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Clemenzi-Allen AA, Hebert J, Reid MA, Mains T, Hammer H, Gandhi M, Pratt L, Wesson P. Interruptions in HIV and Behavioral Health Care for Criminal-Legal Involved People Living with HIV Following Implementation of Decarceration and Shelter in Place in San Francisco, California. AIDS Behav 2024; 28:1093-1103. [PMID: 38060113 PMCID: PMC10896806 DOI: 10.1007/s10461-023-04221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/08/2023]
Abstract
Decarceration policies, enacted for SARS-CoV-2 mitigation in carceral settings, potentially exacerbated barriers to care for people living with HIV (PWH) with criminal legal involvement (CLI) during Shelter-in-Place (SIP) by limiting opportunities for engagement in provisions of HIV and behavioral health care. We compared health care engagement for PWH with CLI in San Francisco, California before and after decarceration and SIP using interrupted time series analyses. Administrative data identified PWH booked at the San Francisco County Jail with at least one clinic encounter from 01/01/2018-03/31/2020 within the municipal health care network. Monthly proportions of HIV, substance use, psychiatric and acute care encounters before (05/01/2019-02/29/2020) and after (03/01/2020-12/31/2020) SIP and decarceration were compared using Generalized Estimating Equation (GEE) log-binomial and logistic regression models, clustering on the patient-level. Of 436 patients, mean age was 43 years (standard-deviation 11); 88% cisgender-male; 39% white, 66% homeless; 67% had trimorbidity by Elixhauser score (medical comorbidity, psychotic disorder or depression, and substance use disorder). Clinical encounters immediately dropped following SIP for HIV (aOR = 0.77; 95% CI: 0.67, 0.90) and substance use visits (aRR = 0.83; 95% CI: 0.70, 0.99) and declined in subsequent months. Differential reductions in clinical encounters were seen among Black/African Americans (aRR = 0.93; 95% CI: 0.88, 0.99) and people experiencing homelessness (aRR = 0.92; 95% CI: 0.87, 0.98). Significant reductions in care were observed for PWH with CLI during the COVID-19 pandemic, particularly among Black/African Americans and people experiencing homelessness. Strategies to End the HIV Epidemic must improve engagement across diverse care settings to improve outcomes for this key population.
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Affiliation(s)
- A Asa Clemenzi-Allen
- San Francisco Department of Public Health, San Francisco, CA, USA.
- Division of HIV, Infection Diseases and Global Medicine, University of California, San Francisco, USA.
- , 798 Brannan St, San Francisco, CA, 94103, USA.
| | - Jillian Hebert
- Department of Family and Community Medicine, University of California, San Francisco, USA
| | - Michael Alistair Reid
- Division of HIV, Infection Diseases and Global Medicine, University of California, San Francisco, USA
| | - Tyler Mains
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Hali Hammer
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Monica Gandhi
- Division of HIV, Infection Diseases and Global Medicine, University of California, San Francisco, USA
| | - Lisa Pratt
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Paul Wesson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
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2
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Janca E, Keen C, Willoughby M, Young JT, Kinner SA. Sex differences in acute health service contact after release from prison in Australia: a data linkage study. Public Health 2023; 223:240-248. [PMID: 37688844 DOI: 10.1016/j.puhe.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 07/18/2023] [Accepted: 08/04/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVES Women released from prison typically experience worse health outcomes than their male counterparts. We examined sex differences in the patterns, characteristics, and predictors of acute health service contact (AHSC) (i.e. ambulance and/or emergency department use) after release from prison. STUDY DESIGN Data linkage study. METHODS Baseline survey data from 1307 adults (21% women) within six weeks of expected release from prisons in Queensland, Australia (2008-2010) were linked prospectively with state-wide ambulance and emergency department, correctional, mental health, and death records. Crude and adjusted incidence rates and incidence rate ratios of AHSC were calculated overall and by sex. An Andersen-Gill model was fit to examine whether sex predicted AHSC. The interaction effect between sex and each model covariate was tested. RESULTS The crude incidence rates of AHSC after release from prison were 1.4 (95% confidence interval [CI]: 1.3-1.5) and 1·1 (95%CI: 1.1-1.2) per person-year for women and men, respectively. The relationship between perceived physical health-related functioning at the baseline and AHSC was modified by sex (P = 0·039). The relationship between perceived health-related functioning and AHSC also differed among women. Compared to women who perceived their physical health as fair or good at the baseline, women who perceived their physical health as poor were at greater risk of AHSC (hazard ratio = 2.4, 95%CI: 1.4-3·9, P = 0.001) after release from prison. CONCLUSIONS Among people released from prison, women's and men's AHSC differs depending on how they perceive their own physical health. The specific needs of women and men must be considered in transitional support policy and planning to improve their health outcomes.
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Affiliation(s)
- E Janca
- School of Population Health, Curtin University, Perth, Western Australia, Australia; Justice Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - C Keen
- Justice Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - M Willoughby
- Justice Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - J T Young
- Justice Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia; National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - S A Kinner
- School of Population Health, Curtin University, Perth, Western Australia, Australia; Justice Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Griffith Criminology Institute, Griffith University, Queensland, Australia
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Erickson M, Deering K, Ranville F, Bingham B, Young P, Korchinski M, Buxton J, Martin RE, Shannon K, Krüsi A. "They Give you a bus Ticket and They Kick you Loose": A Qualitative Analysis of Post-Release Experiences among Recently Incarcerated Women Living with HIV in Metro Vancouver, Canada. Violence Against Women 2023:10778012231172693. [PMID: 37194251 PMCID: PMC10654258 DOI: 10.1177/10778012231172693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
To explore the transition from correctional facilities to community among women living with HIV in Vancouver, Canada, we interviewed 19 recently incarcerated women and 6 service providers. Findings highlighted heightened risk of violence at release, a lack of immediate supports, challenges accessing safe housing and addictions treatment, and interruptions in HIV treatment and care. In the face of structural barriers, women blamed themselves for not being able to break the cycle of incarceration. There is a critical need for enhanced pre-release planning with a priority on housing and substance use services, alongside supports that are trauma-and violence-informed and culturally safe.
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Affiliation(s)
| | - Kathleen Deering
- Center for Gender and Sexual Health Equity, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Flo Ranville
- Center for Gender and Sexual Health Equity, Vancouver, Canada
| | | | - Pam Young
- Unlocking the Gates Services Society, Vancouver, Canada
| | - Mo Korchinski
- Unlocking the Gates Services Society, Vancouver, Canada
| | - Jane Buxton
- Department of Medicine, University of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Ruth Elwood Martin
- Department of Medicine, University of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Kate Shannon
- Center for Gender and Sexual Health Equity, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Andrea Krüsi
- Center for Gender and Sexual Health Equity, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
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Meyer JP, Price CR, Ye Y, Qin Y, Tracey D, Demidont AC, Melbourne K, Altice FL. A PrEP Demonstration Project Using eHealth and Community Outreach to Justice-Involved Cisgender Women and Their Risk Networks. AIDS Behav 2022; 26:3807-3817. [PMID: 35672552 DOI: 10.1007/s10461-022-03709-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/26/2022]
Abstract
Women involved in criminal justice systems (WICJ) are a key population at risk for HIV, and pre-exposure prophylaxis (PrEP) is critical for HIV prevention. This project was designed to evaluate the feasibility and acceptability of delivering PrEP via eHealth to WICJ and members of their risk network (RN). We recruited HIV-negative cisgender WICJ index participants (n = 38) and risk network (RN) members (n = 67) using modified respondent-driven sampling. TDF/FTC was initiated for PrEP in participants meeting clinical criteria and dispensed through eHealth using a community-based, low barrier-to-care outreach model. Key steps in the PrEP care continuum were measured over 12 months. Enrolled participants (n = 105) had high current and lifetime justice-involvement and were predominantly cisgender women and non-Hispanic white with a mean age of 40.9y (SD 9.6). Despite most having primary care providers and medical insurance, PrEP awareness was low, and participants experienced high levels of medical, psychiatric, substance use, social, and economic need. Fifty-two participants (50%) were PrEP-eligible, of whom 24 (46%) initiated PrEP. TDF/FTC was safe and well-tolerated throughout follow-up and 13 individuals chose to remain on PrEP following study conclusion. In this novel PrEP demonstration project for WICJ and RN members, despite high medical, psychiatric, and social comorbidity, PrEP was positively received and effectively delivered using a community outreach model via eHealth.Registered on clinicaltrials.gov under trial registration number NCT03293290.
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Affiliation(s)
- Jaimie P Meyer
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States.
- Yale School of Public Health, Chronic Disease Epidemiology, New Haven, CT, United States.
| | - Carolina R Price
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States
| | - Yiwen Ye
- Yale School of Public Health, Chronic Disease Epidemiology, New Haven, CT, United States
| | - Yilu Qin
- Primary Care Program, Yale New Haven Health, HIV Training Track, New Haven, CT, United States
| | - DeShana Tracey
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States
| | - A C Demidont
- Gilead Sciences, Inc, Foster City, CA, United States
| | | | - Frederick L Altice
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States
- Yale School of Public Health, Epidemiology of Microbial Diseases, New Haven, CT, United States
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5
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Improving Post-Release Care Engagement for People Living with HIV Involved in the Criminal Justice System: A Systematic Review. AIDS Behav 2022; 26:1607-1617. [PMID: 34705154 DOI: 10.1007/s10461-021-03513-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2021] [Indexed: 10/20/2022]
Abstract
Given sub-optimal HIV care outcomes for people living with HIV (PLWH) post-release from incarceration, we systematically searched peer-reviewed literature (2010-2021) describing controlled trial interventions aimed at improving Antiretroviral Therapy (ART) adherence and care linkage following release from correctional facilities for PLWH. Of 392 studies, 16 (4%) met the inclusion criteria. All studies were conducted in the United States and involved some form of intensive case management. Trials that scored highest in terms of study quality provided cell phones for engagement, reported sustained viral load suppression as a measurable outcome to infer ART adherence, and measured longitudinal data collected for at least 3-to-6 months following release. The two trials that demonstrated improved HIV viral load suppression involved Peer Navigators, and incentivized undetectable viral load, respectively. Facilitating support for addictions and addressing other social and structural barriers to achieving optimal health is also of vital importance in bridging care gaps for PLWH.
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6
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Simbar M, Rahmanian F, Nazarpour S, Ramezankhani A, Zayeri F. Priorities for a gender-sensitive sexually transmitted infections and human immunodeficiency virus (STIs/HIV) services: An exploratory mixed methods study. Health Sci Rep 2022; 5:e553. [PMID: 35308420 PMCID: PMC8908080 DOI: 10.1002/hsr2.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 01/21/2022] [Accepted: 02/08/2022] [Indexed: 02/05/2023] Open
Abstract
Background and Aim Providing gender‐sensitive health services is emphasized by the World Health Organization. This study aimed to assess and prioritize the needs for the gender‐sensitive sexually transmitted infections/human immunodeficiency viruses (STIs/HIV) prevention services by a valid and reliable questionnaire. Methods This was an exploratory mixed methods sequential study in Shiraz Iran 2019. The first phase was a qualitative study on 37 providers and managers of the services who were recruited using the purposive and then snowball sampling method. In the second phase, following the content analysis of the qualitative data and a review of related literature, a questionnaire was developed and its psychometric properties were evaluated. Then, in the third phase, the questionnaire was used to assess and prioritize the needs through a quantitative descriptive cross‐sectional study on all 290 providers of STI/HIV prevention services affiliated with Shiraz University of Medical Sciences. Results The finding of the qualitative phase showed gender‐sensitive STI/HIV prevention services should provide gender‐sensitive care and education by the trained personnel and manages with appropriate facilities and equipment. Providing these services also requires supportive policies, intersectoral cooperation, and community capacitation. In the second phase, a questionnaire was developed with 63 items. Assessment of psychometric properties of the questionnaire demonstrated the scale content validity index and ratio (S‐CVI = 0.98 and S‐CVR = 0.87, respectively), as well as the reliability of the questionnaire (internal consistency = 0.972 and intracluster correlation coefficient = 0.910). Results of the third descriptive phase of the study demonstrated the highest priorities for gender‐sensitive education (92.01 ± 11.76%) and care services (92.11 ± 12.04%), respectively. Conclusions To improve the quality of the services, a gender‐based education and care process, as well as a gender‐sensitive structure, including gender‐sensitive personnel, facilities, and management are necessary. Recognizing and meeting the needs for gender‐sensitive services will improve the quality of the services.
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Affiliation(s)
- Masoumeh Simbar
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Midwifery and Reproductive Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Fatemeh Rahmanian
- Department of Midwifery, School of Nursing and Midwifery Shiraz University of Medical Sciences Shiraz Iran
| | - Soheila Nazarpour
- Department of Midwifery, Chalous Branch Islamic Azad University Chalous Iran
| | - Ali Ramezankhani
- Department of Public Health, School of Public Health and Safety Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Farid Zayeri
- Department of Biostatistics Shahid Beheshti University of Medical Sciences Tehran Iran
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7
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Sangaramoorthy T, Haddix M, Agopian A, Yellin H, Mouhanna F, Abdi H, Dorsey K, Peterson J, Kharfen M, Castel AD. Measuring Unmet Needs among Persons Living with HIV at Different Stages of the Care Continuum. AIDS Behav 2021; 25:1954-1967. [PMID: 33537918 DOI: 10.1007/s10461-020-03125-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 12/11/2022]
Abstract
Unmet needs can impede optimal care engagement, impacting the health and well-being of people living with HIV (PLWH); yet, whether unmet needs differ by care engagement status is not well understood. Using surveys and qualitative interviews, we examined and compared unmet needs for PLWH (n = 172) at different levels of care engagement. Unmet needs varied only slightly by care status. Survey findings revealed that provision of housing, emergency financial assistance, employment assistance, and food security were the greatest unmet need; for those in care, housing was the greatest unmet need, whereas for those sporadically in care or out of care, employment assistance was the greatest unmet needs. Qualitative interviews likewise illustrated that a lack of financial resources including insurance, housing, employment, and transportation presented barriers to care engagement across all care groups. Our findings indicate that unmet needs among PLWH are complex and multi-faceted across care engagement status.
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Affiliation(s)
| | - Meredith Haddix
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Anya Agopian
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Hannah Yellin
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Farah Mouhanna
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Hibo Abdi
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Kerri Dorsey
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
- District of Columbia Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA
| | - James Peterson
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Michael Kharfen
- District of Columbia Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA
| | - Amanda D Castel
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA.
- Department of Epidemiology, The Milken Institute School of Public Health, 950 New Hampshire Ave NW, Suite 500, Washington, DC, 20052, USA.
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8
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Duff P, Shannon K, Braschel M, Ranville F, Kestler M, Elwood Martin R, Krüsi A, Deering K. HIV viral load trajectories of women living with HIV in Metro Vancouver, Canada. Int J STD AIDS 2020; 32:322-330. [PMID: 33292094 DOI: 10.1177/0956462420965847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study describes long-term viral load (VL) trajectories and their predictors among women living with HIV (WLWH), using data from Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment (SHAWNA), an open prospective cohort study with linkages to the HIV/AIDS Drug Treatment Program. Using Latent Class Growth Analysis (LCGA) on a sample of 153 WLWH (1088 observations), three distinct trajectories of detectable VL (≥50 copies/ml) were identified: 'sustained low probability of detectable VL', characterized by high probability of long-term VL undetectability (51% of participants); 'high probability of delayed viral undetectability', characterized by a high probability VL detectability at baseline that decreases over time (43% of participants); and 'high probability of detectable VL', characterized by a high probability of long-term VL detectability (7% of participants). In multivariable analysis, incarceration (adjusted odds ratio (AOR) = 3.24; 95%CI:1.34-7.82), younger age (AOR = 0.96; 95%CI:0.92-1.00), and lower CD4 count (AOR = 0.82; 95%CI:0.72-0.93) were associated with 'high probability of delayed viral undetectability' compared to 'sustained low probability of detectable VL.' This study reveals the dynamic and heterogeneous nature of WLWH's long-term VL patterns, and highlights the need for early engagement in HIV care among young WLWH and programs to mitigate the destabilizing impact of incarceration on WLWH's HIV treatment outcomes.
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Affiliation(s)
- Putu Duff
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Flo Ranville
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Mary Kestler
- Faculty of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada.,BC Women's Hospital, Vancouver, British Columbia, Canada
| | - Ruth Elwood Martin
- Faculty of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Kathleen Deering
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
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9
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Housing Subsidies and Housing Stability are Associated with Better HIV Medical Outcomes Among Persons Who Experienced Homelessness and Live with HIV and Mental Illness or Substance Use Disorder. AIDS Behav 2020; 24:3252-3263. [PMID: 32180090 DOI: 10.1007/s10461-020-02810-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Among 958 applicants to a supportive housing program for low-income persons living with HIV (PLWH) and mental illness or a substance use disorder, we assessed impacts of housing placement on housing stability, HIV care engagement, and viral suppression. Surveillance and administrative datasets provided medical and residence information, including stable (e.g., rental assistance, supportive housing) and unstable (e.g., emergency shelter) government-subsidized housing. Sequence analysis identified a "quick stable housing" pattern for 67% of persons placed by this program within 2 years, vs. 28% of unplaced. Compared with unplaced persons not achieving stable housing quickly, persons quickly achieving stable housing were more likely to engage in care, whether placed (per Poisson regression, ARR: 1.14;95% CI 1.09-1.20) or unplaced (1.19;1.13-1.25) by this program, and to be virally suppressed, whether placed (1.22;1.03-1.44) or unplaced (1.26, 1.03-1.56) by this program. Housing programs can help homeless PLWH secure stable housing quickly, manage their infection, and prevent transmission.
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Golembeski CA, Sufrin CB, Williams B, Bedell PS, Glied SA, Binswanger IA, Hylton D, Winkelman TNA, Meyer JP. Improving Health Equity for Women Involved in the Criminal Legal System. Womens Health Issues 2020; 30:313-319. [PMID: 32739132 DOI: 10.1016/j.whi.2020.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/12/2020] [Accepted: 06/20/2020] [Indexed: 01/26/2023]
Affiliation(s)
- Cynthia A Golembeski
- Rutgers University School of Law and School of Public Affairs and Administration, Newark, New Jersey.
| | - Carolyn B Sufrin
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brie Williams
- University of California San Francisco, Division of Geriatrics and Amend at UCSF, Francisco, California
| | - Precious S Bedell
- University of Rochester College of Arts, Sciences, and Engineering, Turning Points Resource Center, Rochester, New York
| | - Sherry A Glied
- New York University Robert F. Wagner Graduate School of Public Service, New York, New York
| | - Ingrid A Binswanger
- Kaiser Permanente Institute for Health Research and Chemical Dependency Treatment Services, University of Colorado School of Medicine, Denver, Colorado
| | | | - Tyler N A Winkelman
- General Internal Medicine, Department of Medicine, Hennepin Healthcare; Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Jaimie P Meyer
- Yale University School of Medicine, New Haven, Connecticut
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Gormley R, Lin SY, Carter A, Nicholson V, Webster K, Martin RE, Milloy MJ, Pick N, Howard T, Wang L, de Pokomandy A, Loutfy M, Kaida A. Social Determinants of Health and Retention in HIV Care Among Recently Incarcerated Women Living with HIV in Canada. AIDS Behav 2020; 24:1212-1225. [PMID: 31486006 DOI: 10.1007/s10461-019-02666-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Women living with HIV (WLWH) are over-represented in corrections in Canada, yet little is known about women's experiences post-release. We used CHIWOS cross-sectional data from WLWH to estimate associations between social determinants of health and HIV-related care outcomes among WLWH with recent (within past year) or ever (before past year) incarceration experience. Lifetime incarceration prevalence was 36.9% (6.5% recent; 30.4% ever), with significant differences by province of residence (British Columbia: 10% recent; 52% ever; Ontario: 5%; 24%; Quebec: 6%; 22%; p < 0.001). In adjusted multinomial logistic regression analyses, compared with never incarcerated, recent incarceration was associated with Indigenous ancestry, lower annual income (< $20,000 CAD), unstable housing, current sex work, injection drug use (IDU), and sub-optimal antiretroviral therapy (ART) adherence, while ever incarceration was associated with current sex work, IDU, and experiencing adulthood violence. Our findings have implications regarding supports needed by WLWH in the post-release period, including ART adherence and achieving health and social goals.
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Affiliation(s)
- Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Sally Y Lin
- University of Victoria, Victoria, BC, Canada
| | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Ruth Elwood Martin
- Collaborating Centre for Prison Health and Education, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - M-J Milloy
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Neora Pick
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Terry Howard
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- GlassHouse Consultants, Vancouver, Canada
| | - Lu Wang
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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12
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Yanes-Lane M, Dussault C, Linthwaite B, Cox J, Klein MB, Sebastiani G, Lebouché B, Kronfli N. Using the barriers and facilitators to linkage to HIV care to inform hepatitis C virus (HCV) linkage to care strategies for people released from prison: Findings from a systematic review. J Viral Hepat 2020; 27:205-220. [PMID: 31638294 DOI: 10.1111/jvh.13220] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/09/2019] [Accepted: 10/06/2019] [Indexed: 01/05/2023]
Abstract
Elimination of hepatitis C virus (HCV) among short-term sentenced prison populations will require improved access to HCV care and specific strategies dedicated to linkage upon release. Prison-based HCV care has lagged behind HIV care, but much can be learned from HIV studies. We performed a systematic review to identify individual-, provider- and system-level barriers and facilitators to linkage to HCV and HIV care among released inmates. We searched MEDLINE, Scopus, the Cochrane Central Register of Controlled Trials and Embase, and performed a grey literature search for English articles published up to November 2018. Two searches were conducted, one each for HCV and HIV; 323 and 684 unique articles were identified of which two and 27 studies were included, respectively. Facilitators to linkage to HCV care included social support, having an existing primary care provider, and receipt of methadone, whereas barriers included a perceived lack of healthcare information and a lack of specialized linkage to care programs. The principal facilitators to linkage to HIV care included social support, treatment for substance use and mental illness, the provision of education, case management, discharge planning and transportation assistance. Important barriers were unstable housing, age <30 years, HIV-related stigma, poor providers' attitudes and the lack of post-release reintegration assistance. While HCV care-specific studies are needed, much can be learned from linkage to HIV care studies. Ultimately, a multi-pronged approach, addressing several individual-level social determinants of health, and key provider- and system-level barriers may be an appropriate starting point for the development of HCV linkage to care strategies.
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Affiliation(s)
- Mercedes Yanes-Lane
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Camille Dussault
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Blake Linthwaite
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Marina B Klein
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,CIHR Canadian HIV trials Network, Vancouver, British Columbia, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
| | - Giada Sebastiani
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada.,Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Nadine Kronfli
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
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13
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Erickson M, Pick N, Ranville F, Martin RE, Braschel M, Kestler M, Krüsi A, Shannon K. Violence and other social structural factors linked to incarceration for women living with HIV in Metro Vancouver: need for trauma-informed HIV care in prisons and post-Release. AIDS Care 2020; 32:1141-1149. [PMID: 31992054 DOI: 10.1080/09540121.2020.1717418] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite women living with HIV (WLWH) being disproportionately criminalized and overrepresented within correctional facilities, there remains limited longitudinal research with WLWH examining factors that make WLWH vulnerable to incarceration. Data are drawn from SHAWNA (Sexual health and HIV/AIDS: Women's Longitudinal Needs Assessment), a community-based research cohort with cisgender and transgender WLWH in Metro Vancouver, Canada. Multivariable logistic regression using generalized estimating equations (GEE) and an exchangeable working correlation matrix was used to prospectively model correlates of recent incarceration exposure over a seven-year period. Amongst 289 WLWH, 76% had been incarcerated in their lifetime, and 17% had experienced recent incarceration. In multivariable GEE analysis, younger age (AOR: 0.92 per year older, 95% CI: 0.89-0.96), recent homelessness (AOR: 2.81, 95% CI: 1.46-5.41), recent gender-based (physical and/or sexual) violence (AOR: 2.26, 95% CI: 1.20-4.22) and recent opioid use (AOR: 1.83, 95% CI: 1.00-3.36), were significantly associated with recent incarceration. Lifetime exposure to gender-based violence by police (AOR: 1.97, CI: 0.97-4.02) was marginally associated with increased odds of recent incarceration. This research suggests a critical need for trauma-informed interventions for WLWH during and following incarceration. Interventions must be gender specific, include housing and substance use supports, and address the impact of gender-based violence.
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Affiliation(s)
| | - Neora Pick
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, Canada
| | | | - Ruth Elwood Martin
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Collaborating Centre for Prison Health and Education, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Mary Kestler
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
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- Centre for Gender and Sexual Health Equity, Vancouver, Canada
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14
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Rahmanian F, Nazarpour S, Simbar M, Ramezankhani A, Zayeri F. Needs assessment for gender sensitive reproductive health services for adolescents. Int J Adolesc Med Health 2020; 32:ijamh-2017-0201. [PMID: 31967961 DOI: 10.1515/ijamh-2017-0201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/23/2018] [Indexed: 02/05/2023]
Abstract
Background A dimension of reproductive health services that should be gender sensitive is reproductive health services for adolescents. Objective This study aims to assess needs for gender sensitive reproductive health care services for adolescents. Methods This was a descriptive cross-sectional study on 341 of health care providers for adolescents in health centers and hospitals affiliated to Shiraz University of Medical Sciences in Iran in 2016. The subjects of the study were recruited using a convenience sampling method. The tools for data collection were: (1) a demographic information questionnaire and; (2) a valid and reliable questionnaire to Assess the Needs of Gender-Sensitive Adolescents Reproductive Health Care Services (ANQ-GSARHS) including three sections; process, structure and policy making for the services. Data were analyzed using SPSS 21. Results Three hundred and forty-one health providers with an average working experience of 8.77 ± 5.39 [mean ± standard deviation (SD)] years participated in the study. The results demonstrated the highest scores for educational needs (92.96% ± 11.49%), supportive policies (92.71% ± 11.70%) and then care needs (92.37% ± 14.34%) of the services. Conclusions Providing gender sensitive reproductive health care services for adolescents needs to be reformed as regards processes, structure and policies of the services. However, the gender appropriate educational and care needs as well as supportive policies are the priorities for reform of the services.
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Affiliation(s)
| | - Soheila Nazarpour
- Department of Midwifery, Chalous Branch, Islamic Azad University, Chalous, Iran
| | - Masoumeh Simbar
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Vali-Asr Avenue, Cross of Vali-Asr and Neiaiesh Highway, Opposite to Rajaee Heart Hospital, Tehran 1996835119, Iran
| | - Ali Ramezankhani
- Department of Public Health, Faculty of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Department of Biostatistics, Faculty of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Antoniou T, Mishra S, Matheson F, Smith-Merrill D, Challacombe L, Rowe J, DiCenso AM, Kouyoumdjian FG, Wobeser W, Kendall C, Loutfy M, Tsang J, Kanee L, Strike C. Using concept mapping to inform the development of a transitional reintegration intervention program for formerly incarcerated people with HIV. BMC Health Serv Res 2019; 19:761. [PMID: 31660976 PMCID: PMC6816153 DOI: 10.1186/s12913-019-4595-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Accessing HIV-related care is challenging for formerly incarcerated people with HIV. Interventions informed by the perspectives of these individuals could facilitate engagement with care and address competing priorities that may act as barriers to this process. Methods We used concept mapping to identify and prioritize the main obstacles to engaging with HIV-related care following prison release. In brainstorming sessions, formerly incarcerated people with HIV generated responses to a focused prompt regarding the main barriers to reengaging with care. These were consolidated in 35 statements. Next, participants sorted the consolidated list of responses into groups and rated each from lowest to highest in terms of its importance and feasibility of being addressed. We used cluster analysis to generate concept maps that were interpreted with participants. Results Overall, 39 participants participated in brainstorming sessions, among whom 18 returned for rating and sorting. Following analysis, a seven-cluster map was generated, with participants rating the ‘Practical Considerations’ (e.g. lack of transportation from prison) and ‘Survival Needs’ (e.g. securing housing and food) clusters as most important. Although ratings were generally similar between women and men, women assigned greater importance to barriers related to reconnecting with children. Conclusions Using concept mapping, we worked with formerly incarcerated people with HIV to identify and prioritize key challenges related to accessing health and social services following prison release. Transitional intervention programs should include programs and processes that address meeting basic subsistence needs and overcoming logistical barriers related to community re-entry.
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Affiliation(s)
- Tony Antoniou
- Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, 410 Sherbourne Street, 4th Floor, Toronto, Ontario, M4X 1K2, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Sharmistha Mishra
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Flora Matheson
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Centre of Criminology and Sociolegal Studies, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Janet Rowe
- Prisoners HIV/AIDS Support Action Network, Toronto, Ontario, Canada
| | | | - Fiona G Kouyoumdjian
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Claire Kendall
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Mona Loutfy
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Jenkin Tsang
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lauren Kanee
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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16
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Meyer JP. The Sustained Harmful Health Effects of Incarceration for Women Living with HIV. J Womens Health (Larchmt) 2019; 28:1017-1018. [PMID: 31355697 DOI: 10.1089/jwh.2019.7940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Jaimie P Meyer
- AIDS Program, Yale School of Medicine, New Haven, Connecticut
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17
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Women, incarceration and HIV: a systematic review of HIV treatment access, continuity of care and health outcomes across incarceration trajectories. AIDS 2019; 33:101-111. [PMID: 30289811 DOI: 10.1097/qad.0000000000002036] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to systematically review the literature on gendered implications of incarceration for HIV outcomes and engagement in care for women living with HIV (WLWH). DESIGN We systematically searched seven bibliographic databases, for peer-reviewed English-language studies, published between 2007 and 2017 reporting on incarceration, women (transgender inclusive) and HIV. METHODS Articles were included for evaluation if they reported outcomes for at least one of three measures of interest: viral load, antiretroviral therapy (ART) adherence or engagement in care among WLWH along incarceration trajectories. RESULTS Out of 1119 studies, 24 (2%) met the inclusion criteria. Of these 24 studies, the majority (n = 23) were conducted in the USA, 19 included samples of women and men and seven studies were transgender inclusive. Our review did not reveal clear sex differences in HIV outcomes during periods of incarceration; however, studies reporting postincarceration outcomes demonstrated significant sex disparities in all three outcomes of interest. Following incarceration, women were less likely to be virally suppressed, less likely to achieve optimal ART adherence and less likely to be engaged in care. CONCLUSION Despite growing numbers of incarcerated WLWH globally, there is a substantial gap in research examining the impact of incarceration on HIV outcomes for WLWH. Significant sex disparities in HIV outcomes and engagement in care exist along incarceration trajectories for WLWH, especially postincarceration. For improved health outcomes, research is needed to examine the experiences of WLWH throughout incarceration trajectories to develop interventions tailored to the specific needs of WLWH both during and following incarceration.
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18
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Adam GP, Di M, Cu-Uvin S, Halladay C, Smith BT, Iyer S, Trikalinos TA. Strategies for improving the lives of US women aged 40 and above living with HIV/AIDS: an evidence map. Syst Rev 2018; 7:25. [PMID: 29391059 PMCID: PMC5796491 DOI: 10.1186/s13643-018-0684-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/12/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND While in its early years the HIV epidemic affected primarily the male and the young, nowadays, the population living with HIV/AIDS is approximately 24% women, and its age composition has shifted towards older ages. Many of the older women who live with HIV/AIDS also live with the medical and social conditions that accompany aging. This work aims to identify and characterize empirical studies of strategies for the comprehensive management of women over 40, including transgender women, who live with HIV/AIDS. Forty was chosen as an operational age cutoff to identify premenopausal women who are less likely to bear children, as well as peri- and postmenopausal women. METHODS We conducted a literature search after discussions with a diverse panel of content experts and other stakeholders and developed an evidence map that identified 890 citations that address questions having to do with programs and barriers to engaging with programs, as well as the role of insurance and comorbidities, and have enrolled older women who live with HIV/AIDS. RESULTS Of these, only 37 (4%) reported results of interest for women over 40 who live with HIV/AIDS, or examined interactions between gender and older age that would allow predictions in this subgroup. Few of the 37 eligible studies focused on women facing obvious challenges, such as immigrants, transgender, physically abused, or those recently released from prison. No studies focused on women caring for dependents, including children and grandchildren, or those diagnosed after age 40. CONCLUSION The evidence base that is directly applicable to women over 40 who live with HIV/AIDS in the USA is limited, and the research need is broad. We propose research prioritization strategies for this population.
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Affiliation(s)
- Gaelen P Adam
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.
| | - Mengyang Di
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Susan Cu-Uvin
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, USA.,Department of Ob-Gyn and Medicine, Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Christopher Halladay
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Bryant T Smith
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Suchitra Iyer
- Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Thomas A Trikalinos
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, USA
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19
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Abstract
The criminal justice (CJ) system can be leveraged to access women for HIV prevention and treatment programs. Research is lacking on effective implementation strategies tailored to the specific needs of CJ-involved women. We conducted a scoping review of published studies in English from the United States that described HIV interventions, involved women or girls, and used the CJ system as an access point for sampling or intervention delivery. We identified 350 studies and synthesized data from 42 unique interventions, based in closed (n = 26), community (n = 7), or multiple/other CJ settings (n = 9). A minority of reviewed programs incorporated women-specific content or conducted gender-stratified analyses. CJ systems are comprised of diverse access points, each with unique strengths and challenges for implementing HIV treatment and prevention programs for women. Further study is warranted to develop women-specific and trauma-informed content and evaluate program effectiveness.
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20
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Conyers LM, Richardson LA, Datti PA, Koch LC, Misrok M. A Critical Review of Health, Social, and Prevention Outcomes Associated With Employment for People Living With HIV. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:475-490. [PMID: 29068719 DOI: 10.1521/aeap.2017.29.5.475] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A growing need has emerged among HIV service providers, policymakers, and researchers to understand ways in which employment, as a key social determinant of health, can be leveraged toward improved health outcomes among people living with HIV (PLHIV) and the prevention of HIV transmission. This critical review summarizes and assesses current research related to (a) the employment needs and challenges among populations disproportionately impacted by HIV, (b) the relationship between employment and important health outcomes associated with the HIV Care Continuum, and (c) implications for policy, service provision, and future research. As a first step to deepening an understanding of these issues, this analysis identifies gaps in knowledge to underscore the need and direction for future research so that well-targeted interventions can be designed and evaluated and more responsive policies can be developed to address the public health implications of the vocational development and employment needs of PLHIV.
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Affiliation(s)
- Liza M Conyers
- Pennsylvania State University, University Park, Pennsylvania
| | | | | | | | - Mark Misrok
- National Working Positive Coalition, New York, New York
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21
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Sprague C, Scanlon ML, Radhakrishnan B, Pantalone DW. The HIV Prison Paradox: Agency and HIV-Positive Women's Experiences in Jail and Prison in Alabama. QUALITATIVE HEALTH RESEARCH 2017; 27:1427-1444. [PMID: 27742766 DOI: 10.1177/1049732316672640] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Incarcerated women face significant barriers to achieve continuous HIV care. We employed a descriptive, exploratory design using qualitative methods and the theoretical construct of agency to investigate participants' self-reported experiences accessing HIV services in jail, in prison, and post-release in two Alabama cities. During January 2014, we conducted in-depth interviews with 25 formerly incarcerated HIV-positive women. Two researchers completed independent coding, producing preliminary codes from transcripts using content analysis. Themes were developed iteratively, verified, and refined. They encompassed (a) special rules for HIV-positive women: isolation, segregation, insults, food rationing, and forced disclosure; (b) absence of counseling following initial HIV diagnosis; and (c) HIV treatment impediments: delays, interruption, and denial. Participants deployed agentic strategies of accommodation, resistance, and care-seeking to navigate the social world of prison and HIV services. Findings illuminate the "HIV prison paradox": the chief opportunities that remain unexploited to engage and re-engage justice-involved women in the HIV care continuum.
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Affiliation(s)
- Courtenay Sprague
- 1 University of Massachusetts Boston, Boston, Massachusetts, USA
- 2 University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - David W Pantalone
- 1 University of Massachusetts Boston, Boston, Massachusetts, USA
- 3 Fenway Health, Boston, Massachusetts, USA
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22
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Beckwith C, Castonguay BU, Trezza C, Bazerman L, Patrick R, Cates A, Olsen H, Kurth A, Liu T, Peterson J, Kuo I. Gender Differences in HIV Care among Criminal Justice-Involved Persons: Baseline Data from the CARE+ Corrections Study. PLoS One 2017; 12:e0169078. [PMID: 28081178 PMCID: PMC5231337 DOI: 10.1371/journal.pone.0169078] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 12/07/2016] [Indexed: 11/17/2022] Open
Abstract
Background HIV-infected individuals recently released from incarceration have suboptimal linkage and engagement in community HIV care. We conducted a study to evaluate an information and communication technology intervention to increase linkage to community care among HIV-infected persons recently involved in the criminal justice (CJ) system. Baseline characteristics including risk behaviors and HIV care indicators are reported and stratified by gender. Methods We recruited HIV-infected individuals in the District of Columbia jail and persons with a recent history of incarceration through community and street outreach. Participants completed a baseline computer-assisted personal interview regarding HIV care and antiretroviral treatment (ART) adherence, substance use, and sexual behaviors. CD4 and HIV plasma viral load testing were performed at baseline or obtained through medical records. Data were analyzed for the sample overall and stratified by gender. Results Of 110 individuals, 70% were community-enrolled, mean age was 40 (SD = 10.5), 85% were Black, and 58% were male, 24% female, and 18% transgender women. Nearly half (47%) had condomless sex in the three months prior to incarceration. Although drug dependence and hazardous alcohol use were highly prevalent overall, transgender women were more likely to have participated in drug treatment than men and women (90%, 61%, and 50% respectively; p = 0.01). Prior to their most recent incarceration, 80% had an HIV provider and 91% had ever taken ART. Among those, only 51% reported ≥90% ART adherence. Fewer women (67%) had received HIV medications during their last incarceration compared to men (96%) and transgender women (95%; p = 0.001). Although neither was statistically significant, transgender women and men had higher proportions of baseline HIV viral suppression compared to women (80%, 69%, and 48.0% respectively, p>0.05); a higher proportion of women had a CD4 count ≤200 compared to men and transgender women (17%, 8% and 5% respectively; p>0.05). Conclusions In this study, HIV-infected persons with recent incarceration in Washington, DC reported important risk factors and co-morbidities, yet the majority had access to HIV care and ART prior to, during, and after incarceration. Self-reported ART adherence was sub-optimal, and while there were not statistically significant differences, CJ-involved women appeared to be at greatest risk of poor HIV outcomes. Trial registration Registered on ClinicalTrials.gov on 10/16/2012. Reference number: NCT01721226.
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Affiliation(s)
- Curt Beckwith
- The Miriam Hospital, Providence, RI, United States of America.,Brown University Alpert School of Medicine, Providence, RI, United States of America
| | - Breana Uhrig Castonguay
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Claudia Trezza
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Lauri Bazerman
- The Miriam Hospital, Providence, RI, United States of America
| | - Rudy Patrick
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Alice Cates
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Halli Olsen
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Ann Kurth
- Yale University School of Nursing, New Haven, CT, United States of America
| | - Tao Liu
- Brown University School of Public Health, Providence, RI, United States of America
| | - James Peterson
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Irene Kuo
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
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23
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Kim S, Ouellet LJ, Mazza J, Spaulding AC. Rasch Analysis and Differential Item Functioning of a Social Support Measure in Jail Inmates With HIV Infection. Eval Health Prof 2016; 40:33-60. [PMID: 27150117 DOI: 10.1177/0163278716644954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The protective effects of social support on health have been documented in a variety of groups. For HIV-infected persons released from correctional settings, strong social support may be particularly important for obtaining effective postrelease medical treatment and supportive services. Researchers and program evaluators seeking to improve access and adherence to postrelease HIV medical care in this population need accurate measures for the level and type of social support, but current measures have not been fully validated for incarcerated individuals with HIV infection. We used the Rasch model to test the Medical Outcomes Study (MOS) social support survey. Data for the analysis were collected as part of the EnhanceLink project in the five urban jails where the MOS was administered. Findings indicate that the MOS survey items may not capture the entire variability of person abilities. Respondents showed problems in discriminating among response options, indicating potential systematic bias. In addition, while there was no significant gender difference, overall levels of social support differed by gender. Further research is warranted to develop more effective social support measurement tools that can better guide interventions for persons transitioning from jail and prison to the community.
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Affiliation(s)
- Sage Kim
- University of Illinois at Chicago, Chicago, IL, USA
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24
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Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, Bozack AK, Caban M, Rourke SB. Housing Status, Medical Care, and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review. Am J Public Health 2015; 106:e1-e23. [PMID: 26562123 DOI: 10.2105/ajph.2015.302905] [Citation(s) in RCA: 235] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Accumulating evidence suggests responses to HIV that combine individual-level interventions with those that address structural or contextual factors that influence risks and health outcomes of infection. Housing is such a factor. Housing occupies a strategic position as an intermediate structural factor, linking "upstream" economic, social, and cultural determinants to the more immediate physical and social environments in which everyday life is lived. The importance of housing status for HIV prevention and care has been recognized, but much of this attention has focused on homeless individuals as a special risk group. Analyses have less often addressed community housing availability and conditions as factors influencing population health or unstable, inadequate, or unaffordable housing as a situation or temporary state. A focus on individual-level characteristics associated with literal homelessness glosses over social, economic, and policy drivers operating largely outside any specific individual's control that affect housing and residential environments and the health resources or risk exposures such contexts provide. OBJECTIVES We examined the available empirical evidence on the association between housing status (broadly defined), medical care, and health outcomes among people with HIV and analyzed results to inform future research, program development, and policy implementation. SEARCH METHODS We searched 8 electronic health and social science databases from January 1, 1996, through March 31, 2014, using search terms related to housing, dwelling, and living arrangements and HIV and AIDS. We contacted experts for additional literature. SELECTION CRITERIA We selected articles if they were quantitative analyses published in English, French, or Spanish that included at least 1 measure of housing status as an independent variable and at least 1 health status, health care, treatment adherence, or risk behavior outcome among people with HIV in high-income countries. We defined housing status to include consideration of material or social dimensions of housing adequacy, stability, and security of tenure. DATA COLLECTION AND ANALYSIS Two independent reviewers performed data extraction and quality appraisal. We used the Cochrane Risk of Bias Tool for randomized controlled trials and a modified version of the Newcastle Ottawa Quality Appraisal Tool for nonintervention studies. In our quality appraisal, we focused on issues of quality for observational studies: appropriate methods for determining exposure and measuring outcomes and methods to control confounding. RESULTS Searches yielded 5528 references from which we included 152 studies, representing 139,757 HIV-positive participants. Most studies were conducted in the United States and Canada. Studies examined access and utilization of HIV medical care, adherence to antiretroviral medications, HIV clinical outcomes, other health outcomes, emergency department and inpatient utilization, and sex and drug risk behaviors. With rare exceptions, across studies in all domains, worse housing status was independently associated with worse outcomes, controlling for a range of individual patient and care system characteristics. CONCLUSIONS Lack of stable, secure, adequate housing is a significant barrier to consistent and appropriate HIV medical care, access and adherence to antiretroviral medications, sustained viral suppression, and risk of forward transmission. Studies that examined the history of homelessness or problematic housing years before outcome assessment were least likely to find negative outcomes, homelessness being a potentially modifiable contextual factor. Randomized controlled trials and observational studies indicate an independent effect of housing assistance on improved outcomes for formerly homeless or inadequately housed people with HIV. Housing challenges result from complex interactions between individual vulnerabilities and broader economic, political, and legal structural determinants of health. The broad structural processes sustaining social exclusion and inequality seem beyond the immediate reach of HIV interventions, but changing housing and residential environments is both possible and promising.
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Affiliation(s)
- Angela A Aidala
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Michael G Wilson
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Virginia Shubert
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - David Gogolishvili
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Jason Globerman
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Sergio Rueda
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Anne K Bozack
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Maria Caban
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Sean B Rourke
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
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Meyer JP, Cepeda J, Taxman FS, Altice FL. Sex-Related Disparities in Criminal Justice and HIV Treatment Outcomes: A Retrospective Cohort Study of HIV-Infected Inmates. Am J Public Health 2015; 105:1901-10. [PMID: 26180958 DOI: 10.2105/ajph.2015.302687] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES We evaluated sex-related differences in HIV and criminal justice (CJ) outcomes. METHODS We quantified sex-related differences in criminal offenses, incarcerations, and HIV outcomes among all HIV-infected inmates on antiretroviral therapy (ART) in Connecticut (2005-2012). Computed criminogenic risk scores estimated future CJ involvement. Stacked logistic regression models with random effects identified significant correlates of HIV viral suppression on CJ entry, reflecting preceding community-based treatment. RESULTS Compared with 866 HIV-infected men on ART (1619 incarcerations), 223 women (461 incarcerations) were more likely to be younger, White, and medically insured, with shorter incarceration periods (mean = 196.8 vs 368.1 days), mostly for public disorder offenses. One third of both women and men had viral suppression on CJ entry, correlating positively with older age and having treated comorbidities. Entry viral suppression inversely correlated with incarceration duration for women and with criminogenic risk score for men. CONCLUSIONS In the largest contemporary cohort of HIV-infected inmates on ART, women's higher prevalence of nonviolent offenses and treatable comorbidities supports alternatives to incarceration strategies. Sex-specific interventions for CJ populations with HIV effectively align public health and safety goals.
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Affiliation(s)
- Jaimie P Meyer
- Jaimie P. Meyer and Frederick L. Altice are with the AIDS Program, Yale School of Medicine, New Haven, CT. Jaimie P. Meyer is also with the Chronic Disease Epidemiology Department, Yale School of Public Health, New Haven. Javier Cepeda and Frederick L. Altice are with the Department of Epidemiology of Microbial Diseases, Yale School of Public Health. Faye S. Taxman is with the Criminology, Law, and Society Department, George Mason University, Fairfax, VA
| | - Javier Cepeda
- Jaimie P. Meyer and Frederick L. Altice are with the AIDS Program, Yale School of Medicine, New Haven, CT. Jaimie P. Meyer is also with the Chronic Disease Epidemiology Department, Yale School of Public Health, New Haven. Javier Cepeda and Frederick L. Altice are with the Department of Epidemiology of Microbial Diseases, Yale School of Public Health. Faye S. Taxman is with the Criminology, Law, and Society Department, George Mason University, Fairfax, VA
| | - Faye S Taxman
- Jaimie P. Meyer and Frederick L. Altice are with the AIDS Program, Yale School of Medicine, New Haven, CT. Jaimie P. Meyer is also with the Chronic Disease Epidemiology Department, Yale School of Public Health, New Haven. Javier Cepeda and Frederick L. Altice are with the Department of Epidemiology of Microbial Diseases, Yale School of Public Health. Faye S. Taxman is with the Criminology, Law, and Society Department, George Mason University, Fairfax, VA
| | - Frederick L Altice
- Jaimie P. Meyer and Frederick L. Altice are with the AIDS Program, Yale School of Medicine, New Haven, CT. Jaimie P. Meyer is also with the Chronic Disease Epidemiology Department, Yale School of Public Health, New Haven. Javier Cepeda and Frederick L. Altice are with the Department of Epidemiology of Microbial Diseases, Yale School of Public Health. Faye S. Taxman is with the Criminology, Law, and Society Department, George Mason University, Fairfax, VA
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Milloy MJ, Montaner JSG, Wood E. Incarceration of people living with HIV/AIDS: implications for treatment-as-prevention. Curr HIV/AIDS Rep 2015; 11:308-16. [PMID: 24962285 DOI: 10.1007/s11904-014-0214-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Contact with the criminal justice system, including incarceration, is a common experience for many people living with HIV/AIDS. Optimism has recently been expressed that correctional facilities could be important locations for treatment-as-prevention (TasP)-based initiatives. We review recent findings regarding the effect of incarceration on patterns of HIV transmission, testing, treatment initiation and retention. We found that the prevalence of HIV infection among incarcerated individuals remains higher than analogous non-incarcerated populations. Recent studies have shown that voluntary HIV/AIDS testing is feasible in many correctional facilities, although the number of previously undiagnosed individuals identified has been modest. Studies have implied enhanced linkage to HIV/AIDS treatment and care in jails in the United States was associated with improvements in the HIV cascade of care. However, for many individuals living with HIV/AIDS, exposure to the correctional system remains an important barrier to retention in HIV/AIDS treatment and care. Future research should evaluate structural interventions to address these barriers and facilitate the scale-up of TasP-based efforts among individuals living in correctional settings.
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Affiliation(s)
- M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada,
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Abstract
Release from short-term jail detention is highly destabilizing, associated with relapse to substance use, recidivism, and disrupted health care continuity. Little is known about emergency department (ED) use, potentially a surrogate for medical, psychiatric, or social instability, by people living with HIV/AIDS (PLWHA) leaving jails. All ED visits were reviewed from medical records for a cohort of 109 PLHWA in the year following release from county jail in Connecticut, between January 1, 2008 and December 31, 2010. Primary outcomes were frequency and timing of ED visits, modeled using multivariate negative binomial regression and Cox proportional hazards regression, respectively. Demographic, substance use, and psychiatric disorder severity factors were evaluated as potential covariates. Overall, 71 (65.1%) of the 109 participants made 300 unique ED visits (2.75 visits/person-year) in the year following jail-release. Frequency of ED use was positively associated with female sex (incidence rate ratios, IRR 2.40 [1.36-4.35]), homelessness (IRR 2.22 [1.15-4.41]), and recent substance use (IRR 2.47 [1.33-4.64]), and inversely associated with lifetime drug severity (IRR 0.01 [0-0.10]), and being retained in HIV primary care (IRR 0.80 [0.65-0.99]). Those in late or sustained HIV care used the ED sooner than those not retained in HIV primary care (median for late retention 16.3 days, median for sustained retention 24.9 days, median for no retention not reached at 12 months, p value 0.004). Using multivariate modeling, those who used the ED earliest upon release were more likely to be homeless (HR 1.98 [1.02-3.84]), to be retained in HIV care (HR 1.30 [1.04-1.61]), and to have recently used drugs (HR 2.51 [1.30-4.87]), yet had a low lifetime drug severity (HR 0.01 [0.00-0.14]). Among PLWHA released from jail, frequency of ED use is high, often soon after release, and is associated with social and drug-related destabilizing factors. Future interventions for this specific population should focus on addressing these resource gaps, ensuring housing, and establishing immediate linkage to HIV primary care after release from jail.
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Affiliation(s)
- Andrew T Boyd
- AIDS Program, Yale School of Medicine, New Haven, CT, USA,
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Meyer JP, Cepeda J, Wu J, Trestman RL, Altice FL, Springer SA. Optimization of human immunodeficiency virus treatment during incarceration: viral suppression at the prison gate. JAMA Intern Med 2014; 174:721-9. [PMID: 24687044 PMCID: PMC4074594 DOI: 10.1001/jamainternmed.2014.601] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Human immunodeficiency virus (HIV) management in correctional settings is logistically feasible, but HIV-related outcomes before release have not been recently systematically examined. OBJECTIVE To evaluate HIV treatment outcomes throughout incarceration, including jail and prison. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of longitudinally linked demographic, pharmacy, and laboratory data on 882 prisoners within the Connecticut Department of Correction (2005-2012) with confirmed HIV infection, who were continually incarcerated 90 days or more, had at least 2 HIV-1 RNA and CD4 lymphocyte measurements, and were prescribed antiretroviral therapy. MAIN OUTCOMES AND MEASURES Three electronic databases (correctional, laboratory, and pharmacy) were integrated to assess HIV viral suppression (HIV-1 RNA levels, <400 copies/mL) on intake and release. Secondary outcomes were mean change in log-transformed HIV-1 RNA levels and mean change in CD4 lymphocyte count during incarceration. Demographic characteristics, prescribed pharmacotherapies, receipt of directly observed therapy, and duration of incarceration were analyzed as possible explanatory variables for HIV viral suppression in logistic regression models. RESULTS Among 882 HIV-infected prisoners with 1185 incarceration periods, mean HIV-1 RNA level decreased by 1.1 log10 and CD4 lymphocyte count increased by 98 cells/µL over time, with a higher proportion achieving viral suppression by release compared with entry (70.0% vs 29.8%; P < .001); 36.9% of antiretroviral therapy (ART) regimens were changed during incarceration. After adjusting for baseline HIV-1 RNA level, prerelease viral suppression correlated with female sex (adjusted odds ratio, 1.81; 95% CI, 1.26-2.59) and psychiatric disorder severity below the sample median (adjusted odds ratio, 1.50; 95% CI, 1.12-1.99), but not race/ethnicity, incarceration duration, ART regimen or dosing strategy, or directly observed therapy. CONCLUSIONS AND RELEVANCE Though just one-third of HIV-infected prisoners receiving ART entered correctional facilities with viral suppression, HIV treatment was optimized during incarceration, resulting in the majority achieving viral suppression by release. Treatment for HIV within prison is facilitated by a highly structured environment and, when combined with simple well-tolerated ART regimens, can result in viral suppression during incarceration. In the absence of important and effective community-based resources, incarceration can be an opportunity of last resort to initiate continuous ART for individual health and, following the "treatment as prevention" paradigm, potentially reduce the likelihood of HIV transmission to others after release if continuity of HIV care is sustained.
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Affiliation(s)
- Jaimie P Meyer
- AIDS Program, Yale University School of Medicine, New Haven, Connecticut2Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut
| | - Javier Cepeda
- Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut
| | - Johnny Wu
- Correctional Managed Healthcare, University of Connecticut, Farmington
| | - Robert L Trestman
- Correctional Managed Healthcare, University of Connecticut, Farmington
| | - Frederick L Altice
- AIDS Program, Yale University School of Medicine, New Haven, Connecticut3Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut5Centre of Excellence on Research in AIDS, University of Malaya, Kuala Lumpur, Mala
| | - Sandra A Springer
- AIDS Program, Yale University School of Medicine, New Haven, Connecticut
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Meyer JP, Zelenev A, Wickersham JA, Williams CT, Teixeira PA, Altice FL. Gender disparities in HIV treatment outcomes following release from jail: results from a multicenter study. Am J Public Health 2014; 104:434-41. [PMID: 24432878 DOI: 10.2105/ajph.2013.301553] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We assessed gender differences in longitudinal HIV treatment outcomes among HIV-infected jail detainees transitioning to the community. METHODS Data were from the largest multisite prospective cohort study of HIV-infected released jail detainees (n = 1270)-the Enhancing Linkages to HIV Primary Care and Services in Jail Setting Initiative, January 2008 and March 2011, which had 10 sites in 9 states. We assessed baseline and 6-month HIV treatment outcomes, stratifying by gender. RESULTS Of 867 evaluable participants, 277 (31.9%) were women. Compared with men, women were more likely to be younger, non-Hispanic White, married, homeless, and depressed, but were similar in recent alcohol and heroin use. By 6 months postrelease, women were significantly less likely than men to experience optimal HIV treatment outcomes, including (1) retention in care (50% vs 63%), (2) antiretroviral therapy prescription (39% vs 58%) or optimal antiretroviral therapy adherence (28% vs 44%), and (3) viral suppression (18% vs 30%). In multiple logistic regression models, women were half as likely as men to achieve viral suppression. CONCLUSIONS HIV-infected women transitioning from jail experience greater comorbidity and worse HIV treatment outcomes than men. Future interventions that transition people from jail to community-based HIV clinical care should be gender-specific.
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Affiliation(s)
- Jaimie P Meyer
- Jaimie P. Meyer, Alexei Zelenev, Jeffrey A. Wickersham, and Frederick L. Altice are with the AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT. Jaimie P. Meyer is also with Chronic Disease Epidemiology, Yale University School of Public Health, New Haven. Chyvette T. Williams is with University of Illinois at Chicago School of Public Health. Paul A. Teixeira is with New York City Department of Health and Mental Hygiene, New York, NY. Frederick L. Altice is also with Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, and Centre of Excellence on Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia
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Flanigan TP. Jails: the new frontier. HIV testing, treatment, and linkage to care after release. AIDS Behav 2013; 17 Suppl 2:S83-5. [PMID: 23975472 DOI: 10.1007/s10461-013-0552-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Timothy P Flanigan
- The Miriam Hospital, Alpert Medical School of Brown University, 164 Summit Avenue, Providence, RI, 02906, USA,
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Meyer JP, Wickersham JA, Fu JJ, Brown SE, Sullivan TP, Springer SA, Altice FL. Partner violence and health among HIV-infected jail detainees. Int J Prison Health 2013; 9:124-41. [PMID: 24376468 PMCID: PMC3873166 DOI: 10.1108/ijph-03-2013-0011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Little is known about the association of intimate partner violence (IPV) with specific HIV-treatment outcomes, especially among criminal justice (CJ) populations who are disproportionately affected by IPV, HIV, mental, and substance use disorders (SUDs) and are at high risk of poor post-release continuity of care. DESIGN/METHODOLOGY/APPROACH Mixed methods were used to describe the prevalence, severity, and correlates of lifetime IPV exposure among HIV-infected jail detainees enrolled in a novel jail-release demonstration project in Connecticut. Additionally, the effect of IPV on HIV treatment outcomes and longitudinal healthcare utilization was examined. FINDINGS Structured baseline surveys defined 49 percent of 84 participants as having significant IPV exposure, which was associated with female gender, longer duration since HIV diagnosis, suicidal ideation, having higher alcohol use severity, having experienced other forms of childhood and adulthood abuse, and homo/bisexual orientation. IPV was not directly correlated with HIV healthcare utilization or treatment outcomes. In-depth qualitative interviews with 20 surveyed participants, however, confirmed that IPV was associated with disengagement from HIV care especially in the context of overlapping vulnerabilities, including transitioning from CJ to community settings, having untreated mental disorders, and actively using drugs or alcohol at the time of incarceration. ORIGINALITY/VALUE Post-release interventions for HIV-infected CJ populations should minimally integrate HIV secondary prevention with violence reduction and treatment for SUDs.
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