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

• Published in: PLoS medicine 2018-10, Vol.15 (10), p.e1002667-e1002667
• Main Authors: Loeliger, Kelsey B, Meyer, Jaimie P, Desai, Mayur M, Ciarleglio, Maria M, Gallagher, Colleen, Altice, Frederick L
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; Age Factors; AIDS; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral therapy; Biology and Life Sciences; Case Management - statistics & numerical data; Cohort analysis; Connecticut; Cost control; Drug abuse; Drug use; Epidemiology; Female; Funding; Health surveillance; HIV; HIV Infections - drug therapy; Housing; Human immunodeficiency virus; Humans; Imprisonment; Infectious diseases; Injection; Insurance, Health - statistics & numerical data; Judicial system; Male; Management; Management services; Medication Adherence - statistics & numerical data; Medicine and health sciences; Mental disorders; Middle Aged; Mortality; Patient Dropouts - statistics & numerical data; People and places; Prisoners; Prisoners - statistics & numerical data; Prisons; Public health; Recidivism; Regression analysis; Retention; Retrospective Studies; Social Sciences; Studies; Substance use; Supervision; Sustained Virologic Response
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1002667

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. 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. In a large cohort of CJ-involved PLWH with a 3-year post-relea