Less than half of people with HIV who are incarcerated are retained in care 3 years after their release, according to results of a study conducted in Connecticut.
“Few prior studies had described long-term retention in HIV care (RIC) or viral suppression (VS) for people incarcerated in prisons or jails and transitioning to communities. In fact, incarceration periods are often excluded from studies of RIC,” Kelsey B. Loeliger, an MD/PhD candidate in the Yale Schools of Medicine and Public Health and colleagues wrote. “This is an important knowledge gap because HIV and incarceration are overlapping epidemics that disproportionately affect people who are already marginalized by homelessness, substance use and psychiatric disorders, and socioeconomic status.”
Loeliger and colleagues merged statewide databases from the Connecticut Department of Correction and Connecticut Department of Public Health for people living with HIV who were released from prisons or jails in Connecticut between Jan. 1, 2007, and Dec. 31, 2011. They examined study participants’ RIC and VS for 3 years after their release.
According to the findings, among 1,094 individuals included in the study, continuous RIC declined over time, with 67.2% retained in care during the first year, 51.3% retaining during the first two years and 42.5% retaining during all 3 years. The study also showed that individuals who were reincarcerated were more likely to be retained in care, with 48% meeting RIC criteria vs. 34% of people who were no reincarcerated. However, they were less likely to have VS, 72% vs. 81%.
This year at CROI, researchers reported that long-acting naltrexone improves HIV care in freed inmates with alcohol or opiate abuse disorders, increasing their likelihood of maintaining VS for months.
According to the current study, sustained RIC and VS after release were 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, Loeliger and colleagues reported. In addition to these factors, they said receiving an increased number of case management visits after release and spending an increased proportion of follow-up time re-incarcerated were correlated with better RIC and VS outcomes.
“Dedicated resources are need to optimize people’s HIV care while they are in prison and to link them to care following release,” the authors concluded. “Although prior studies suggest that prison provides a temporary window of opportunity to reconnect people to care, sustained retention in care and continuity of care ultimately require keeping people in the community longer and avoiding incarceration.” – by Caitlyn Stulpin