HIV in people reincarcerated in Connecticut prisons and jails: an observational cohort study

Abstract

Summary 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.

Correlates of retention on extended-release naltrexone among persons living with HIV infection transitioning to the community from the criminal justice system

“…There was a high rate of recidivism within the first 6 months post release of initiating the study. Although specific reasons for rearrests are not described in this analysis, it does speak to the high recidivism rate among previously incarcerated persons in CT as previously reported (Meyer et al, 2014a, 2014b; Springer et al, 2004); it is possible that the behavior leading to the rearrests was initiated upon release and may include illicit drug use as a cause for reduced retention in this study given the high prevalence of comorbid substance use disorders in this sample (Meyer et al, 2014a). Reducing the recidivism rate includes not only alcohol and drug treatment as addressed by the two parent randomized controlled trials in this paper, but also importantly includes psychiatric disorder evaluation and treatment, linkage to effective housing, as well as identification of other important psychosocial factors that have been found to be associated with recidivism and poor retention in care post-release (Di Paola et al, 2014a; Meyer et al, 2014a, 2014b; Springer et al, 2011b).…”

Sex-Related Disparities in Criminal Justice and HIV Treatment Outcomes: A Retrospective Cohort Study of HIV-Infected Inmates

“…This shift will likely preferentially affect women who, as shown here, experience a significantly higher burden of comorbidity than men. Instead of using drug courts to off-load prisons, alternatives to incarceration strategies can be leveraged to help stabilize chaotic lives in a more effective and enduring way than imprisonment, in which HIV treatment outcomes are temporarily optimized then deteriorate rapidly after release (14, 16). …”

“…The cohort has been described previously in terms of HIV treatment outcomes and recidivism (14, 38). Individuals were included in the present analysis if they: 1) were incarcerated within any CTDOC facility (prison or jail) for any duration between March 2005 and June 2012; 2) had documented HIV and received ART during any incarceration; and 3) had at least one measurement of HIV viral load (VL) during incarceration.…”

“…CD4 and VL variables were analyzed continuously on intake and release; VS was analyzed as a dichotomous variable. ART regimen was examined at the times of entry and release and was defined by its components in terms of mutually exclusive categories, as previously described (14, 38). ART regimen was further characterized in terms of calculated daily pill burden (based on included components and dosing strategy) and mode of medication administration, as previously described (14).…”

“…After prison-release, ART benefits wane for both women and men (13, 15, 16). During this chaotic transition period, suboptimal engagement in care paired with reduced ART adherence and persistence, increases risk of genotypic resistance and continued HIV transmission, with negative consequences for individual and public health (17-20).…”