Improved Care Needed for People With HIV in Prison and After Release

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Dedicated resources are needed to optimize HIV care for people living with HIV while they are in prison and link them to care following release.
Dedicated resources are needed to optimize HIV care for people living with HIV while they are in prison and link them to care following release.

Although prior studies suggest that prison provides a temporary window of opportunity to reconnect individuals to medical care,1-3 dedicated resources are needed to optimize  HIV care for people living with HIV (PLWHIV) while they are in prison and link them to care following release, according to retrospective cohort study results published in PLoS Medicine.4

Current strategies to prevent and reduce HIV-related morbidity, mortality, and transmission include patient retention in HIV care and viral suppression via antiretroviral treatment.4 These strategies have not been comprehensively assessed in criminal justice populations with known health disparities, therefore researchers sought to identify predictors of patient retention in HIV care and viral suppression following release from prison or jail. 

The study included 1094 PLWH who were incarcerated in Connecticut between 2007 and 2011 who were followed for 3 years after release, and found that post-release patient retention in HIV care declined steadily over follow-up (67.2% retained for the first year, 51.3% for years 1 to 2, and 42.5% for years 1 to 3). Individuals who were re-incarcerated were more likely to meet patient retention in HIV care criteria but less likely to have viral suppression compared with individuals who were not re-incarcerated. Sustained patient retention in HIV care and viral suppression were both associated with older age, having health insurance, being treated for HIV while in prison, receiving case management services during follow-up, and early linkage to care in the community following release. Receiving an increased number of case management visits after release and spending an increased percentage of follow-up time re-incarcerated were correlated with better patient retention in HIV care and viral suppression outcomes.

The investigators concluded that “while reincarceration and conditional release provide opportunities to engage in care, reducing recidivism and supporting community-based patient retention in HIV care efforts are key to improving longitudinal treatment outcomes among criminal justice-involved PLWH.”4

References

  1. Meyer JP, Cepeda J, Wu J, Trestman RL, Altice FL, Springer SA. Optimization of human immunodeficiency virus treatment during incarceration: viral suppression at the prison gate. JAMA Intern Med. 2014;174(5):721-729.
  2. Milloy MJ, Montaner JS, Wood E. Incarceration of people living with HIV/AIDS: implications for treatment-as-prevention. Curr HIV/AIDS Rep. 2014;11(3):308-316.
  3. 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(2):e77-e84.
  4. 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(10): e1002667.
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