Observational study of continuity of HIV care following release from correctional facilities in South Africa

Abstract

Background: We sought to describe linkage to care, ART continuity, and factors associated with linkage to care among people with HIV following release from incarceration in South Africa. Methods: We conducted a study of South African correctional service community reentrants who were receiving ART at the time of release. The study was implemented in three of 46 correctional service management areas. Participants were enrolled prior to corrections release and followed up to 90 days post-release to obtain selfreported linkage to care status and number of days of ART provided at corrections release. Clinic electronic and paper charts were sought and abstracted to verify self-reported linkage to care. Log-binomial regression, adjusted for facility, was used to identify associations with post-release linkage to care (self-reported and verified). We sought to specifically assess for associations with HIV diagnosis during index incarceration, ART initiation during index incarceration, and duration of incarceration. Results: From May 2014 to December 2016, 554 inmates met eligibility and 516 (93%) consented to participate; 391 were released on ART, 40 of whom were excluded from analysis post-release. Of the remaining 351, 301 (86%) were men and the median age was 35 years (interquartile range 30, 40). Linkage to care was self-reported by 227 (64%) and linkage to care could be verified for 121 (34%). At most, 47% of participants had no lapse in ART supply. Initiating ART during the index incarceration showed a trend toward increased self-reported post-release linkage to care. Age > 35 years was associated with increased verified linkage to care while HIV diagnosis outside of a correctional setting and ART initiation during the index incarceration showed trends toward association with increased verified linkage to care. Discussion: The results of our study are the first description of retention in care following correctional facility release from an African setting and indicate high levels of attrition during the transition from correctional facility to community care. Initiating ART within a correctional facility did not impair post-release linkage to care.

“That makes me feel human”: a qualitative evaluation of the acceptability of an HIV differentiated care intervention for formerly incarcerated people re-entering community settings in South Africa

“…The TCAC was tailored to overcome care transition challenges particularly affecting HIV-positive re-entrants. It was informed by a model of key barriers to care transition developed from prior work and the Behavioral Model for Vulnerable Populations [12,17,34]. The intervention was specifically designed to improve retention in HIV care and ART adherence among re-entrants by addressing logistical barriers to care, long wait times at clinics, clinic-based enacted stigma toward HIV and incarceration, low social support, substance use, and joblessness.…”

“…However, many face care transition challenges upon release, which leads to low engagement in HIV care and poor ART adherence during re-entry [8][9][10][11]. A study among 351 HIV-positive re-entrants in South Africa found that only 34% of participants had no lapse in ART supply within 90 days of release [12]. A meta-analysis of linkage to care studies from the United States (U.S.) reported similar proportions of post-release linkage to care with a median of 36% [13].…”

Tuberculosis in prisons: an unintended sentence?

“…7 Strategies to promote continued engagement in care for incarcerated individuals following their release from correctional facilities are required to ensure sustainability of efforts. 8 The ongoing COVID-19 pandemic and subsequent development of effective vaccines have demonstrated what can be done when there is a collective political will and resources are made avail able. These aspects still remain key barriers for tuberculosis and HIV control in correctional facilities.…”

Preferences for transitional HIV care among people living with HIV recently released from prison in Zambia: a discrete choice experiment

“…Unfortunately, such benefits are short‐lived for PLHIV after release (“releasees”) due to problems with post‐release care continuity posed by multiple psychosocial, health system and structural barriers [ 6 , 12 , 13 , 14 , 15 ]. Although data to quantify the extent of the problem in SSA are scarce, available reports suggest that one‐third or more of releasees fail to link to community care or experience HIV treatment interruption post‐release [ 16 , 17 ].…”

“…Unfortunately, such benefits are short-lived for PLHIV after release ("releasees") due to problems with post-release care continuity posed by multiple psychosocial, health system and structural barriers [6,[12][13][14][15]. Although data to quantify the extent of the problem in SSA are scarce, available reports suggest that one-third or more of releasees fail to link to community care or experience HIV treatment interruption post-release [16,17]. Despite these HIV care disruptions, no studies from SSA have attempted to assess HIV service delivery preferences among incarcerated PLHIV as they transition from prisons into the community, and specific recommendations about interventions to promote post-release HIV care continuity are lacking [18,19].…”