prison inmates and others in similarly dire situations – not, traditionally, how many have viewed their mission.
The award, he said, “helps to project the importance of providing health care in nontraditional settings – of how that can be an effective intervention to impact individuals’ lives and in the community.”
It’s not a model limited to HIV, Flanigan noted. It could be used to target hepatitis C, tuberculosis, substance abuse, diabetes, hypertension. This is a strategy “we are all very excited about” at Brown and Miriam, he said, “but for other academic health centers, it’s still a novel idea. We’d like to see it become more mainstream.”
Flanigan received the award at the HIVMA’s October meeting.
