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Fuge TG, Tsourtos G, Miller ER. Imprisonment for South Ethiopian people living with HIV presents a double health burden: lived experiences of prisoners. BMC Health Serv Res 2024; 24:122. [PMID: 38254096 PMCID: PMC10804648 DOI: 10.1186/s12913-024-10587-y] [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: 09/15/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Optimal adherence is crucial for ensuring both therapeutic and preventative benefits of antiretroviral therapy (ART). Sub-optimal adherence is common in prisoners and little information is available about its predisposing circumstances in resource-limited settings. We explored lived experiences of inmates living with HIV (ILWH) and experiential accounts of service providers in South Ethiopia to identify barriers to and facilitators of HIV care use in the prison context. METHODS We conducted qualitative in-depth interviewing with eleven ILWH and eleven service providers. Audio recorded interview data were transcribed verbatim in Amharic language, translated into English and coded based on emerging concepts. We employed a descriptive phenomenological approach to abstract meaning attributed to the prisoners' lived experiences in relation to HIV care use and service providers' experiential account regarding care provision as presented to our consciousness. FINDINGS Several concepts emerged as barriers to HIV care use amongst ILWH in South Ethiopia including: limited access to standard care, insufficient health staff support, uncooperative security system, loss of patient privacy, a lack of status disclosure due to social stigma, and food supply insufficiency. In addition to a unique opportunity offered by an imprisonment for some ILWH to refrain from health damaging behaviours, the presence of social support in the prison system facilitated care use. CONCLUSIONS This study identified important structural and social contexts that can both hinder and enhance HIV care use amongst ILWH in South Ethiopia. Given the disproportionate burden of HIV in prisoners and the potential of transmission to others during and after incarceration, development of contextually-responsive strategies is required to address the barriers and to also strengthen the enablers.
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Affiliation(s)
| | | | - Emma R Miller
- The Stretton Institute, Stretton Health Equity, The University of Adelaide, Adelaide, Australia
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2
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Diagnosis, Treatment, and Prevention of HIV Infection among Detainees: A Review of the Literature. Healthcare (Basel) 2022; 10:healthcare10122380. [PMID: 36553904 PMCID: PMC9777892 DOI: 10.3390/healthcare10122380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Detainees are one of the most vulnerable populations to human immunodeficiency virus (HIV). This is mostly caused by the lack of knowledge on the topic among the inmates; the lack of prophylaxis; the high percentage of risky behaviors in jail, such as sexual abuse, unprotected sexual intercourses, and injective drug use; and the generally low perception of the risk of transmission. It has also been observed that the problem does not cease to exist at the moment of release, but it also may be aggravated by the weak support system or the total absence of programs for people living with HIV/AIDS (PLWHA) to avoid discontinuation of antiretroviral drugs. Difficulty in providing housing and jobs and, therefore, a form of stability for ex-detainees, also contributes to none adherence to antiretroviral therapy. Among the detainees, there are also categories of people more susceptible to discrimination and violence and, therefore, to risky behaviors, such as black people, Hispanics, transgender people, and men who have sex with men (MSM). We reviewed the literature in order to provide a more complete picture on the situation of PLWHA in jail and to also analyze the difficulties of ex-detainees in adhering to HIV therapy.
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Hawks L, Lopoo E, Puglisi L, Cellini J, Thompson K, Halberstam AA, Tolliver D, Martinez-Hamilton S, Wang EA. Community investment interventions as a means for decarceration: A scoping review. LANCET REGIONAL HEALTH. AMERICAS 2021; 8:100150. [PMID: 36778729 PMCID: PMC9903691 DOI: 10.1016/j.lana.2021.100150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There is growing support to reverse mass incarceration in the United States, especially in the wake of the COVID-19 pandemic. Little is known about what types and scale of community investments are most effective to support mass decarceration. Using a public health prevention framework, we conducted a scoping review to examine community-based programs that reduced criminal legal involvement. We searched PubMed, Embase and three EBSCO databases from 1990 through September 2019 for all experimental or quasi-experimental studies testing interventions pertaining to education, housing, healthcare, employment, or social support services and how they affected an individual's criminal legal outcomes. Our review identified 53 studies that demonstrated the efficacy of early childhood educational interventions and nurse-family partnership programs, post-secondary education for incarcerated students, navigation programs linking incarcerated people to community resources, and peer support upon release to reduce criminal legal system exposure. In concert with legislative action to end mass incarceration, additional research is needed to test interventions designed to achieve mass decarceration which cross multiple domains, interrogate community-level impacts and ascertain long-term outcomes.
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Affiliation(s)
- L Hawks
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI,Corresponding Author: Laura Hawks, MD, MPH, Medical College of Wisconsin, Division of General Internal Medicine, 8701 Watertown Plank Rd., Milwaukee, WI 53226-3596. Tel: 414-955-7566; Fax: 414-805-0855.
| | - E Lopoo
- Square One Project, Columbia University Justice Lab, New York, NY
| | - L Puglisi
- Yale School of Medicine, New Haven, CT,SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT
| | - J Cellini
- Countway Library, Harvard TH Chan School of Public Health, Boston, MA
| | - K Thompson
- Yale School of Medicine, New Haven, CT,National Clinical Scholars Program, Yale School of Medicine, New Haven, CT
| | | | - D Tolliver
- Yale School of Medicine, New Haven, CT,National Clinical Scholars Program, Yale School of Medicine, New Haven, CT
| | | | - EA Wang
- Yale School of Medicine, New Haven, CT,SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT
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4
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Taylor S, Haworth-Brockman M, Keynan Y. Slipping through: mobility's influence on infectious disease risks for justice-involved women in Canada. HEALTH & JUSTICE 2021; 9:35. [PMID: 34845559 PMCID: PMC8630874 DOI: 10.1186/s40352-021-00157-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The relationship between incarceration and women's vulnerability to sexually transmitted and blood-borne infections (STBBI) is understudied in Canada, despite numerous studies showing that justice-involved women experience very high rates of infection. Justice-involved women in Canada are highly mobile, as a result of high rates of incarceration and extremely short sentences. From a public health perspective, it is productive to understand how the mobility of justice-involved women shapes their vulnerability to STBBI. RESULTS This narrative review demonstrates that mobility between incarceration facilities and communities drives sexually transmitted and blood-borne disease risk for justice-involved women in Canada. Associations and interactions between epidemics of gender-based and intimate partner violence, substance use, and STBBIs shape the experiences of justice-involved women in Canada. In correctional facilities, the pre-existing vulnerability of justice-involved women is compounded by a lack of comprehensive STBBI care and limited harm reduction services. On release, unstable housing, disruptions to social support networks, interruptions in medical care, and relapse to or continuation of substance use, significantly increase individual disease risk and the likelihood of community transmission. High rates of incarceration for short periods perpetuate this cycle and complicate the delivery of healthcare. CONCLUSIONS The review provides evidence of the need for stronger gender-transformative public health planning and responses for incarcerated women, in both federal and provincial corrections settings in Canada. A supportive, evidence-based approach to STBBI identification and treatment for incarcerated women - one that that removes stigma, maintains privacy and improves access, combined with structural policies to prevent incarceration - could decrease STBBI incidence and interrupt the cycle of incarceration and poor health outcomes. A coordinated and accountable program of reintegration that facilitates continuity of public health interventions for STBBI, as well as safe housing, harm reduction and other supports, can improve outcomes as well. Lastly, metrics to measure performance of STBBI management during incarceration and upon release would help to identify gaps and improve outcomes for justice-involved women in the Canadian context.
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Affiliation(s)
- Susie Taylor
- National Collaborating Centre for Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Room L332A, Basic Medical Sciences Building, 745 Bannatyne Ave, Winnipeg, Manitoba, R3E 0T5, Canada.
| | - Margaret Haworth-Brockman
- National Collaborating Centre for Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Room L332A, Basic Medical Sciences Building, 745 Bannatyne Ave, Winnipeg, Manitoba, R3E 0T5, Canada
| | - Yoav Keynan
- National Collaborating Centre for Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Room L332A, Basic Medical Sciences Building, 745 Bannatyne Ave, Winnipeg, Manitoba, R3E 0T5, Canada
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5
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Dasgupta S, Tie Y, Beer L, Weiser J. Unmet needs for ancillary care services are associated with HIV clinical outcomes among adults with diagnosed HIV. AIDS Care 2021; 34:606-614. [PMID: 34180733 PMCID: PMC8712612 DOI: 10.1080/09540121.2021.1946001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Ancillary care services are essential for supporting care engagement and viral suppression among persons with HIV. Estimating unmet needs for ancillary care services may help address care barriers and improve clinical outcomes, but recent, nationally representative estimates are lacking. Using CDC Medical Monitoring Project data from 2015-2018, we report representative estimates of unmet needs for ancillary care services and associations with HIV clinical outcomes among U.S. adults with HIV. Data were collected through interview and medical record abstraction. We described weighted percentages for all characteristics and associations with HIV clinical outcomes using prevalence ratios with predicted marginal means, adjusting for potential confounding. Substantial unmet needs were reported; unmet needs were higher among persons with social determinants of poor health, persons who engaged in drug use or binge drinking, and those who experienced depression or anxiety. Having unmet needs for care was associated with adverseHIV clinical outcomes, with a dose response effect between number of unmet needs and outcomes. Expanding ancillary care access based on a comprehensive care model, strengthening partnerships between providers to connect patients to essential services, and tailoring services based on need may help reduce disparities in unmet needs and improve outcomes.
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Affiliation(s)
- Sharoda Dasgupta
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yunfeng Tie
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda Beer
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Weiser
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ho ISS, Holloway A, Stenhouse R. What do HIV-positive drug users' experiences tell us about their antiretroviral medication-taking? An international integrated literature review. Addiction 2020; 115:623-652. [PMID: 31626354 DOI: 10.1111/add.14857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/26/2019] [Accepted: 10/07/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS HIV-positive drug users' poor adherence to antiretroviral regimens can pose a significant and negative impact on individual and global health. This review aims to identify knowledge gaps and inconsistencies within the current evidence base and to measure HIV-positive drug users' adherence rates and the factors that influence their adherence. METHODS A search of quantitative and qualitative studies in relation to HIV-positive drug users' adherence to antiretroviral treatment was performed using five databases: Applied Social Sciences Index and Abstract (ASSIA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Embase and PsycINFO (Ovid interface). Relevant studies were retrieved based on the inclusion and exclusion criteria stated in the review. Findings were compared, contrasted and synthesized to provide a coherent account of HIV-positive drug users' adherence rates and the factors that influence their adherence. RESULTS The proportion of HIV-positive drug users who achieved ≥ 95% adherence across the studies varied widely, from 19.3 to 83.9%. Adherence rates changed over the course of HIV treatment. The factors that influenced adherence were reported as follows: stigmatization, motivation, active drug use, accessibility and conditionality of HIV and addiction care, side effects and complexity of treatment regimens, forgetfulness and non-incorporation of dosing times into daily schedules. CONCLUSIONS HIV-positive drug users' medication-taking is a dynamic social process that requires health professionals to assess adherence to HIV treatment on a regular basis.
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7
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Methamphetamine use drives decreases in viral suppression for people living with HIV released from a large municipal jail: Results of the LINK LA clinical trial. Drug Alcohol Depend 2019; 202:178-184. [PMID: 31352308 PMCID: PMC6686887 DOI: 10.1016/j.drugalcdep.2019.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND People living with HIV (PLWH) often experience decreases in HIV viral suppression (VS) after release from jail. The Linking Inmates to Care in LA (LINK LA) peer navigation intervention helped maintain VS 12 months after release from jail compared to standard of care. In this study, we analyzed correlates of substance use and tested whether substance use was an independent correlate of decreased VS in LINK LA participants. METHODS We analyzed LINK LA data collected at baseline, 3, and 12 months. We defined high-risk drug use as any reported methamphetamine, cocaine, or opioid use in the 30 days prior to a study visit (or jail entry at baseline). We used generalized linear mixed models to test associations of sociodemographic variables with type of substance used, and we tested correlates of VS while controlling for time, the intervention, and their interaction. RESULTS At baseline (n = 356), 71% of participants reported high-risk drug use: 58%, methamphetamine; 17%, cocaine; 7%, heroin; and 4%, prescription opioids. Non-Hispanic Whites and those younger than 35 were most likely to use methamphetamine; Blacks were most likely to use cocaine; people who inject drugs were most likely to use opioids. Participants who used high-risk drugs had 53% lower adjusted odds than non-users of maintaining VS (AOR 0.47, 95% CI 0.31-0.70, p < 0.001). CONCLUSION High-risk drug use, dominated by methamphetamine use, independently correlated with decreased VS among recently incarcerated PLWH. Improving HIV care continuum outcomes among populations leaving jail requires attention to efforts to address high-risk drug use.
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Antiretroviral Adherence Following Prison Release in a Randomized Trial of the imPACT Intervention to Maintain Suppression of HIV Viremia. AIDS Behav 2019; 23:2386-2395. [PMID: 30963321 DOI: 10.1007/s10461-019-02488-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Many people living with HIV (PLWH) pass through correctional facilities each year, a large proportion of whom do not maintain viral suppression following release. We examined the effects of imPACT, an intervention designed to promote post-release viral suppression, on antiretroviral therapy (ART) adherence. PLWH awaiting release from prisons in two southern states were randomized to imPACT (consisting of motivational interviewing, care linkage coordination, and text message medication reminders) versus standard care (SC). ART adherence, measured by unannounced monthly telephone pill counts, was compared between study arms over 6 months post-release. Of 381 participants eligible for post-release follow-up, 302 (79%) completed ≥ 1 of 6 possible pill counts (median: 4; IQR 1-6). Average adherence over follow-up was 80.3% (95% CI 77.5, 83.1) and 81.0% (78.3, 83.6) of expected doses taken in the imPACT and SC arms, respectively. There was no difference between arms when accounting for missing data using multiple imputation (mean difference = - 0.2 percentage points [- 3.7, 3.3]), controlling for study site and week of follow-up. Of the 936 (40.9%) pill counts that were missed, 212 (22.7%) were due to re-incarceration. Those who missed pill counts for any reason were more likely to be unsuppressed, suggesting that they had lower adherence. However, missingness was balanced between arms. Among PLWH released from prison, ART adherence averaged > 80% in both study arms over 6 months-a level higher than seen with most other chronic diseases. However, missing data may have led to an overestimate of adherence. Factors independent of the intervention influence ART adherence in this population and should be identified to inform future targeted interventions.
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9
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Ickowicz S, Salleh NAM, Fairbairn N, Richardson L, Small W, Milloy MJ. Criminal Justice System Involvement as a Risk Factor for Detectable Plasma HIV Viral Load in People Who Use Illicit Drugs: A Longitudinal Cohort Study. AIDS Behav 2019; 23:2634-2639. [PMID: 31236749 PMCID: PMC6773261 DOI: 10.1007/s10461-019-02547-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Among HIV-positive people who use illicit drugs (PWUD) in our setting, repeated periods of incarceration adversely affect ART adherence in a dose-dependent manner. However, the impact of non-custodial criminal justice involvement on HIV-related outcomes has not been previously investigated. Data were obtained from a longitudinal cohort of HIV-positive PWUD in a setting of universal no-cost ART and complete dispensation records. Multivariate generalized estimating equations were used to calculate the longitudinal odds of having a detectable HIV VL (VL) associated with custodial and non-custodial CJS exposure. Between 2005 and 2014, 716 HIV-positive ART-exposed PWUD were recruited. In multivariate analysis, both custodial [Adjusted odds ratio (AOR) 0.61, 95% CI 0.45-0.82] and noncustodial (AOR 0.78, 95% CI 0.62-0.99) involvement in the criminal justice system was associated with detectable HIV VL. Among HIV-positive PWUD, both custodial and non-custodial criminal justice involvement is associated with worse HIV treatment outcomes. Our findings highlight the need for increased ART adherence support across the full spectrum of the criminal justice system.
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Affiliation(s)
- Sarah Ickowicz
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - N A Mohd Salleh
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Sociology, University of British Columbia, Vancouver, BC, Canada
| | - Will Small
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.
- Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
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10
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Rezansoff SN, Moniruzzaman A, Somers JM. Temporal associations between medication adherence for patients with schizophrenia and opioid dependence: A 17-year Canadian Cohort Study. Schizophr Res 2019; 210:157-163. [PMID: 31202570 DOI: 10.1016/j.schres.2019.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/09/2019] [Accepted: 05/26/2019] [Indexed: 11/16/2022]
Abstract
The current study investigated whether a previously reported beneficial effect of methadone maintenance therapy (MMT) on antiretroviral adherence is also present in relation to antipsychotic treatment for schizophrenia. Administrative data were linked over a 17-year period for 1996 people who were dually diagnosed with schizophrenia and opioid dependence and, as an indicator of further marginalization, experienced at least one episode of correctional supervision in British Columbia. Adherence was estimated using the medication possession ratio (MPR ≥ 0.80), calculated in each 120-day period beginning with the first date of concurrent use of MMT and antipsychotic medication. Generalized Estimating Equations were used to estimate the association between independent and dependent variables. The probability of antipsychotic adherence doubled in periods that were preceded by a period of MMT adherence (AOR: P: 2.07; 95% CI: 1.90-2.26). Subgroup and sensitivity analyses yielded results similar to those derived through the primary analysis, examining: conviction history; length of follow-up; initiation of MMT prior to antipsychotic induction; excluding participants who died during the study period; and restricted to participants who received methadone exclusively as part of a MMT program. Despite a strong temporal association between MMT and antipsychotic adherence, overall MPRs for both prescriptions remained <0.50 throughout the study period. Antipsychotic adherence was more than twice as likely following periods of adherence to MMT among dually-diagnosed patients. Research is needed to identify the conditions responsible for MMT adherence, and to further clarify the relationship between opioid agonist treatment and antipsychotic pharmacotherapy in this vulnerable and under-studied population.
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Affiliation(s)
- Stefanie N Rezansoff
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, British Columbia, Canada.
| | - Akm Moniruzzaman
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, British Columbia, Canada.
| | - Julian M Somers
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, British Columbia, Canada.
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Lin D, Zhang CY, He ZK, Zhao XD. How does hard-to-reach status affect antiretroviral therapy adherence in the HIV-infected population? Results from a meta-analysis of observational studies. BMC Public Health 2019; 19:789. [PMID: 31221113 PMCID: PMC6587270 DOI: 10.1186/s12889-019-7135-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/09/2019] [Indexed: 11/24/2022] Open
Abstract
Background Socially disadvantaged groups, such as drug users, sex workers and homeless individuals, are labelled as “hard-to-reach” (HTR) in public health and medical research. HIV disproportionately impacts these populations, but data on how the HTR status could affect antiretroviral therapy (ART) adherence among HIV-positive people are limited and have not been previously synthesized in a systematic manner. We performed a meta-analysis to explore the association between HTR status and optimal antiretroviral therapy adherence in the HIV-infected population to provide evidence and recommendations regarding ART adherence improvement and HIV infection control and prevention among HTR people. Methods The PubMed, EMBASE, and Cochrance Library databases and the bibliographies of relevant studies were systematically searched up to December 2018. Full-text studies published in English were included, and no geographic or race restrictions were applied. Studies that quantitatively assessed the association between HTR status and optimal ART adherence among HIV-infected populations with a status of homelessness, sex work, or drug use were eligible for inclusion. We estimated the pooled odds ratios (ORs) of HTR characteristics related to ART adherence from each eligible study using a random effects model. The sensitivity, heterogeneity and publication bias were assessed. Results Our search identified 593 articles, of which 29 studies were eligible and included in this meta-analysis. The studies were carried out between 1993 and 2017 and reported between 1999 and 2018. The results showed that HTR status resulted in a 45% reduction in the odds of achieving optimal ART adherence compared to odds in the general population (OR = 0.55, 95% confidential intervals (CIs) 0.49–0.62), and this significant inverse association was consistently found regardless of study design, exposure measurement, adherence cut-off points, etc. Subgroup analyses revealed that the HTRs tend to be suboptimal adhering during a longer observational period. Conclusions HIV treatment adherence is extremely negatively affected by HTR status. It is crucial to develop appropriate interventions to improve ART adherence and health outcomes among HTR people who are HIV-infected. Electronic supplementary material The online version of this article (10.1186/s12889-019-7135-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dan Lin
- Fujian Center for Disease Control and Prevention / Fujian Provincial Key Laboratory of Zoonosis Research, 76 Jintai Road, Fuzhou, China.
| | - Chun-Yang Zhang
- Fujian Center for Disease Control and Prevention / Fujian Provincial Key Laboratory of Zoonosis Research, 76 Jintai Road, Fuzhou, China
| | - Zi-Kai He
- Fujian Center for Disease Control and Prevention / Fujian Provincial Key Laboratory of Zoonosis Research, 76 Jintai Road, Fuzhou, China
| | - Xiao-Dong Zhao
- Fujian Center for Disease Control and Prevention / Fujian Provincial Key Laboratory of Zoonosis Research, 76 Jintai Road, Fuzhou, China
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12
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Psichogiou M, Giallouros G, Pantavou K, Pavlitina E, Papadopoulou M, Williams LD, Hadjikou A, Kakalou E, Skoutelis A, Protopapas K, Antoniadou A, Boulmetis G, Paraskevis D, Hatzakis A, Friedman SR, Nikolopoulos GK. Identifying, linking, and treating people who inject drugs and were recently infected with HIV in the context of a network-based intervention. AIDS Care 2019; 31:1376-1383. [PMID: 30939897 DOI: 10.1080/09540121.2019.1601671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Identifying and linking people to care soon after HIV infection could limit viral transmission and protect their health. This work aims at describing the continuum of care among recently HIV-infected people who inject drugs (PWID) and participated in an intervention in the context of an HIV outbreak in Athens, Greece. The Transmission Reduction Intervention Project (TRIP) conducted risk network-based contact tracing and screened people for recent HIV infection. A comprehensive approach with a case management component that aimed to remove barriers to accessing care was adopted. Follow-up data on antiretroviral treatment (ART) and HIV-RNA levels were obtained from HIV clinics. TRIP enrolled 45 recently HIV-infected PWID (80% male) with a median viral load at recruitment of 5.43 log10 copies/mL. Of the recently infected persons in TRIP, 87% were linked to care; of these, 77% started ART; and of those on ART, 89% achieved viral load <200 copies/mL. TRIP and its public health allies managed to get most of the recently HIV-infected PWID who were identified by the program into care and many of them onto ART. This resulted in very low HIV-RNA levels. Treatment as prevention can work if individuals are aided in overcoming difficulties in entry to, or attrition from care.
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Affiliation(s)
- Mina Psichogiou
- First Department of Internal Medicine, Medical School, "Laiko" General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | | | | | - Eirini Pavlitina
- Transmission Reduction Intervention Project, Athens site , Athens , Greece
| | - Martha Papadopoulou
- First Department of Internal Medicine, Medical School, "Laiko" General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Leslie D Williams
- National Development and Research Institutes , New York City , NY , USA
| | - Andria Hadjikou
- Medical School, University of Cyprus , Nicosia , Cyprus.,European University Cyprus , Nicosia , Cyprus
| | - Eleni Kakalou
- General Hospital of Athens "Evangelismos" , Athens , Greece
| | | | - Konstantinos Protopapas
- Department of Internal Medicine, Medical School, University General Hospital "Attikon", National and Kapodistrian University of Athens , Athens , Greece
| | - Anastasia Antoniadou
- Department of Internal Medicine, Medical School, University General Hospital "Attikon", National and Kapodistrian University of Athens , Athens , Greece
| | | | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Samuel R Friedman
- National Development and Research Institutes , New York City , NY , USA
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13
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Supportive Housing Promotes AIDS-Free Survival for Chronically Homeless HIV Positive Persons with Behavioral Health Conditions. AIDS Behav 2019; 23:776-783. [PMID: 30684098 DOI: 10.1007/s10461-019-02398-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We assessed the influence of supportive housing, incarceration, and health service use on markers of HIV infection for people living with HIV and serious mental illness or substance use disorder (SUD) participating in a New York City supportive housing program (NY III). Using matched administrative data from 2007 to 2014, we compared survivor time without AIDS, achievement of undetectable viral load, and maintenance of viral suppression between NY III tenants (n = 696), applicants placed in other supportive housing programs (n = 333), and applicants not placed in supportive housing (n = 268). Inverse probability of treatment weights were applied to Cox proportional hazards regression models to account for confounding of observed variables. Individuals not placed in supportive housing had a significantly greater risk of death or AIDS diagnosis than NY III tenants [adjusted hazard ratio = 1.84 (1.40, 2.44), p < 0.001]. Incarceration and outpatient SUD treatment were significantly associated with negative short-term outcomes (time to undetectable viral load) but positive long-term outcomes (time to death or AIDS diagnosis). Supportive housing, SUD treatment, and incarceration were associated with prolonged survival without AIDS among supportive housing applicants living with HIV.
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Balayan T, Oprea C, Yurin O, Jevtovic D, Begovac J, Lakatos B, Sedlacek D, Karpov I, Horban A, Kowalska JD. People who inject drugs remain hard-to-reach population across all HIV continuum stages in Central, Eastern and South Eastern Europe - data from Euro-guidelines in Central and Eastern Europe Network. Infect Dis (Lond) 2019; 51:277-286. [PMID: 30786803 DOI: 10.1080/23744235.2019.1565415] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/OBJECTIVES Inadequate HIV care for hard-to-reach populations may result in failing the UNAIDS 90-90-90 goal. Therefore, we aimed to review the HIV continuum of care and hard-to-reach populations for each step of the continuum in Central, Eastern and South Eastern Europe. METHODS Euro-guidelines in Central and Eastern Europe (ECEE) Network Group were created in February 2016. The aim of the network was to review the standards of HIV care in the countries of the region. Information about each stage of HIV continuum of care and hard-to-reach populations for each stage was collected through on-line surveys. Respondents were ECEE members chosen based on their expertise and involvement in national HIV care. Data sources (year 2016) used by respondents included HIV Clinics electronic databases, Institutes of Public Health, Centres for AIDS Prevention, and HIV Programme Reviews. RESULTS The percentage of people living with HIV (PLHIV) linked to HIV care after HIV diagnosis was ranged between 80% and 96% in Central Europe, 51% and 92% in Eastern Europe and 80% and 100% in South-Eastern Europe. The percentage of PLHIV who are on ART was ranged from 80% to 93% in Central Europe, 18% to 92% in Eastern Europe and 80% to 100% in South-Eastern Europe. The percentage of people virologically suppressed while on ART was reported as 70-95%, 12-95% and 62-97% in Central, Eastern, and South Eastern Europe, respectively. All three regions reported people who inject drugs (PWID) as hard-to-reach population across all HIV continuum stages. Migrants were the second most reported hard-to-reach population. The proportion of late presenters among newly diagnosed ranged between 20% and 55%, 40% and 55% and 48% and 60% in Central, Eastern and South Eastern Europe, respectively. Four countries reported ARVs' delivery delays resulting in treatment interruptions in 2016: two (25%) in South-Eastern, one (20%) in Central and 1 (16.7%) in Eastern Europe. CONCLUSION Irrespective of the diversity in national HIV epidemics, countries from all three regions reported PWIDs as hard-to-reach population across all HIV continuum stages. Some countries are close to the UNAIDS 2020 goals, others need to strive for progress. However, differences in data sources and variations in definitions limit the utility of continuum of care as a comparative tool.
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Affiliation(s)
- Tatevik Balayan
- a National Center for Disease Control and Prevention , Yerevan , Armenia
| | - Cristiana Oprea
- b Victor Babes Clinical Hospital for Infectious Diseases, Carol Davila University of Medicine and Pharmacy , Bucharest , Romania
| | - Oleg Yurin
- c Central Research Institute of Epidemiology, Federal AIDS Centre , Moscow , Russian Federation
| | - Djorde Jevtovic
- d Belgrade University Medical School, Infectious Diseases Hospital , Belgrade Serbia
| | - Josip Begovac
- e University of Zagreb School of Medicine, University Hospital of Infectious Diseases , Zagreb , Croatia
| | - Botond Lakatos
- f Saint Laszlo Hospital National Center of HIV, Semmelweis University Faculty of Infectious Diseases , Budapest , Hungary
| | - Dalibor Sedlacek
- g Charles University Hospital in Pilsen , Pilsen , Czech Republic
| | - Igor Karpov
- h Belarus State Medical University , Minsk , Belarus
| | - Andrzej Horban
- i Hospital for Infectious Diseases Medical University of Warsaw , Warsaw , Poland
| | - Justyna D Kowalska
- i Hospital for Infectious Diseases Medical University of Warsaw , Warsaw , Poland
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Loeliger KB, Meyer JP, Desai MM, Ciarleglio MM, Gallagher C, Altice FL. Retention in HIV care during the 3 years following release from incarceration: A cohort study. PLoS Med 2018; 15:e1002667. [PMID: 30300351 PMCID: PMC6177126 DOI: 10.1371/journal.pmed.1002667] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/05/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sustained retention in HIV care (RIC) and viral suppression (VS) are central to US national HIV prevention strategies, but have not been comprehensively assessed in criminal justice (CJ) populations with known health disparities. The purpose of this study is to identify predictors of RIC and VS following release from prison or jail. METHODS AND FINDINGS This is a retrospective cohort study of all adult people living with HIV (PLWH) incarcerated in Connecticut, US, during the period January 1, 2007, to December 31, 2011, and observed through December 31, 2014 (n = 1,094). Most cohort participants were unmarried (83.7%) men (77.0%) who were black or Hispanic (78.1%) and acquired HIV from injection drug use (72.6%). Prison-based pharmacy and custody databases were linked with community HIV surveillance monitoring and case management databases. Post-release RIC declined steadily over 3 years of follow-up (67.2% retained for year 1, 51.3% retained for years 1-2, and 42.5% retained for years 1-3). Compared with individuals who were not re-incarcerated, individuals who were re-incarcerated were more likely to meet RIC criteria (48% versus 34%; p < 0.001) but less likely to have VS (72% versus 81%; p = 0.048). Using multivariable logistic regression models (individual-level analysis for 1,001 individuals after excluding 93 deaths), both sustained RIC and VS at 3 years post-release were independently associated with older age (RIC: adjusted odds ratio [AOR] = 1.61, 95% CI = 1.22-2.12; VS: AOR = 1.37, 95% CI = 1.06-1.78), having health insurance (RIC: AOR = 2.15, 95% CI = 1.60-2.89; VS: AOR = 2.01, 95% CI = 1.53-2.64), and receiving an increased number of transitional case management visits. The same factors were significant when we assessed RIC and VS outcomes in each 6-month period using generalized estimating equations (for 1,094 individuals contributing 6,227 6-month periods prior to death or censoring). Additionally, receipt of antiretroviral therapy during incarceration (RIC: AOR = 1.33, 95% CI 1.07-1.65; VS: AOR = 1.91, 95% CI = 1.56-2.34), early linkage to care post-release (RIC: AOR = 2.64, 95% CI = 2.03-3.43; VS: AOR = 1.79; 95% CI = 1.45-2.21), and absolute time and proportion of follow-up time spent re-incarcerated were highly correlated with better treatment outcomes. Limited data were available on changes over time in injection drug use or other substance use disorders, psychiatric disorders, or housing status. CONCLUSIONS In a large cohort of CJ-involved PLWH with a 3-year post-release evaluation, RIC diminished significantly over time, but was associated with HIV care during incarceration, health insurance, case management services, and early linkage to care post-release. While re-incarceration and conditional release provide opportunities to engage in care, reducing recidivism and supporting community-based RIC efforts are key to improving longitudinal treatment outcomes among CJ-involved PLWH.
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Affiliation(s)
- Kelsey B. Loeliger
- AIDS Program, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Jaimie P. Meyer
- AIDS Program, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
| | - Mayur M. Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Maria M. Ciarleglio
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Colleen Gallagher
- Health and Addiction Services Quality Improvement Program, Connecticut Department of Correction, Wethersfield, Connecticut, United States of America
| | - Frederick L. Altice
- AIDS Program, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- Centre of Excellence in Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia
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Masyukova MI, Hanna DB, Fox AD. HIV treatment outcomes among formerly incarcerated transitions clinic patients in a high prevalence setting. HEALTH & JUSTICE 2018; 6:16. [PMID: 30225817 PMCID: PMC6755570 DOI: 10.1186/s40352-018-0074-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/31/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Incarceration disproportionately affects people living with HIV/AIDS. When people are released from jail or prison, they face multiple barriers to HIV care, and those who do engage in care may have suboptimal HIV treatment outcomes. A limited number of studies have investigated HIV treatment outcomes among people who have been released from incarceration. METHODS We conducted a retrospective cohort study comparing HIV viral load (VL) suppression and retention in care 12 months after entry into care among patients of a post-incarceration Transitions Clinic (TC) and a comparison group who received HIV care in the same community. Of 138 participants, 38 TC patients were matched to 100 non-TC controls based on age, race/ethnicity, gender, and date of HIV care entry. RESULTS There was no significant difference in clinical study outcomes between TC and non-TC patients: 63% vs. 67% (p = 0.67) were retained in care and 54% vs. 63% (p = 0.33) had suppressed VL at 12 months. After adjusting for substance use disorder and viral load suppression at the start of treatment, the odds ratio of TC patients' 12-month retention was 0.60 (95% CI 0.25-1.49) and VL suppression was 0.44 (95% CI 0.16-1.23) compared with non-TC patients. CONCLUSIONS Our findings show HIV care outcomes for patients at a post-incarceration Transitions Clinic that are similar to those of community-based comparison patients. The transitions clinic model, which provides medical, behavioral health, and supportive services to formerly incarcerated people, may be an effective model of care for this population; however, more scholarship is needed to quantify the components most effective in supporting retention in care and viral load suppression.
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Affiliation(s)
- Mariya I Masyukova
- Department of Family and Social Medicine, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, New York, USA.
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Aaron D Fox
- Department of Medicine, Division of General Internal Medicine, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, New York, USA
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17
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The Association between Incarceration and Transactional Sex among HIV-infected Young Men Who Have Sex with Men in the United States. J Urban Health 2018; 95:576-583. [PMID: 29633227 PMCID: PMC6095762 DOI: 10.1007/s11524-018-0247-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Criminal justice practices in the USA disproportionately affect sexual and racial/ethnic minority men, who are at higher risk of incarceration. Previous research demonstrates associations between incarceration and sexual risk behaviors for men who have sex with men (MSM). However, little of this work focuses on young MSM (YMSM), particularly HIV-infected YMSM, despite nearly one-third reporting engagement in sexual risk behaviors, such as transactional sex. We therefore explored the association between incarceration and transactional sex among HIV-infected YMSM. We recruited 97 HIV-infected YMSM across 14 clinical sites in urban centers from August 2015 to February 2016. We used multivariate logistic regression to examine the relationship between incarceration and transactional sex among YMSM. The majority was 24 years old (78%) and racial/ethnic minority (95%); over half were not in school and reported an annual income of < $12,000. In the multivariate model, having ever been incarcerated (aOR = 3.20; 95% CI 1.07-9.63) was independently associated with a history of transactional sex. Being 24 years vs. younger (aOR = 9.68; 95% CI 1.42-65.78) and having ever been homeless (aOR = 3.71, 95% CI 1.18-11.65) also remained independently associated with a history of transactional sex. This analysis fills a gap in the literature by examining the relationship between incarceration and transactional sex among HIV-infected YMSM. Facilitating youths' engagement with social services available in their HIV clinic may serve as a key strategy in promoting health. Public health efforts need to address social-structural factors driving disproportionate rates of arrest and incarceration and related harms among this population.
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18
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Re-entry experiences of Black men living with HIV/AIDS after release from prison: Intersectionality and implications for care. Soc Sci Med 2018; 211:78-86. [PMID: 29913303 DOI: 10.1016/j.socscimed.2018.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/28/2018] [Accepted: 06/08/2018] [Indexed: 01/06/2023]
Abstract
RATIONALE Both the HIV epidemic and incarceration disproportionately affect Black men in the United States. A critical period for incarcerated Black men living with HIV/AIDS is re-entry into the community, which is often associated with adverse health outcomes. Additionally, Black men living with HIV/AIDS involved in the criminal justice system are burdened by multiple, intersecting disadvantaged identities and social positions. OBJECTIVE This study aimed to examine community re-entry experiences among Black men living with HIV/AIDS from an intersectional perspective. METHOD In-depth, semi-structured interviews were conducted with 16 incarcerated Black men in Wisconsin, at pre-release from prison and six months after re-entry. Thematic analysis guided by intersectionality theory was used to analyze interview transcripts. RESULTS Seven emerged themes included Intersectional Identities and Social Positions, Family Support, Neighborhood Violence, Relationship with Law Enforcement, Employment, Mental Health Concerns, and Medical Care and Medication Management. Intersecting identities and social positions interact with factors at multiple levels to inform health and HIV care. A conceptual framework was developed to illustrate relationships among themes. CONCLUSIONS Findings demonstrate the relevance of intersectionality theory in HIV care with Black men involved in criminal justice system. Incorporating a social-ecological perspective into intersectionality framework could be useful in theoretical and empirical research. Disenfranchised communities may particularly benefit from interventions that address community- and systemic-level issues.
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Barriers to Adherence to Antiretroviral Treatment Among Inmates of a Prison in Tehran, Iran: A Qualitative Study. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2018. [DOI: 10.5812/archcid.57911] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Loeliger KB, Altice FL, Desai MM, Ciarleglio MM, Gallagher C, Meyer JP. Predictors of linkage to HIV care and viral suppression after release from jails and prisons: a retrospective cohort study. Lancet HIV 2017; 5:e96-e106. [PMID: 29191440 DOI: 10.1016/s2352-3018(17)30209-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/15/2017] [Accepted: 09/19/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Incarceration provides an opportunity for engagement in HIV care but is associated with poor HIV treatment outcomes after release. We aimed to assess post-release linkage to HIV care (LTC) and the effect of transitional case management services. METHODS To create a retrospective cohort of all adults with HIV released from jails and prisons in Connecticut, USA (2007-14), we linked administrative custody and pharmacy databases with mandatory HIV/AIDS surveillance monitoring and case management data. We examined time to LTC (defined as first viral load measurement after release) and viral suppression at LTC. We used generalised estimating equations to show predictors of LTC within 14 days and 30 days of release. FINDINGS Among 3302 incarceration periods for 1350 individuals between 2007 and 2014, 672 (21%) of 3181 periods had LTC within 14 days of release, 1042 (34%) of 3064 had LTC within 30 days of release, and 301 (29%) of 1042 had detectable viral loads at LTC. Factors positively associated with LTC within 14 days of release are intermediate (31-364 days) incarceration duration (adjusted odds ratio 1·52; 95% CI 1·19-1·95), and transitional case management (1·65; 1·36-1·99), receipt of antiretroviral therapy during incarceration (1·39; 1·11-1·74), and two or more medical comorbidities (1·86; 1·48-2·36). Reincarceration (0·70; 0·56-0·88) and conditional release (0·62; 0·50-0·78) were negatively associated with LTC within 14 days. Hispanic ethnicity, bonded release, and psychiatric comorbidity were also associated with LTC within 30 days but reincarceration was not. INTERPRETATION LTC after release is suboptimal but improves when inmates' medical, psychiatric, and case management needs are identified and addressed before release. People who are rapidly cycling through jail facilities are particularly vulnerable to missed linkage opportunities. The use of integrated programmes to align justice and health-care goals has great potential to improve long-term HIV treatment outcomes. FUNDING US National Institutes of Health.
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Affiliation(s)
- Kelsey B Loeliger
- Yale AIDS Program, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Frederick L Altice
- Yale AIDS Program, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Centre of Excellence in Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Maria M Ciarleglio
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Colleen Gallagher
- Health and Addiction Services Quality Improvement Program, Connecticut Department of Correction, Wethersfield, CT, USA
| | - Jaimie P Meyer
- Yale AIDS Program, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.
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Simmons MM, Fincke BG, Drainoni ML, Kim B, Byrne T, Smelson D, Casey K, Ellison ML, Visher C, Blue-Howells J, McInnes DK. A two-state comparative implementation of peer-support intervention to link veterans to health-related services after incarceration: a study protocol. BMC Health Serv Res 2017; 17:647. [PMID: 28899394 PMCID: PMC5596492 DOI: 10.1186/s12913-017-2572-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 600,000 persons are released from prison annually in the United States. Relatively few receive sufficient re-entry services and are at risk for unemployment, homelessness, poverty, substance abuse relapse and recidivism. Persons leaving prison who have a mental illness and/or a substance use disorder are particularly challenged. This project aims to create a peer mentor program to extend the reach and effectiveness of reentry services provided by the Department of Veterans' Affairs (VA). We will implement a peer support for reentry veterans sequentially in two states. Our outcome measures are 1) fidelity of the intervention, 2) linkage to VA health care and, 3) continued engagement in health care. The aims for this project are as follows: (1) Conduct contextual analysis to identify VA and community reentry resources, and describe how reentry veterans use them. (2) Implement peer-support, in one state, to link reentry veterans to Veterans' Health Administration (VHA) primary care, mental health, and SUD services. (3) Port the peer-support intervention to another, geographically, and contextually different state. DESIGN This intervention involves a 2-state sequential implementation study (Massachusetts, followed by Pennsylvania) using a Facilitation Implementation strategy. We will conduct formative and summative analyses, including assessment of fidelity, and a matched comparison group to evaluate the intervention's outcomes of veteran linkage and engagement in VHA health care (using health care utilization measures). The study proceeds in 3 phases. DISCUSSION We anticipate that a peer support program will be effective at improving the reentry process for veterans, particularly in linking them to health, mental health, and SUD services and helping them to stay engaged in those services. It will fill a gap by providing veterans with access to a trusted individual, who understands their experience as a veteran and who has experienced justice involvement. The outputs from this project, including training materials, peer guidebooks, and implementation strategies can be adapted by other states and regions that wish to enhance services for veterans (or other populations) leaving incarceration. A larger cluster-randomized implementation-effectiveness study is planned. TRIAL REGISTRATION This protocol is registered with clinicaltrials.gov on November 4, 2016 and was assigned the number NCT02964897 .
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Affiliation(s)
- Molly M Simmons
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA. .,Boston University School of Public Health, Boston, USA.
| | - Benjamin G Fincke
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Boston University School of Public Health, Boston, USA
| | - Mari-Lynn Drainoni
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Boston University School of Public Health, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Bo Kim
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Harvard Medical School, Boston, USA
| | - Tom Byrne
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Boston University School of Social Work, Boston, USA
| | - David Smelson
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,VA National Center on Homelessness among Veterans, Bedford, USA.,University of Massachusetts Medical School, Worcester, USA
| | - Kevin Casey
- VA New England Healthcare System, Bedford, USA
| | - Marsha L Ellison
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,University of Massachusetts Medical School, Worcester, USA
| | | | | | - D Keith McInnes
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Boston University School of Public Health, Boston, USA
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Nolan S, Walley AY, Heeren TC, Patts GJ, Ventura AS, Sullivan MM, Samet JH, Saitz R. HIV-infected individuals who use alcohol and other drugs, and virologic suppression. AIDS Care 2017; 29:1129-1136. [PMID: 28513200 DOI: 10.1080/09540121.2017.1327646] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
People living with HIV (PLWH) on antiretroviral therapy (ART) who use substances were examined to (a) describe those with virologic control and (b) determine which substance use-factors are associated with lack of virologic control. Participants were adult PLWH taking ART with either past 12-month DSM-IV substance dependence or past 30-day alcohol or illicit drug use. Substance use factors included number of DSM-IV alcohol or drug dependence criteria and past 30-day specific substance use. Associations with HIV viral load (HVL) (<200 vs. ≥200 copies/mL) were tested using logistic regression models. Multivariable analyses adjusted for age, sex, homelessness and anxiety or depression. Participants (n = 202) were median age 50 years, 66% male, 51% African American and 75% self-reported ≥90% past 30-day ART adherence. Though HVL suppression (HVL <200 copies/mL) was achieved in 78% (158/202), past 30-day substance use was common among this group: 77% cigarette use; 51% heavy alcohol use; 50% marijuana; 27% cocaine; 16% heroin; and 15% illicit prescription opioid use. After adjusting for covariates, specific substance use was not associated with a detectable HVL, however number of past 12-month DSM-IV drug dependence criteria was (adjusted odds ratio = 1.23 for each additional criterion, 95% CI: 1.04-1.46). Three-quarters of a substance-using cohort of PLWH receiving ART had virologic control and ≥90% ART adherence. Substance dependence criteria (particularly drug dependence), not specifically substance use, were associated with lack of virologic control. Optimal HIV outcomes can be achieved by individuals who use alcohol or drugs and addressing symptoms of substance dependence may improve HIV-related outcomes.
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Affiliation(s)
- Seonaid Nolan
- a Department of Medicine , University of British Columbia, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
| | - Alexander Y Walley
- b Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine , Boston University School of Medicine and Boston Medical Center , Boston , MA , USA
| | - Timothy C Heeren
- c Department of Biostatistics , Boston University School of Public Health , Boston , MA , USA
| | - Gregory J Patts
- d Data Coordinating Center , Boston University School of Public Health , Boston , MA , USA
| | - Alicia S Ventura
- b Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine , Boston University School of Medicine and Boston Medical Center , Boston , MA , USA
| | - Meg M Sullivan
- e Section of Infectious Diseases, Department of Medicine , Boston University School of Medicine and Boston Medical Center , Boston , MA , USA
| | - Jeffrey H Samet
- b Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine , Boston University School of Medicine and Boston Medical Center , Boston , MA , USA.,f Department of Community Health Sciences , Boston University School of Public Health , Boston , MA , USA
| | - Richard Saitz
- b Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine , Boston University School of Medicine and Boston Medical Center , Boston , MA , USA.,f Department of Community Health Sciences , Boston University School of Public Health , Boston , MA , USA
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Tsang J, Mishra S, Rowe J, O’Campo P, Ziegler C, Kouyoumdjian FG, Matheson FI, Bayoumi AM, Zahid S, Antoniou T. Transitional care for formerly incarcerated persons with HIV: protocol for a realist review. Syst Rev 2017; 6:29. [PMID: 28193290 PMCID: PMC5307639 DOI: 10.1186/s13643-017-0428-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/04/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Little is known about the mechanisms that influence the success or failure of programs to facilitate re-engagement with health and social services for formerly incarcerated persons with HIV. This review aims to identify how interventions to address such transitions work, for whom and under what circumstances. METHODS We will use realist review methodology to conduct our analysis. We will systematically search electronic databases and grey literature for English language qualitative and quantitative studies of interventions. Two investigators will independently screen citations and full-text articles, abstract data, appraise study quality and synthesize the literature. Data analysis will include identifying context-mechanism-outcome configurations, exploring and comparing patterns in these configurations, making comparisons across contexts and developing explanatory frameworks. DISCUSSION This review will identify mechanisms that influence the success or failure of transition interventions for formerly incarcerated individuals with HIV. The findings will be integrated with those from complementary qualitative and quantitative studies to inform future interventions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016040054.
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Affiliation(s)
- Jenkin Tsang
- The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
| | - Sharmistha Mishra
- The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Department of Medicine, University of Toronto, Toronto, ON Canada
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON Canada
| | - Janet Rowe
- Prisoners with HIV/AIDS Support Action Network, Toronto, ON Canada
| | - Patricia O’Campo
- The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Carolyn Ziegler
- The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
| | - Fiona G. Kouyoumdjian
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON Canada
- Department of Family Medicine, McMaster University, Hamilton, ON Canada
| | - Flora I. Matheson
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Ahmed M. Bayoumi
- The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Department of Medicine, University of Toronto, Toronto, ON Canada
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON Canada
- Division of General Internal Medicine, St. Michael’s Hospital, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada
| | - Shatabdy Zahid
- The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
| | - Tony Antoniou
- The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Department of Family and Community Medicine, St. Michael’s Hospital and University of Toronto, 410 Sherbourne Street, 4th Floor, Toronto, ON M4X 1K2 Canada
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Uthman OA, Oladimeji O, Nduka C. Adherence to antiretroviral therapy among HIV-infected prisoners: a systematic review and meta-analysis. AIDS Care 2016; 29:489-497. [PMID: 27582186 DOI: 10.1080/09540121.2016.1223799] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Data on antiretroviral therapy (ART) adherence among prison inmates are limited and not previously synthesized in a systematic manner. The objective of this study was to provide accurate and up-to-date ART adherence estimates among prison inmates. We searched electronic databases for all studies reporting adherence as a primary or secondary outcome among prison inmates. A random-effects model was used to pool adherence rates; sensitivity, heterogeneity and publication bias were assessed. Eleven studies involving 2895 HIV-infected prison inmates were included. The studies were carried out between 1992 and 2011 and reported between 1998 and 2013. A pooled analysis of all studies indicated a pooled estimate of 54.6% (95% confidence interval 48.1-60.9%) of prison inmates had adequate (≥95%) ART adherence. The adherence estimates were significantly higher among cross-studies and studies that used self-reported measures. In summary, our findings indicate that optimal adherence remains a challenge among prison inmates. It is crucial to monitor ART adherence and develop appropriate interventions to improve adherence among these population.
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Affiliation(s)
- Olalekan A Uthman
- a Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Warwick Medical School , University of Warwick , Coventry , UK.,b Department of Public Health (IHCAR) , Karolinska Institutet , Stockholm , Sweden.,c Centre for Evidence-Based Health Care , Stellenbosch University , Tygerberg , South Africa
| | - Olanrewaju Oladimeji
- d Discipline of Public Health Medicine, College of Health Science, University of KwaZulu-Natal , Durban , South Africa.,e Center for Community Healthcare, Research and Development , Abuja , Nigeria
| | - Chidozie Nduka
- f Division of Health Sciences, Warwick Medical School , University of Warwick , Coventry , UK
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Social Network Characteristics Moderate the Association Between Stigmatizing Attributions About HIV and Non-adherence Among Black Americans Living with HIV: a Longitudinal Assessment. Ann Behav Med 2016; 49:865-72. [PMID: 26296702 DOI: 10.1007/s12160-015-9724-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Stigma may contribute to HIV-related disparities among HIV-positive Black Americans. PURPOSE We examined whether social network characteristics moderate stigma's effects. METHODS At baseline and 6 months post-baseline, 147 HIV-positive Black Americans on antiretroviral treatment completed egocentric social network assessments, from which we derived a structural social support capacity measure (i.e., ability to leverage support from the network, represented by the average interaction frequency between the participant and each alter). Stigma was operationalized with an indicator of whether any social network member had expressed stigmatizing attributions of blame or responsibility about HIV. Daily medication adherence was monitored electronically. RESULTS In a multivariate regression, baseline stigma was significantly related to decreased adherence over time. The association between stigma and non-adherence was attenuated among participants who increased the frequency of their interactions with alters over time. CONCLUSIONS Well-connected social networks have the potential to buffer the effects of stigma.
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Montague BT, Rosen DL, Sammartino C, Costa M, Gutman R, Solomon L, Rich J. Systematic Assessment of Linkage to Care for Persons with HIV Released from Corrections Facilities Using Existing Datasets. AIDS Patient Care STDS 2016; 30:84-91. [PMID: 26836237 DOI: 10.1089/apc.2015.0258] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Populations in corrections continue to have high prevalence of HIV. Expanded testing and treatment programs allow persons to be identified and stabilized on treatment while incarcerated. However, these gains and frequently lost on reentry. Systemic frameworks are needed to monitor linkage to care to guide programs supporting linkage to care. To assess the adequacy of linkage to care on reentry, incarceration data from the National Corrections Reporting Program and data from the Ryan White Services Report from 2010 to 2012 were linked using an encrypted client identification (eUCI). Time from release to the first visit and presence of detectable HIV RNA at linkage were assessed. Multivariate survival analyses were performed to identify associations between patient characteristics and time to linkage. Among those linking, only 43% in Rhode Island and 49% in North Carolina linked within 90 days, and 33% in both states had detectable viremia at the first visit. Those not previously in care and with shorter incarceration experiences longer linkage times. Persons identified as black, had median times greater than 1 year. Using existing datasets, significant gaps in linkage to care for persons with HIV on release from corrections were demonstrated in Rhode Island and North Carolina. Systemically implementing this monitoring to evaluate changes over time would provide important information to support interventions to improve linkage in high-risk populations. Using national datasets for both corrections and clinical data, this framework equally could be used to evaluate experiences of persons with HIV linking to care on release from corrections facilities nationwide.
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Affiliation(s)
- Brian T. Montague
- Department of Infectious Diseases, University of Colorado, Aurora, Colorado
| | - David L. Rosen
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cara Sammartino
- School of Public Health, Brown University, Providence, Rhode Island
| | | | - Roee Gutman
- School of Public Health, Brown University, Providence, Rhode Island
| | | | - Josiah Rich
- School of Public Health, Brown University, Providence, Rhode Island
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
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Monarca R, Madeddu G, Ranieri R, Carbonara S, Leo G, Sardo M, Choroma F, Casari S, Marri D, Muredda AA, Nava FA, Babudieri S. HIV treatment and care among Italian inmates: a one-month point survey. BMC Infect Dis 2015; 15:562. [PMID: 26653247 PMCID: PMC4676105 DOI: 10.1186/s12879-015-1301-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 11/30/2015] [Indexed: 01/14/2023] Open
Abstract
Background HIV infection, with an estimated prevalence be between 2 and 50 times those of the general adult population is a major health challenge for prison authorities worldwide. Since no nationwide surveillance system is present in Italy, data on HIV prevalence and treatment in prisons are limited to only a few and small observational studies. We aimed to estimate HIV prevalence and obtain an overview on diagnostic and therapeutic activities concerning HIV infection in the Italian penitentiary system. Methods We piloted a multi-centre cross-sectional study investigating the prevalence of HIV infection and assessing HIV-related medical activities in Italian correctional institutions. Results A total of 15,675 prisoners from 25 institutions, accounting for approximately one-fourth of the prison inmates in Italy, were included in the study, of whom, 97.7 % were males, 37.1 % foreigners and 27 % had a history of intravenous drug addiction. HIV-tests were available in 42.3 % of the total population, with a known HIV Infection proportion of 5.1 %. In the month prior to the study, 604 of the 1,764 subjects who entered prison were tested for HIV, with a HIV-positive prevalence of 3.3 %. Among the 338 HIV-positive prisoners, 81.4 % were under antiretroviral treatment and 73.5 % showed undetectable HIV-RNA. In 23/338 (6.8 %) a coinfection with HBV and in 189/338 (55.9 %) with HCV was also present. Among the 67 (19.8 %) inmates with HIV who did not receive HIV treatment, 13 (19.5 %) had T-CD4+ count <350 cells/mm3 and 9 (69.2 %) of these had refused the treatment. The majority of the inmates with HIV-infection were on a PI-based (62.5 %) or on NNRTIs-based (24.4 %) regimen. Only a minority of patients received once daily regimens (17.2 %). Conclusions Although clinical and therapeutic management of HIV infection remains difficult in Italian prisons, diagnostics, treatment and care were offered to the majority of HIV-infected inmates. Specific programs should be directed towards the prison population and strict cooperation between prison and health institutions is needed to increase HIV treatment.
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Affiliation(s)
- R Monarca
- Infectious Diseases Unit, Belcolle Hospital, Viterbo, Italy.
| | - G Madeddu
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 35b, 07100, Sassari, Italy.
| | - R Ranieri
- Infectious Diseases Unit, A.O. San Paolo, Milan, Italy.
| | - S Carbonara
- Institute of Infectious Diseases, University of Bari, Bari, Italy.
| | - G Leo
- Infectious Diseases Unit, Amedeo di Savoia Hospital, Torino, Italy.
| | - M Sardo
- Cotugno Hospital, Infectious Diseases Unit, Naples, Italy.
| | - F Choroma
- Infectious Diseases Unit, AUSL, Parma, Italy.
| | - S Casari
- Institute of Infectious Diseases, University of Brescia, Brescia, Italy.
| | - D Marri
- Infectious Diseases Unit, A.O. Santa Maria alle Scotte, Siena, Italy.
| | - A A Muredda
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 35b, 07100, Sassari, Italy.
| | - F A Nava
- Penitentiary Medicine, Padova, Italy.
| | - S Babudieri
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 35b, 07100, Sassari, Italy.
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Bracken N, Hilliard C, McCuller WJ, Harawa NT. Facilitators of HIV Medical Care Engagement Among Former Prisoners. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:566-583. [PMID: 26595268 PMCID: PMC5140274 DOI: 10.1521/aeap.2015.27.6.566] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Linkage to and retention in medical care is a concern for HIV-positive individuals leaving custody settings in the United States. The minimal existing research points to low rates of entry into care in the months following release and lapsed viral control among releasees who are subsequently reincarcerated. We conducted seven small focus group discussions with 27 HIVpositive individuals who were recently incarcerated in a California State prison to understand those factors that facilitated linkage to and retention in HIV care following their release. We used a consensual approach to code and analyze the focus group transcripts. Four main themes emerged from the analysis: (1) interpersonal relationships, (2) professional relationships, (3) coping strategies and resources, and (4) individual attitudes. Improving HIV-related outcomes among individuals after their release from prison requires strengthening supportive relationships, fostering the appropriate attitudes and skills, and ensuring access to resources that stabilize daily living and facilitate the process of accessing care.
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Abstract
PURPOSE OF REVIEW People who inject drugs (PWID), sex workers, and MSM simultaneously bear a high burden of HIV and stigma and discrimination. The purpose of this review was to summarize recent information about the understanding of the HIV care cascade among PWID, sex workers, and MSM populations around the globe. RECENT FINDINGS A review of the published literature relating to the care cascade in these three key populations was conducted. Data on the care cascade among key populations are sparse, particularly for PWID and sex workers. In the 12 countries in which a study or report of the care cascade was available stratified by these populations, all three populations have care cascade outcomes that are far below the 90-90-90 target set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) for 2020. Culturally tailored interventions, including colocation of services and peer navigators, can improve care cascade outcomes among key populations. SUMMARY Key populations' care cascade outcomes must be included in international reporting metrics to expand cascade data for these groups. Improving care cascade outcomes in these key populations through culturally tailored interventions should be a priority in the coming years.
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Affiliation(s)
- Kathryn Risher
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth Mayer
- Harvard School of Medicine, Boston, MA, USA
- The Fenway Institute, Boston, MA, USA
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Swan H, Hiller ML, Albizu-Garcia CE, Pich M, Patterson Y, O’Connell DJ. Efficacy of a Process Improvement Intervention on Inmate Awareness of HIV Services: A Multi-Site Trial. HEALTH & JUSTICE 2015; 3:11. [PMID: 26203411 PMCID: PMC4507816 DOI: 10.1186/s40352-015-0023-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/23/2015] [Indexed: 11/26/2023]
Abstract
The prevalence of HIV among U.S. inmates is much greater than in the general population, creating public health concerns and cost issues for the criminal justice system. The HIV Services and Treatment Implementation in Corrections protocol of the NIDA funded Criminal Justice Drug Abuse Treatment Studies cooperative tested the efficacy of an organizational process improvement strategy on improving HIV services in correctional facilities. For this paper, we analyzed efficacy of this strategy on improving inmate awareness and perceptions of HIV services. The study used a multi-site (n=28) clustered randomized trial approach. Facilities randomized to the experimental condition used a coach-driven local change team approach to improve HIV services at their facility. Facilities in the control condition were given a directive to improve HIV services on their own. Surveys about awareness and perceptions of HIV services were administered anonymously to inmates who were incarcerated in study facilities at baseline (n=1253) and follow-up (n=1048). A series of one-way ANOVAs were run to test whether there were differences between inmates in the experimental and control facilities at baseline and follow-up. Differences were observed at baseline, with the experimental group having significantly lower scores than the control group on key variables. But, at post-test, following the intervention, these differences were no longer significant. Taken in context of the findings from the main study, these results suggest that the change team approach to improving HIV services in correctional facilities is efficacious for improving inmates' awareness and perceptions of HIV services.
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Affiliation(s)
- Holly Swan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Road (152), Bedford, MA 01730 USA
| | - Matthew L Hiller
- Department of Criminal Justice, Temple University, 1115 W. Polett Walk, Philadelphia, PA 19122 USA
| | - Carmen E Albizu-Garcia
- Center for Evaluation and Sociomedical Research (CIES), Graduate School of Public Health, Medical Sciences Campus University of Puerto Rico, San Juan, Puerto Rico
| | - Michele Pich
- Faculty Center for Excellence in Teaching and Learning, Law and Justice Studies; Rowan University, Glassboro, NJ 08028 USA
| | | | - Daniel J O’Connell
- Center for Drug and Health Studies, University of Delaware, 257 East Main Street, Newark, DE 19716 USA
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Provider perspectives regarding the health care needs of a key population: HIV-infected prisoners after incarceration. J Assoc Nurses AIDS Care 2015; 26:556-69. [PMID: 26279385 DOI: 10.1016/j.jana.2015.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/14/2015] [Indexed: 01/17/2023]
Abstract
During incarceration, many HIV-infected prisoners receive care and are adherent to medication. However, following release, many have difficulty engaging in HIV care and remaining on antiretroviral therapy. Community-based service providers for HIV-infected releasees have a deep understanding of the health needs and challenges these individuals face on community re-entry. We conducted in-depth qualitative interviews with 38 health care and service professionals in two southern U.S. states regarding the barriers releasees faced in meeting their health needs, including HIV care and treatment post release. Individual, community, and organization-level barriers to HIV care and treatment adherence post release were identified, and offered unique insight into the ways that these multilevel obstacles affect HIV-infected former prisoners' abilities to engage in care and access necessary social services. Provider perspectives should be considered when designing interventions to support HIV care after release.
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Iroh PA, Mayo H, Nijhawan AE. The HIV Care Cascade Before, During, and After Incarceration: A Systematic Review and Data Synthesis. Am J Public Health 2015; 105:e5-16. [PMID: 25973818 DOI: 10.2105/ajph.2015.302635] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We conducted a systematic literature review of the data on HIV testing, engagement in care, and treatment in incarcerated persons, and estimated the care cascade in this group. We identified 2706 titles in MEDLINE, EBSCO, and Cochrane Library databases for studies indexed to January 13, 2015, and included 92 for analysis. We summarized HIV testing results by type (blinded, opt-out, voluntary); reviewed studies on HIV care engagement, treatment, and virological suppression; and synthesized these results into an HIV care cascade before, during, and after incarceration. The HIV care cascade following diagnosis increased during incarceration and declined substantially after release, often to levels lower than before incarceration. Incarceration provides an opportunity to address HIV care in hard-to-reach individuals, though new interventions are needed to improve postrelease care continuity.
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Affiliation(s)
- Princess A Iroh
- Princess A. Iroh and Ank E. Nijhawan are with Department of Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas. Helen Mayo is with Health Sciences Digital Library and Learning Center, University of Texas Southwestern Medical Center
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Telisinghe L, Hippner P, Churchyard GJ, Gresak G, Grant AD, Charalambous S, Fielding KL. Outcomes of on-site antiretroviral therapy provision in a South African correctional facility. Int J STD AIDS 2015; 27:1153-1161. [PMID: 25941052 DOI: 10.1177/0956462415584467] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/31/2015] [Indexed: 12/15/2022]
Abstract
We evaluated a novel on-site antiretroviral therapy (ART) programme in a South African correctional facility using routinely collected programme data, from a retrospective cohort of adult inmates starting ART between 03/2007 and 03/2009 followed-up to 09/2009. We report (1) mortality (using survival analysis); (2) retention in the programme (to 09/2009); and (3) virological suppression at six and 12 months (<400 copies/ml) following ART initiation. In total, 404 started ART (median age 33 years; 91.3% men; median baseline CD4 cell count 152 cells/µl [interquartile range 85-225]). Among 299 starting ART for the first time (ART-naïve), 23 deaths occurred during 252 person-years (median follow-up nine months). Mortality rates were 17.2 at 0-6 months (95% confidence interval 10.9-26.9) and 2.8 at >6 months (95% confidence interval 1.1-7.5)/100 person-years; p < 0.001. At 09/2009, 35.6% (144/404) remained in the correctional facility, with 94.4% (136/144) retained in the programme; 38.4% (155/404) were released; and 20.0% (81/404) transferred to another facility. ART-naïve patients in care six and 12 months after ART initiation, 94.7% (124/131) and 92.5% (74/80) were virologically suppressed, respectively. High early mortality warrants the early identification and management of HIV-positive inmates. The high mobility of inmates necessitates systems for facilitating continuity of care. Good virological responses and retention supports decentralising HIV care to correctional facilities.
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Affiliation(s)
- Lilanganee Telisinghe
- The Aurum Institute, Johannesburg, South Africa .,CAPRISA, University of KwaZulu-Natal, Durban, South Africa
| | | | - Gavin J Churchyard
- The Aurum Institute, Johannesburg, South Africa.,London School of Hygiene and Tropical Medicine, London, UK.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | - Alison D Grant
- London School of Hygiene and Tropical Medicine, London, UK
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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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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36
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High levels of heterogeneity in the HIV cascade of care across different population subgroups in British Columbia, Canada. PLoS One 2014; 9:e115277. [PMID: 25541682 PMCID: PMC4277297 DOI: 10.1371/journal.pone.0115277] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/23/2014] [Indexed: 01/22/2023] Open
Abstract
Background The HIV cascade of care (cascade) is a comprehensive tool which identifies attrition along the HIV care continuum. We executed analyses to explicate heterogeneity in the cascade across key strata, as well as identify predictors of attrition across stages of the cascade. Methods Using linked individual-level data for the population of HIV-positive individuals in BC, we considered the 2011 calendar year, including individuals diagnosed at least 6 months prior, and excluding individuals that died or were lost to follow-up before January 1st, 2011. We defined five stages in the cascade framework: HIV ‘diagnosed’, ‘linked’ to care, ‘retained’ in care, ‘on HAART’ and virologically ‘suppressed’. We stratified the cascade by sex, age, risk category, and regional health authority. Finally, multiple logistic regression models were built to predict attrition across each stage of the cascade, adjusting for stratification variables. Results We identified 7621 HIV diagnosed individuals during the study period; 80% were male and 5% were <30, 17% 30–39, 37% 40–49 and 40% were ≥50 years. Of these, 32% were MSM, 28% IDU, 8% MSM/IDU, 12% heterosexual, and 20% other. Overall, 85% of individuals ‘on HAART’ were ‘suppressed’; however, this proportion ranged from 60%–93% in our various stratifications. Most individuals, in all subgroups, were lost between the stages: ‘linked’ to ‘retained’ and ‘on HAART’ to ‘suppressed’. Subgroups with the highest attrition between these stages included females and individuals <30 years (regardless of transmission risk group). IDUs experienced the greatest attrition of all subgroups. Logistic regression results found extensive statistically significant heterogeneity in attrition across the cascade between subgroups and regional health authorities. Conclusions We found that extensive heterogeneity in attrition existed across subgroups and regional health authorities along the HIV cascade of care in B.C., Canada. Our results provide critical information to optimize engagement in care and health service delivery.
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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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Samji H, Taha TE, Moore D, Burchell AN, Cescon A, Cooper C, Raboud JM, Klein MB, Loutfy MR, Machouf N, Tsoukas CM, Montaner JSG, Hogg RS. Predictors of unstructured antiretroviral treatment interruption and resumption among HIV-positive individuals in Canada. HIV Med 2014; 16:76-87. [PMID: 25174373 DOI: 10.1111/hiv.12173] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Sustained optimal use of combination antiretroviral therapy (cART) has been shown to decrease morbidity, mortality and HIV transmission. However, incomplete adherence and treatment interruption (TI) remain challenges to the full realization of the promise of cART. We estimated trends and predictors of treatment interruption and resumption among individuals in the Canadian Observational Cohort (CANOC) collaboration. METHODS cART-naïve individuals ≥ 18 years of age who initiated cART between 2000 and 2011 were included in the study. We defined TIs as ≥ 90 consecutive days off cART. We used descriptive analyses to study TI trends over time and Cox regression to identify factors predicting time to first TI and time to treatment resumption after a first TI. RESULTS A total of 7633 participants were eligible for inclusion in the study, of whom 1860 (24.5%) experienced a TI. The prevalence of TI in the first calendar year of cART decreased by half over the study period. Our analyses highlighted a higher risk of TI among women [adjusted hazard ratio (aHR) 1.59; 95% confidence interval (CI) 1.33-1.92], younger individuals (aHR 1.27; 95% CI 1.15-1.37 per decade increase), earlier treatment initiators (CD4 count ≥ 350 vs. <200 cells/μL: aHR 1.46; 95% CI 1.17-1.81), Aboriginal participants (aHR 1.67; 95% CI 1.27-2.20), injecting drug users (aHR 1.43; 95% CI 1.09-1.89) and users of zidovudine vs. tenofovir in the initial cART regimen (aHR 2.47; 95% CI 1.92-3.20). Conversely, factors predicting treatment resumption were male sex, older age, and a CD4 cell count <200 cells/μL at cART initiation. CONCLUSIONS Despite significant improvements in cART since its advent, our results demonstrate that TIs remain relatively prevalent. Strategies to support continuous HIV treatment are needed to maximize the benefits of cART.
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Affiliation(s)
- H Samji
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
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Roux P, Lions C, Cohen J, Winnock M, Salmon-Céron D, Bani-Sadr F, Sogni P, Spire B, Dabis F, Carrieri MP. Impact of HCV treatment and depressive symptoms on adherence to HAART among HIV-HCV-coinfected patients: results from the ANRS-CO13-HEPAVIH cohort. Antivir Ther 2013; 19:171-8. [PMID: 24166726 DOI: 10.3851/imp2699] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND The additional burden of HCV infection in HIV-HCV-coinfected individuals may have some consequences on adherence to HAART. Few studies have explored the pattern of correlates of non-adherence to HAART while simultaneously considering the impact of HCV treatment and depressive symptoms on adherence to HAART. We used longitudinal data to assess factors associated with non-adherence to HAART. METHODS The French national prospective cohort ANRS-CO13-HEPAVIH is a multicentrer cohort, which recruited 1,175 HIV-HCV-coinfected patients in 17 hospital outpatient units delivering HIV and HCV care in France between October 2006 and June 2008. For this analysis, we selected participants on HAART with self-reported data for adherence to HAART (n=727 patients, 1,190 visits). Data were collected using self-administered questionnaires and medical records. A mixed logistic regression model based on an exchangeable correlation matrix was used to identify factors associated with non-adherence to HAART. RESULTS Patients reported non-adherence to HAART in 808 (68%) of the 1,190 visits. Four variables remained associated with non-adherence to HAART after multivariate analysis: hazardous alcohol consumption, cocaine use and depressive symptoms, regardless of whether treatment for depression was being received. Finally, patients being treated for HCV infection were less likely to be non-adherent to HAART. CONCLUSIONS Besides the problem of polydrug use, two other dimensions deserve special attention when considering adherence to HAART in HIV-HCV-coinfected patients. Access to HCV treatment should be encouraged as well adequate treatment for depression in this population to improve adherence and response to HAART.
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Baillargeon JG, Giordano TP, Harzke AJ, Baillargeon G, Rich JD, Paar DP. Enrollment in outpatient care among newly released prison inmates with HIV infection. Public Health Rep 2010; 125 Suppl 1:64-71. [PMID: 20408389 DOI: 10.1177/00333549101250s109] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Although many prisoners infected with human immunodeficiency virus (HIV) initiate and adhere to treatment regimens while incarcerated, the benefits of in-prison therapy are frequently lost after community reentry. Little information is available on the percentage of released inmates who establish community-based HIV outpatient treatment in a timely fashion. We sought to determine the proportion of HIV-infected Texas prison inmates who enrolled in an HIV clinic within 90 days after release and to identify variables associated with timely linkage to clinical care. METHODS This was a retrospective cohort study of 1,750 HIV-infected inmates who were released from the Texas Department of Criminal Justice (TDCJ) and returned to Harris County between January 2004 and December 2007. We obtained demographic and clinical data from centralized databases maintained by TDCJ and the Harris County Health District, and used logistic regression analysis to identify factors associated with linkage to post-release outpatient RESULTS Only 20% of released inmates enrolled in an HIV clinic within 30 days of release, and only 28% did so within 90 days. Released inmates > or = 30 years of age were more likely than their younger counterparts to have enrolled in care at the 30- and 90-day time points. Inmates diagnosed with schizophrenia were more likely to have initiated care within 30 days. Inmates who received antiretroviral therapy while incarcerated and those who received enhanced discharge planning were more likely to begin care at both time points. CONCLUSIONS A large proportion of HIV-infected inmates fail to establish outpatient care after their release from the Texas prison system. Implementation of intensive discharge planning programs may be necessary to ensure continuity of HIV care among newly released inmates.
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Affiliation(s)
- Jacques G Baillargeon
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
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Weiser SD, Neilands TB, Comfort ML, Dilworth SE, Cohen J, Tulsky JP, Riley ED. Gender-specific correlates of incarceration among marginally housed individuals in San Francisco. Am J Public Health 2009; 99:1459-63. [PMID: 19542041 DOI: 10.2105/ajph.2008.141655] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed how different patterns of housing instability affect incarceration and whether correlates of incarceration are gender specific. METHODS We used multivariate logistic regression to assess associations between patterns of housing instability and recent jail stays among a reproducible sample of 1175 marginally housed adults in San Francisco, California. RESULTS Over the previous year, 71% of men and 21% of women in the sample reported jail stays. Among women, long-term single-room occupancy hotel stays ( > 90 days) were protective for incarceration. Stays in the street were associated with incarceration among both genders, but among men, short-term (i.e., <or= 90 days) street stays were associated with the highest odds of incarceration, and among women, long-term street stays were most correlated with incarceration. Sex trade increased the odds of incarceration among men only; recent drug use was associated with incarceration among both genders. CONCLUSIONS Correlates of incarceration differed by gender, and patterns of housing instability differentially affected incarceration for men and women. Policies to improve housing options and drug treatment for the urban poor are critical to breaking the cycle of incarceration and homelessness and improving health outcomes.
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Affiliation(s)
- Sheri D Weiser
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA 94143-1372, USA.
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