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Wiehe SE, Nelson TL, Aalsma MC, Rosenman MB, Gharbi S, Fortenberry JD. HIV Care Continuum Among People Living With HIV and History of Arrest and Mental Health Diagnosis. J Acquir Immune Defic Syndr 2023; 94:403-411. [PMID: 37949443 PMCID: PMC10642694 DOI: 10.1097/qai.0000000000003296] [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] [Received: 05/08/2023] [Accepted: 08/15/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Justice involvement and psychiatric comorbidities contribute to excess HIV morbidity, yet their interaction is poorly understood. We examined associations of this overlap with HIV outcomes among people living with HIV (PLWH). METHODS We conducted a retrospective cohort study of PLWH aged 13 years and older residing in Marion County (Indianapolis), IN, during 2018 (n = 5730) using linked HIV surveillance, arrest, and clinical data. We used univariable and multivariable regression to evaluate main and interaction effects of 2010-2017 arrest and mental health diagnosis on 2018 linkage to care (LTC), retention in care (RIC), and undetectable viral load (UVL). RESULTS LTC decreased among those with, versus without, an arrest (P = 0.02), although mental health diagnoses had no significant effect on LTC. When controlling for demographics and substance use disorder, analyses indicated a protective effect of arrest history on odds of RIC (adjusted odds ratio [aOR] = 1.54) and UVL (aOR = 1.26). Mental health diagnosis also increased odds of RIC (aOR = 2.02) and UVL (aOR = 1.95). Post hoc tests demonstrated that these results were mediated by outpatient care utilization, although an arrest or mental health diagnosis did increase odds of RIC among PLWH and a history of low outpatient utilization. CONCLUSIONS Outpatient care utilization improves HIV outcomes, even among those with justice involvement and psychiatric comorbidities. Holistic approaches to care can increase utilization. Implementation of "no wrong door" approaches, such as integration of mental health care in the primary care setting, simplifies health care navigation and improves access. Among those arrested, access to a Behavioral Court program can improve, rather than disrupt, HIV care.
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Affiliation(s)
- Sarah E. Wiehe
- Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN
| | - Tammie L. Nelson
- Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN
| | - Matthew C. Aalsma
- Pediatrics, Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN; and
| | - Marc B. Rosenman
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sami Gharbi
- Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN
| | - J. Dennis Fortenberry
- Pediatrics, Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN; and
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Iloanusi S, Yunusa I, Mgbere O, Abughosh SM, Chen H, Essien EJ. Development and internal validation of a risk prediction model for HIV disease severity among people living with HIV and mental illness or substance use disorder. Ann Epidemiol 2023; 87:79-92. [PMID: 37742879 DOI: 10.1016/j.annepidem.2023.09.007] [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: 05/06/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Mental illness (MI) and substance use disorders (SUD) are highly prevalent among people living with HIV (PLWH), and have been linked to poor HIV clinical outcomes. Innovative tools for early risk identification can facilitate timely interventions for PLWH and MI/SUD to improve their health outcomes, however, this is currently lacking in Texas, a state with the 4th largest population of PLWH in the United States. To address this gap, we developed a predictive model to estimate the risk of suboptimal HIV clinical outcomes among PLWH and MI/SUD in Texas. METHODS The Texas Medical Monitoring Project data obtained from June 2015-May 2020 were used to develop and internally validate the predictive model. Univariate descriptive and bivariate inferential statistics were performed to describe the characteristics of the study population and unadjusted associations with HIV clinical outcomes. Multivariable logistic regression was used to develop the prediction model. Internal validation was performed using the bootstrap method. RESULTS A total of 518 respondents aged 18 years and above, representing 27,255 adults living with HIV and mental illness or substance use disorders in Texas were included. Most participants were male (77.0%), less than 50 years of age (60.0%), and had mild diagnosed mental illness and substance use disorder (54.8%). The risk predictive model contained eight predictors, which together yielded an area under the receiver operating characteristic (ROC) curve of 0.727. Non-retention in care appeared to be the strongest risk predictor for having suboptimal HIV clinical outcome (adjusted odds ratio (aOR) = 3.27; 95% confidence interval (CI) = 1.45, 7.42). CONCLUSIONS The predictive model had good discrimination between persons at risk of poor HIV clinical outcomes and those not at risk.
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Affiliation(s)
- Sorochi Iloanusi
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX.
| | - Ismaeel Yunusa
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia
| | - Osaro Mgbere
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX; Public Health Science and Surveillance Division, Houston Health Department, Houston, TX; Institute of Community Health, University of Houston College of Pharmacy, Houston, TX
| | - Susan M Abughosh
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX; Institute of Community Health, University of Houston College of Pharmacy, Houston, TX
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX; Institute of Community Health, University of Houston College of Pharmacy, Houston, TX
| | - Ekere J Essien
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX; Institute of Community Health, University of Houston College of Pharmacy, Houston, TX
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Lincoln T, Simon-Levine D, Smith J, Donenberg GR, Springer SA, Zaller N, Altice FL, Moore K, Jordan AO, Draine J, Desabrais M. Prevalence and Predictors of Mental/Emotional Distress Among HIV+ Jail Detainees at Enrollment in an Observational Study. JOURNAL OF CORRECTIONAL HEALTH CARE 2016; 21:125-39. [PMID: 25788608 DOI: 10.1177/1078345815574566] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This study evaluates the prevalence of mental/emotional distress and its specific correlates among people living with HIV/AIDS (PLWHA) in 20 jail systems across the United States. Of the 878 PLWHA jail detainees, 52% had high levels of mental/emotional distress, defined by the composite Addiction Severity Index score. High mental/emotional distress was found to be associated with the inmate living in a city with lower income inequality, lower health ranking, and higher degree of danger. Proximate variables included being female, bisexual orientation, poorer physical health, and increased severity of substance abuse. Inmates in jails with accredited health services and those satisfied with family support had lower mental/emotional distress scores. These findings indicate the need for expanded mental health assessment of PLWHAs entering jail.
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Affiliation(s)
- Thomas Lincoln
- Baystate Medical Center, Springfield, MA, USA Tufts University School of Medicine, Boston, MA, USA
| | | | | | - Geri R Donenberg
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA Community Outreach Intervention Projects and Healthy Youths Program, University of Illinois at Chicago, Chicago, IL, USA
| | - Sandra A Springer
- Yale AIDS Program, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Nickolas Zaller
- Division of Infectious Diseases, The Miriam Hospital, Providence, RI, USA
| | - Frederick L Altice
- Section of Infectious Diseases, Yale University, New Haven, CT, USA Division of Epidemiology of Microbial Diseases, Yale University, New Haven, CT, USA
| | | | - Alison O Jordan
- New York City Department of Health and Mental Hygiene, East Elmhurst, NY, USA
| | - Jeffrey Draine
- School of Social Work, Temple University, Philadelphia, PA, USA
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Meyer JP, Cepeda J, Springer SA, Wu J, Trestman RL, Altice FL. HIV in people reincarcerated in Connecticut prisons and jails: an observational cohort study. Lancet HIV 2014; 1:e77-e84. [PMID: 25473651 DOI: 10.1016/s2352-3018(14)70022-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Reincarceration in prison or jail correlates with non-sustained HIV viral suppression, but HIV treatment outcomes in released prisoners who are reincarcerated have not recently been systematically assessed despite advances in antiretroviral treatment (ART) potency, simplicity, and tolerability. METHODS In a retrospective cohort of reincarcerated inmates with HIV in Connecticut (2005-12), we used longitudinally linked demographic, pharmacy, and laboratory databases to examine correlates of viral suppression. The primary outcome was viral suppression on reincarceration, defined as viral load lower than 400 RNA copies per mL. FINDINGS Of 497 prisoners and jail detainees with HIV, with 934 reincarcerations, individuals were mostly unmarried, uninsured, and black men prescribed a protease-inhibitor-based ART regimen. During the median 329 days (IQR 179-621) between prison release and reincarceration, the proportion of incarceration periods with viral suppression decreased significantly from 52% to 31% (mean HIV-RNA increased by 0·4 log10; p<0·0001), lower than Connecticut's HIV-infected prison population and those prescribed ART nationally. 158 (51%) of 307 individuals with viral suppression on release had viral suppression on reincarceration. Viral suppression on reincarceration was associated with increasing age (adjusted odds ratio [aOR] 1·04, 95% CI 1·01-1·07), being prescribed non-nucleoside reverse transcriptase inhibitor-based regimens (1·63, 1·14-2·34), and having higher levels of medical or psychiatric comorbidity (1·16, 1·03-1·30). INTERPRETATION Identification of individuals most at risk for recidivism and loss of viral suppression might mitigate the risk that repeated reincarceration poses to systems of public health and safety. FUNDING Bristol-Myers Squibb Virology, Patterson Trust, and National Institute on Drug Abuse.
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Affiliation(s)
- Jaimie P Meyer
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA (J P Meyer MD, S A Springer MD, Prof F L Altice MD); Chronic Disease Epidemiology (J P Meyer), Epidemiology of Microbial Diseases (J Cepeda MPH, Prof F L Altice), Yale School of Public Health, New Haven, CT, USA; Correctional Managed Healthcare, University of Connecticut, Farmington, CT, USA (J Wu MD, Prof R L Trestman MD); Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA (Prof R L Trestman); and Centre of Excellence on Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia (Prof F L Altice)
| | - Javier Cepeda
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA (J P Meyer MD, S A Springer MD, Prof F L Altice MD); Chronic Disease Epidemiology (J P Meyer), Epidemiology of Microbial Diseases (J Cepeda MPH, Prof F L Altice), Yale School of Public Health, New Haven, CT, USA; Correctional Managed Healthcare, University of Connecticut, Farmington, CT, USA (J Wu MD, Prof R L Trestman MD); Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA (Prof R L Trestman); and Centre of Excellence on Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia (Prof F L Altice)
| | - Sandra A Springer
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA (J P Meyer MD, S A Springer MD, Prof F L Altice MD); Chronic Disease Epidemiology (J P Meyer), Epidemiology of Microbial Diseases (J Cepeda MPH, Prof F L Altice), Yale School of Public Health, New Haven, CT, USA; Correctional Managed Healthcare, University of Connecticut, Farmington, CT, USA (J Wu MD, Prof R L Trestman MD); Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA (Prof R L Trestman); and Centre of Excellence on Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia (Prof F L Altice)
| | - Johnny Wu
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA (J P Meyer MD, S A Springer MD, Prof F L Altice MD); Chronic Disease Epidemiology (J P Meyer), Epidemiology of Microbial Diseases (J Cepeda MPH, Prof F L Altice), Yale School of Public Health, New Haven, CT, USA; Correctional Managed Healthcare, University of Connecticut, Farmington, CT, USA (J Wu MD, Prof R L Trestman MD); Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA (Prof R L Trestman); and Centre of Excellence on Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia (Prof F L Altice)
| | - Robert L Trestman
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA (J P Meyer MD, S A Springer MD, Prof F L Altice MD); Chronic Disease Epidemiology (J P Meyer), Epidemiology of Microbial Diseases (J Cepeda MPH, Prof F L Altice), Yale School of Public Health, New Haven, CT, USA; Correctional Managed Healthcare, University of Connecticut, Farmington, CT, USA (J Wu MD, Prof R L Trestman MD); Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA (Prof R L Trestman); and Centre of Excellence on Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia (Prof F L Altice)
| | - Frederick L Altice
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA (J P Meyer MD, S A Springer MD, Prof F L Altice MD); Chronic Disease Epidemiology (J P Meyer), Epidemiology of Microbial Diseases (J Cepeda MPH, Prof F L Altice), Yale School of Public Health, New Haven, CT, USA; Correctional Managed Healthcare, University of Connecticut, Farmington, CT, USA (J Wu MD, Prof R L Trestman MD); Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA (Prof R L Trestman); and Centre of Excellence on Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia (Prof F L Altice)
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Di Paola A, Altice FL, Powell ML, Trestman RL, Springer SA. A comparison of psychiatric diagnoses among HIV-infected prisoners receiving combination antiretroviral therapy and transitioning to the community. HEALTH & JUSTICE 2014; 2:11. [PMID: 25606368 PMCID: PMC4297667 DOI: 10.1186/s40352-014-0011-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 08/22/2014] [Indexed: 05/25/2023]
Abstract
BACKGROUND The criminal justice system (CJS), specifically prisons and jails, is ideally suited for uniform screening of psychiatric (PD) and substance use disorders (SUDs) among people living with HIV/AIDS (PLWHA), who are concentrated in these settings. By accurately diagnosing PDs and SUDs in these controlled settings, treatment can be initiated and contribute to improved continuity of care upon release. In the context of PLWHA, it may also improve combination antiretroviral treatment (cART) adherence, and reduce HIV transmission risk behaviors. METHODS A retrospective data analysis was conducted by creating a cohort of PLWHA transitioning to the community from prison or jail enrolled who were enrolled in a controlled trial of directly administered antiretroviral (DAART). Participants were systematically assessed for PDs and SUDs using the Mini International Neuropsychiatric Interview (MINI), a standardized psychiatric assessment tool, and compared to diagnoses documented within the correctional medical record. RESULTS Findings confirm a high prevalence of Axis I PDs (47.4%) and SUDs (67.1%) in PLWHA even after prolonged abstinence from alcohol and drugs. Although prevalence of PDs and SUDs were high in the medical record, there was fair to poor agreement among PDs using the MINI, making evident the potential benefit of more objective and concurrent PD assessments to guide treatment. CONCLUSIONS Additional PD diagnoses may be detected in PLWHA in CJS using supplementary and objective screening tools. By identifying and treating PDs and SUDs in the CJS, care may be improved and may ultimately contribute to healthier outcomes after community release if patients are effectively transitioned.
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Affiliation(s)
- Angela Di Paola
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, Suite 323, New Haven, CT 06519 USA
| | - Frederick L Altice
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, Suite 323, New Haven, CT 06519 USA
- Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, 60 College Street, New Haven, CT 06519 USA
| | - Mary Lindsay Powell
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, Suite 323, New Haven, CT 06519 USA
| | - Robert L Trestman
- University of Connecticut Health Center, Correctional Managed Health Care, 263 Farmington Avenue, Farmington, CT 06030 USA
| | - Sandra A Springer
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, Suite 323, New Haven, CT 06519 USA
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Lopes M, Olfson M, Rabkin J, Hasin DS, Alegría AA, Lin KH, Grant BF, Blanco C. Gender, HIV status, and psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2012; 73:384-91. [PMID: 22053858 PMCID: PMC3816377 DOI: 10.4088/jcp.10m06304] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 12/15/2010] [Indexed: 01/16/2023]
Abstract
OBJECTIVE More than 30 years after the onset of the human immunodeficiency virus (HIV) epidemic, there is no information on the prevalence of psychiatric disorders among HIV-positive individuals in the general population. We sought to compare the prevalence of 12-month psychiatric disorders among HIV-positive and HIV-negative adults stratified by sex and to examine the differential increase in risk of a psychiatric disorder as a function of the interaction of sex and HIV status. METHOD Face-to-face interviews were conducted between 2004 and 2005 with participants in the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2, a large nationally representative sample of US adults (34,653). The diagnostic interview used was the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. RESULTS When compared with their HIV-negative same-sex counterparts, HIV-positive men were more likely to have any mood disorder (odds ratio [OR] = 6.10; 95% confidence interval [CI], 2.99-12.44), major depressive disorder/dysthymia (OR = 3.77; 95% CI, 1.16-12.27), any anxiety disorder (OR = 4.02; 95% CI, 2.12-7.64), and any personality disorder (OR = 2.50; 95% CI, 1.34-4.67). In relation to their same-sex HIV-negative counterparts, the effect of HIV status on the odds of any mood disorder (OR = 7.17; 95% CI, 2.52-20.41), any anxiety disorder (OR = 3.45; 95% CI, 1.27-9.38), and any personality disorder (OR = 2.66; 95% CI, 1.16-6.10) was significantly greater for men than women. CONCLUSIONS HIV status was significantly more strongly associated with psychiatric disorders in men than in women. HIV-positive men had a higher prevalence than HIV-negative men of most psychiatric disorders. By contrast, HIV-positive women were not significantly more likely than HIV-negative women to have psychiatric disorders.
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Affiliation(s)
- Mariana Lopes
- New York State Psychiatric Institute, New York, NY 10032, United States
| | - Mark Olfson
- New York State Psychiatric Institute, New York, NY 10032, United States.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, United States
| | - Judith Rabkin
- New York State Psychiatric Institute, New York, NY 10032, United States.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, United States
| | - Deborah S. Hasin
- New York State Psychiatric Institute, New York, NY 10032, United States.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, United States.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, United States
| | | | - Keng-Han Lin
- New York State Psychiatric Institute, New York, NY 10032, United States
| | - Bridget F. Grant
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, United States
| | - Carlos Blanco
- New York State Psychiatric Institute, New York, NY 10032, United States.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, United States
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DE Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, Detraux J, Gautam S, Möller HJ, Ndetei DM, Newcomer JW, Uwakwe R, Leucht S. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 2011; 10:52-77. [PMID: 21379357 PMCID: PMC3048500 DOI: 10.1002/j.2051-5545.2011.tb00014.x] [Citation(s) in RCA: 1462] [Impact Index Per Article: 112.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The lifespan of people with severe mental illness (SMI) is shorter compared to the general population. This excess mortality is mainly due to physical illness. We report prevalence rates of different physical illnesses as well as important individual lifestyle choices, side effects of psychotropic treatment and disparities in health care access, utilization and provision that contribute to these poor physical health outcomes. We searched MEDLINE (1966 - August 2010) combining the MeSH terms of schizophrenia, bipolar disorder and major depressive disorder with the different MeSH terms of general physical disease categories to select pertinent reviews and additional relevant studies through cross-referencing to identify prevalence figures and factors contributing to the excess morbidity and mortality rates. Nutritional and metabolic diseases, cardiovascular diseases, viral diseases, respiratory tract diseases, musculoskeletal diseases, sexual dysfunction, pregnancy complications, stomatognathic diseases, and possibly obesity-related cancers are, compared to the general population, more prevalent among people with SMI. It seems that lifestyle as well as treatment specific factors account for much of the increased risk for most of these physical diseases. Moreover, there is sufficient evidence that people with SMI are less likely to receive standard levels of care for most of these diseases. Lifestyle factors, relatively easy to measure, are barely considered for screening; baseline testing of numerous important physical parameters is insufficiently performed. Besides modifiable lifestyle factors and side effects of psychotropic medications, access to and quality of health care remains to be improved for individuals with SMI.
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Psychiatric morbidity in HIV-infected male prisoners. J Formos Med Assoc 2010; 109:177-84. [PMID: 20434025 DOI: 10.1016/s0929-6646(10)60040-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 09/14/2009] [Accepted: 11/10/2009] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND/PURPOSE The seroincidence of human immunodeficiency virus (HIV) in Taiwan has drastically increased since 2004, particularly among injection drug users and prisoners. The major purpose of this study was to explore the prevalence and correlates of psychiatric morbidity among HIV-infected male prisoners. METHODS In 2006, data were collected from all of HIV-infected male prisoners (n = 535) in seven prisons in Taiwan. This collection was performed using a self-administered, anonymous questionnaire in group settings directed by our interviewers. Psychiatric morbidity was measured using the five-item Brief Symptom Rating Scale in 535 participants, which represented an 85% response rate. After excluding incomplete data, 479 participants were included in the analysis. RESULTS Psychiatric morbidity was present in 46% of participants. Multivariate logistic regression revealed that correlates of the five-item Brief Symptom Rating Scale defined cases included the following: being a recidivist, having poor self-rated health status, and having experienced psychiatric symptoms in one's lifetime (e.g. significant physical pain or discomfort, depression for 2 weeks or longer, serious anxiety or tension, trouble understanding, concentrating, or remembering, and serious thoughts of suicide), with a Nagelkerke R(2) equal to 0.365. CONCLUSION Psychiatric morbidity is prevalent among HIV-infected male prisoners. Tailored HIV/AIDS education related to mental health is therefore suggested for inclusion as part of a comprehensive HIV/AIDS training program among incarcerated populations.
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Baillargeon J, Giordano TP, Harzke AJ, Spaulding AC, Wu ZH, Grady JJ, Baillargeon G, Paar DP. Predictors of reincarceration and disease progression among released HIV-infected inmates. AIDS Patient Care STDS 2010; 24:389-94. [PMID: 20565323 DOI: 10.1089/apc.2009.0303] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We conducted a retrospective cohort study to determine the 3-year reincarceration rate of all HIV-infected inmates (n = 1917) released from the Texas prison system between January 2004 and March 2006. We also analyzed postrelease changes in HIV clinical status in the subgroup of inmates who were subsequently reincarcerated and had either CD4 lymphocyte counts (n = 119) or plasma HIV RNA levels (n = 122) recorded in their electronic medical record at both release and reincarceration. Multivariable analyses were performed to assess predictors of reincarceration and clinical changes in HIV status. Only 20% of all HIV-infected inmates were reincarcerated within 3 years of release. Female inmates (hazard ratio [HR] 0.63; 95% confidence interval [CI], 0.47, 0.84) and inmates taking antiretroviral therapy at the time of release (HR 0.31; 95% CI, 0.25, 0.39) were at decreased risk of reincarceration. African Americans (HR 1.58; 95% CI, 1.22, 2.05), inmates with a major psychiatric disorder (HR 1.82; 95% CI, 1.41, 2.34), and inmates released on parole (HR 2.86; 95% CI, 2.31, 3.55) were at increased risk of reincarceration. A subgroup of reincarcerated inmates had a mean decrease in CD4 cell count of 79.4 lymphocytes per microliter (p < 0.0003) and a mean increase in viral load of 1.5 log(10) copies per milliliter (p < 0.0001) in the period between release and reincarceration. Our findings, although substantially limited by selection bias, highlight the importance of developing discharge planning programs to improve linkage to community-based HIV care and reduce recidivism among released HIV-infected inmates.
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Affiliation(s)
- Jacques Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
- Community Health Services, University of Texas Medical Branch, Galveston, Texas
| | - Thomas P. Giordano
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey VA Medical Center Health Services Research and Development Center of Excellence, Houston, Texas
| | - Amy Jo Harzke
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
- Community Health Services, University of Texas Medical Branch, Galveston, Texas
| | | | - Z. Helen Wu
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - James J. Grady
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Gwen Baillargeon
- Community Health Services, University of Texas Medical Branch, Galveston, Texas
| | - David P. Paar
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
- Department of Medicine, University of Texas Medical Branch, Galveston, Texas
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Zahari MM, Hwan Bae W, Zainal NZ, Habil H, Kamarulzaman A, Altice FL. Psychiatric and substance abuse comorbidity among HIV seropositive and HIV seronegative prisoners in Malaysia. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2010; 36:31-8. [PMID: 20141394 DOI: 10.3109/00952990903544828] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the association between HIV infection and psychiatric disorders among prisoners, where mental illness, substance abuse, and HIV are disproportionately represented. DESIGN Cross-sectional study. METHODS Using a sequential randomization scheme, 200 HIV-seropositive and 200 HIV-seronegative prisoners were selected for evaluation of psychiatric illnesses with the Structured Clinical Interview for Diagnostic Statistical Manual of Mental Disorders-IV (SCID-I). RESULTS The prevalence of mental illness and substance use disorders, particularly opioid dependence, was extremely high. HIV infection was significantly correlated with age, ethnicity, marital status, history of injection drug use, lifetime duration of incarceration, substance abuse, and polysubstance drug use. After controlling for potential confounders, HIV infection was significantly associated with non-substance-induced psychiatric disorders (AOR = 1.92; 95% CI: 1.03-3.59). While prisoners with a triple diagnosis (psychiatric disorders, substance use disorders, and HIV) spent 46.7 more cumulative lifetime months in prison than those with only a psychiatric diagnosis (p < .01), those with a dual diagnosis (psychiatric plus substance use disorders) were comparable to those with one psychiatric diagnosis only. Neither HIV infection nor triple diagnosis was associated with violent offenses. CONCLUSION These findings suggest that a public health approach that simultaneously addresses psychiatric illnesses, substance abuse, and HIV infection is needed in both the correctional and the community settings in order to provide adequate care for triply-diagnosed patients and prevent them from returning to prison.
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Scheyett A, Parker S, Golin C, White B, Davis CP, Wohl D. HIV-infected prison inmates: depression and implications for release back to communities. AIDS Behav 2010; 14:300-7. [PMID: 18709452 DOI: 10.1007/s10461-008-9443-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 07/25/2008] [Indexed: 11/29/2022]
Abstract
High rates of both HIV and depression are seen in prison populations; depression has been linked to disease progression in HIV, risky behaviors, and medication non-adherence. Despite this, few studies have examined HIV-infected inmates with depression. We therefore conducted an exploratory study of a sample of HIV-infected inmates in North Carolina prisons (N = 101) to determine what proportion of this sample screened positive for depression and whether depression was associated with different pre-incarceration characteristics or post-release needs. A high proportion of HIV infected inmates (44.5%) screened positive for depression. Depressed inmates were significantly more likely have low coping self-efficacy scores (180 vs. 214), to report having had resource needs (OR = 2.91) prior to incarceration and to anticipate needing income (OR = 2.81), housing (OR = 4.07), transportation (OR = 9.15), and assistance with adherence (OR = 8.67) post-release. We conclude by discussion the implications of our findings for prison based care and effective prison release planning for HIV infected inmates.
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Affiliation(s)
- Anna Scheyett
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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12
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Epperson MW, Khan MR, Miller DP, Perron BE, El-Bassel N, Gilbert L. Assessing criminal justice involvement as an indicator of human immunodeficiency virus risk among women in methadone treatment. J Subst Abuse Treat 2010; 38:375-83. [PMID: 20356702 DOI: 10.1016/j.jsat.2010.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 02/26/2010] [Accepted: 03/02/2010] [Indexed: 11/27/2022]
Abstract
This study examines the relationship between criminal justice involvement and high-risk sexual partnerships among a random sample of 416 women in methadone treatment in New York City. Logistic regression models were used to estimate the associations between recent criminal justice involvement (arrest or incarceration in the past 6 months) and recent high-risk partnerships (multiple sex partners, sex trading, or sex with a risky partner in the past 6 months) when adjusting for sociodemographic factors and recent regular drug use. Women with recent criminal justice involvement demonstrated higher odds of engaging in high-risk sex partnerships. Although regular drug use was a significant confounder of several of these relationships, recent arrest or incarceration remained significantly associated with multiple sex partnerships, sex with a risky partner, and engaging in unprotected sex and a high-risk partnership even after controlling for regular drug use and other social stressors. This study highlights the vulnerability of drug-involved women offenders to human immunodeficiency virus (HIV) risk and points to the need for investigation into the role of arrest and incarceration as factors that may contribute to HIV infection.
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Affiliation(s)
- Matthew W Epperson
- Center for Behavioral Health Services and Criminal Justice Research, Rutgers University, New Brunswick, NJ 08901, USA.
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13
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Belenko S, Dembo R, Rollie M, Childs K, Salvatore C. Detecting, preventing, and treating sexually transmitted diseases among adolescent arrestees: an unmet public health need. Am J Public Health 2009; 99:1032-41. [PMID: 19372535 PMCID: PMC2679796 DOI: 10.2105/ajph.2007.122937] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2008] [Indexed: 11/04/2022]
Abstract
Studies of detained and incarcerated adolescent offenders in the United States indicate that these juveniles have an elevated risk of sexually transmitted diseases (STDs). However, many more arrestees enter the "front end" of the juvenile justice system than are detained or incarcerated, and research into the STD risk profiles and service needs of this larger group is lacking. An expansion of STD testing (including of asymptomatic youths), prevention, and treatment is needed, as is improved knowledge about gender- and race-specific services. A pilot program in Florida has shown that juvenile justice and public health systems can collaborate to implement STD testing among new arrestees. With integrated linkages to treatment and prevention after release, this model could greatly reduce the STD burden in this underserved, high-risk population.
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Affiliation(s)
- Steven Belenko
- Department of Criminal Justice, Temple University, Philadelphia, PA 19122, USA.
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14
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National estimation of rates of HIV serology testing in US emergency departments 1993-2005: baseline prior to the 2006 Centers for Disease Control and Prevention recommendations. AIDS 2008; 22:2127-34. [PMID: 18832876 DOI: 10.1097/qad.0b013e328310e066] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The 2006 Centers for Disease Control and Prevention recommendations place increased emphasis on emergency departments (EDs) as one of the most important medical care settings for implementing routine HIV testing. No longitudinal estimates exist regarding national rates of HIV testing in EDs. We analyzed a nationally representative ED database to assess HIV testing rates and characterize patients who received HIV testing, prior to the release of the 2006 guidelines. DESIGN A cross-sectional analysis of US ED visits (1993-2005) using the National Hospital Ambulatory Medical Care Survey was performed. METHODS Patients aged 13-64 years were included for analysis. Diagnoses were grouped with Healthcare Cost and Utilization Project Clinical Classifications Software. Analyses were performed using procedures for multiple-stage survey data. RESULTS HIV testing was performed in an estimated 2.8 million ED visits (95% confidence interval, 2.4-3.2) or a rate of 3.2 per 1000 ED visits (95% confidence interval, 2.8-3.7). Patients aged 20-39 years, African-American, and Hispanic had the highest testing rates. Among those tested, leading reasons for visit were abdominal pain (9%), puncture wound/needlestick (8%), rape victim (6%), and fever (5%). The leading medication class prescribed was antimicrobials (32%). The leading ED diagnosis was injury/poisoning (30%) followed by infectious diseases (18%). Of note, 6% of those tested were diagnosed with HIV infection during their ED visits. CONCLUSION Prior to the release of the 2006 Centers for Disease Control and Prevention guidelines for routine HIV testing in all healthcare settings, baseline national HIV testing rates in EDs were extremely low and appeared to be driven by clinical presentation.
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15
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Baillargeon JG, Paar DP, Wu H, Giordano TP, Murray O, Raimer BG, Avery EN, Diamond PM, Pulvino JS. Psychiatric disorders, HIV infection and HIV/hepatitis co-infection in the correctional setting. AIDS Care 2008; 20:124-9. [PMID: 18278623 DOI: 10.1080/09540120701426532] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Psychiatric disorders such as bipolar disorder, schizophrenia and depression have long been associated with risk behaviors for HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV). The US prison population is reported to have elevated rates of HIV, hepatitis and most psychiatric disorders. This study examined the association of six major psychiatric disorders with HIV mono-infection, HIV/HCV co-infection and HIV/HBV co-infection in one of the nation's largest prison populations. The study population consisted of 370,511 Texas Department of Criminal Justice inmates who were incarcerated for any duration between January 1, 2003 and July 1, 2006. Information on medical conditions and sociodemographic factors was obtained from an institution-wide electronic medical information system. Offenders diagnosed with HIV mono-infection, HIV/HCV, HIV/HBV and all HIV combined exhibited elevated rates of major depression, bipolar disorder, schizophrenia, schizoaffective disorder, non-schizophrenic psychotic disorder and any psychiatric disorder. In comparison to offenders with HIV mono-infection, those with HIV/HCV co-infection had an elevated prevalence of any psychiatric disorder. This cross-sectional study's finding of positive associations between psychiatric disease and both HIV infection and hepatitis co-infection among Texas prison inmates holds both clinical and public health relevance. It will be important for future investigations to examine the extent to which psychiatric disorders serve as a barrier to medical care, communication with clinicians and adherence to prescribed medical regimens among both HIV-mono-infected and HIV/hepatitis-co-infected inmates.
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Affiliation(s)
- J G Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555-1006, USA.
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16
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Gebbie KM, Larkin RM, Klein SJ, Wright L, Satriano J, Culkin JJ, Devore BS. Improving Access to Mental Health Services for New York State Prison Inmates. JOURNAL OF CORRECTIONAL HEALTH CARE 2008. [DOI: 10.1177/1078345807313875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kristine M. Gebbie
- Center for Health Policy, School of Nursing, Columbia University, New York
| | - Roland M. Larkin
- Center for Health Policy, School of Nursing, Columbia University, New York
| | - Susan J. Klein
- AIDS Institute, New York State Department of Health, Albany, New York
| | - Lester Wright
- New York State Department of Correctional Services, Albany, New York
| | - James Satriano
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York
| | - John J. Culkin
- New York State Department of Correctional Services, Albany, New York
| | - Barbara S. Devore
- AIDS Institute, New York State Department of Health, Albany, New York
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17
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Leucht S, Burkard T, Henderson J, Maj M, Sartorius N. Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 2007; 116:317-33. [PMID: 17919153 DOI: 10.1111/j.1600-0447.2007.01095.x] [Citation(s) in RCA: 432] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The lifespan of people with schizophrenia is shortened compared to the general population. We reviewed the literature on comorbid physical diseases in schizophrenia to provide a basis for initiatives to fight this unacceptable situation. METHOD We searched MEDLINE (1966 - May 2006) combining the MeSH term of schizophrenia with the 23 MeSH terms of general physical disease categories to identify relevant epidemiological studies. RESULTS A total of 44 202 abstracts were screened. People with schizophrenia have higher prevalences of HIV infection and hepatitis, osteoporosis, altered pain sensitivity, sexual dysfunction, obstetric complications, cardiovascular diseases, overweight, diabetes, dental problems, and polydipsia than the general population. Rheumatoid arthritis and cancer may occur less frequently than in the general population. Eighty-six per cent of the studies came from industrialized countries limiting the generalizability of the findings. CONCLUSION The increased frequency of physical diseases in schizophrenia might be on account of factors related to schizophrenia and its treatment, but undoubtedly also results from the unsatisfactory organization of health services, from the attitudes of medical doctors, and the social stigma ascribed to the schizophrenic patients.
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Affiliation(s)
- S Leucht
- Klinik für Psychiatrie und Psychotherapie der TU-München, Klinikum rechts der Isar, Ismaningerstr, München, Germany.
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18
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Koen L, Uys S, Niehaus DJH, Emsley RA. Negative Symptoms and HIV/AIDS Risk-Behavior Knowledge in Schizophrenia. PSYCHOSOMATICS 2007; 48:128-34. [PMID: 17329606 DOI: 10.1176/appi.psy.48.2.128] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Schizophrenia sufferers have been demonstrated to have relatively poor HIV/AIDS risk-behavior knowledge and, as a group, are found to be particularly vulnerable to contracting HIV. The authors asked whether an association could be demonstrated between specific symptoms and differing levels of knowledge. A structured clinical interview and HIV/AIDS Risk Questionnaires were administered to 102 subjects, and a principal-component analysis was performed for global and individual items, followed by comparisons between factors. Three factors (negative, positive, and global thought-disorder) emerged as significant between poor HIV/AIDS risk-behavior knowledge and higher negative-symptom scores. Findings support the notion that existing educational programs should be adapted to target specific areas of deficit.
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Affiliation(s)
- Liezl Koen
- Ngaphakathi Workgroup, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa.
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Abstract
Considerable gender disparity exists in the incidence of HIV/AIDS in men, with men experiencing the largest burden of this epidemic. In addition, over six million men in the United States experience depressive disorders. HIV-infected men experience the three most common depressive disorders-major depression, dysthymia, and bipolar disorder. Comorbidity associated with the dual diagnosis of HIV infection and common depressive disorders in men is a critical men's health issue. This article's purpose is to increase health care professionals' awareness and knowledge regarding the significant impact of a dual diagnosis of HIV infection and depression on men's health.
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Abstract
Approximately one quarter of people living with HIV/AIDS in the United States pass through the correctional system, resulting in a burden of infection on the correctional health care system that has challenged correctional and public health officials. The HIV epidemic behind bars results from the high prevalence of HIV risk behaviors among those incarcerated: illicit drug use, untreated mental illness, prostitution, homelessness, and poverty. Challenges to HIV care in correctional settings include management of comorbid conditions, remoteness from HIV care sites, organizational constraints, and access to effective therapies. Despite these challenges, prisoners with HIV have derived considerable benefit from HIV detection and treatment. In order to achieve parity in HIV outcomes among vulnerable populations, effective prison-release programs that incorporate effective case management with effective drug treatment and adherence strategies are required to extend the benefit of highly active antiretroviral therapy as prisoners transition back to community settings.
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Affiliation(s)
- Sandra A Springer
- Yale University School of Medicine, Yale AIDS Program, Section of Infectious Diseases, 135 College Street, Suite 323, New Haven, CT 06510, USA.
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