Format

Send to

Choose Destination
PLoS Med. 2018 Oct 9;15(10):e1002667. doi: 10.1371/journal.pmed.1002667. eCollection 2018 Oct.

Retention in HIV care during the 3 years following release from incarceration: A cohort study.

Author information

1
AIDS Program, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America.
2
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America.
3
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America.
4
Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America.
5
Health and Addiction Services Quality Improvement Program, Connecticut Department of Correction, Wethersfield, Connecticut, United States of America.
6
Centre of Excellence in Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia.

Abstract

BACKGROUND:

Sustained retention in HIV care (RIC) and viral suppression (VS) are central to US national HIV prevention strategies, but have not been comprehensively assessed in criminal justice (CJ) populations with known health disparities. The purpose of this study is to identify predictors of RIC and VS following release from prison or jail.

METHODS AND FINDINGS:

This is a retrospective cohort study of all adult people living with HIV (PLWH) incarcerated in Connecticut, US, during the period January 1, 2007, to December 31, 2011, and observed through December 31, 2014 (n = 1,094). Most cohort participants were unmarried (83.7%) men (77.0%) who were black or Hispanic (78.1%) and acquired HIV from injection drug use (72.6%). Prison-based pharmacy and custody databases were linked with community HIV surveillance monitoring and case management databases. Post-release RIC declined steadily over 3 years of follow-up (67.2% retained for year 1, 51.3% retained for years 1-2, and 42.5% retained for years 1-3). Compared with individuals who were not re-incarcerated, individuals who were re-incarcerated were more likely to meet RIC criteria (48% versus 34%; p < 0.001) but less likely to have VS (72% versus 81%; p = 0.048). Using multivariable logistic regression models (individual-level analysis for 1,001 individuals after excluding 93 deaths), both sustained RIC and VS at 3 years post-release were independently associated with older age (RIC: adjusted odds ratio [AOR] = 1.61, 95% CI = 1.22-2.12; VS: AOR = 1.37, 95% CI = 1.06-1.78), having health insurance (RIC: AOR = 2.15, 95% CI = 1.60-2.89; VS: AOR = 2.01, 95% CI = 1.53-2.64), and receiving an increased number of transitional case management visits. The same factors were significant when we assessed RIC and VS outcomes in each 6-month period using generalized estimating equations (for 1,094 individuals contributing 6,227 6-month periods prior to death or censoring). Additionally, receipt of antiretroviral therapy during incarceration (RIC: AOR = 1.33, 95% CI 1.07-1.65; VS: AOR = 1.91, 95% CI = 1.56-2.34), early linkage to care post-release (RIC: AOR = 2.64, 95% CI = 2.03-3.43; VS: AOR = 1.79; 95% CI = 1.45-2.21), and absolute time and proportion of follow-up time spent re-incarcerated were highly correlated with better treatment outcomes. Limited data were available on changes over time in injection drug use or other substance use disorders, psychiatric disorders, or housing status.

CONCLUSIONS:

In a large cohort of CJ-involved PLWH with a 3-year post-release evaluation, RIC diminished significantly over time, but was associated with HIV care during incarceration, health insurance, case management services, and early linkage to care post-release. While re-incarceration and conditional release provide opportunities to engage in care, reducing recidivism and supporting community-based RIC efforts are key to improving longitudinal treatment outcomes among CJ-involved PLWH.

PMID:
30300351
PMCID:
PMC6177126
DOI:
10.1371/journal.pmed.1002667
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: FLA reports Speakers Bureau: Simply Speaking HIV, Gilead Sciences, Merck, Clinical Care Options (role: speaker); Grants: NIH, NIDA, HRSA, SAMHSA, Gilead Foundation (role: PI); Advisory Board: Merck, Gilead (role: member/consultant). JPM reports Scientific Advisory Board: Gilead Sciences (role: member/consultant); Grants: NIDA, Doris Duke Charitable Foundation, and Gilead Investigator Sponsored Award (role: PI); Faculty: Clinical Care Options.

Supplemental Content

Full text links

Icon for Public Library of Science Icon for PubMed Central
Loading ...
Support Center