HIV treatment and care among Italian inmates: a one-month point survey

Abstract

BackgroundHIV 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.MethodsWe piloted a multi-centre cross-sectional study investigating the prevalence of HIV infection and assessing HIV-related medical activities in Italian correctional institutions.ResultsA 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 %).ConclusionsAlthough 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.

Virological outcomes of antiretroviral therapy in Zomba central prison, Malawi; a cross‐sectional study

“…In a South African prison, losses to follow up among 148 prisoners were high (22%) both during incarceration and after release but in the 70 patients who remained in care, 92% had an undetectable VL [16]. Our virological results and those of the South African study compare favourably with reports from prisons in affluent settings where rates of undetectable VL were between 50 and 74% [8][9][10][11] as well as with recent routinely collected VL data from the whole population on ART in Malawi, showing that 11% of VL results were >1,000 copies/ml [17].…”

“…In Connecticut USA, 70% of 882 prisoners on ART between 2005 and 2012 had undetectable VL before release from prison [9] and achieving full viral suppression was associated with female gender and a lower psychiatric illness score. In 275 Italian prisoners on ART, optimal virological results were observed in 74% in a report from 2013 [10] and in an audit of HIV care in British prisons 68% of 74 prisoners on ART had full HIV suppression [11].…”

Care to Incarcertaed People With Hiv/Aids: Literature Review

“…12,19 In relation to testing and counseling, a study conducted in Italy in 2013 found that all PUs studied offered HIV testing. 13 Another study conducted in Malaysia found that 66.9% of participants were diagnosed with HIV in a previous incarceration, 56.5% in the current incarceration and 10.5% by compulsory testing during incarceration. 14 It is noteworthy that this last study includes elements of the cascade of care before incarceration and during prison, considering the diagnosis, retention of care (offer of TCD4+) and ART prescription, however, disease prevention, therapeutic adherence and viral suppression were not explored.…”

“…Regarding their approach, seven were quantitative (three descriptive, two cross sectional and two descriptive / cross sectional) and two were qualitative (Table 1). The care provided to people with HIV/AIDS in prison was addressed by the articles regarding the following themes: HIV prevention,12,19 HIV testing and diagnosis,13-16 HIV treatment, [13][14][15][16] Articulation with health services in addressing HIV. 12,15,18,20 In the HIV prevention theme, it was found that the development of such action within the PU can be an alternative to decrease the number of new cases of detainees infected with the virus, 19 however there are prisons that represent a high-risk environment for the HIV transmission.…”

Assistência prestada às pessoas que vivem com HIV para prevenção da transmissão do vírus no âmbito prisional

“…Para que a prevenção combinada seja eficaz, pressupõe-se adequação na realidade local da população em que as intervenções serão direcionadas, levando em consideração os contextos, práticas e processos identitários dos sujeitos (BRASIL, 2018b). Por exemplo, os testes rápidos no sistema prisional mostram-se eficazes no diagnóstico oportuno de PPL, uma vez que parte deles realiza o teste durante a detenção; contudo, fazer parte da ação não significa que o indivíduo aceitará o diagnóstico ou iniciará o tratamento, reforçando a necessidade de ações individuais singulares e sigilosas(MONARCA et al, 2015;BICK et al, 2016;SPAULDING et al, 2013;SIMONSEN et al, 2015). Além disso, mesmo que o teste rápido para HIV seja uma alternativa na identificação de pessoas com a infeção pelo vírus nas UP, barreiras envolvendo a logística de disponibilização de insumos podem estar presentes para o desempenho desta ação no âmbito institucional(SIMONSEN et al, 2015).Vale ressaltar ainda a estratégia designada "TasP" (Treatment as Prevention), ou seja, tratamento como prevenção, a qual representa uma das inovações propostas junto à PreP e à PEP sexual.…”