New study conducted by Loeliger and her colleagues assessed the retention in care and viral suppression in a large cohort of incarcerated people living with HIV. Fewer than half of people with HIV are retained in care three years after release from incarceration, stated study published in PLOS Medicine.
HIV prevention and treatment strategies aim to reduce HIV-related morbidity, mortality and transmission by retaining people with HIV in care and sustaining them on antiretroviral treatment to achieve viral suppression. Few prior studies have described long-term retention in HIV care or viral suppression for people transitioning from prisons or jails to communities. 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.
The authors merged statewide databases from the Departments of Public Health and Correction on all people living with HIV who were released from prisons or jails in Connecticut between 2007 and 2011. Among 1,094 individuals included in the study, continuous retention in care declined over the three following years (67.2%, 51.3%, and 42.5%, respectively). Sustained retention in HIV care (RIC) and viral suppression (VS) three years after release were independently associated with older age (RIC: Adjusted Odds Ratio = 1.61]; 95% Confidence Interval [1.22, 2.12] and VS: AOR = 1.37; 95% CI [1.06, 1.78]), having health insurance (RIC: AOR = 2.15; 95% CI [1.60, 2.89] and VS: AOR = 2.01; 95% CI [1.53, 2.64], and receiving more transitional case-management services. Moreover, better treatment outcomes were strongly associated with receiving antiretroviral therapy during incarceration (RIC: AOR = 1.33; 95% CI [1.07, 1.65] and VS: AOR= 1.91; 95% CI [1.56, 2.34] and early access to care after release (RIC: AOR = 2.64; 95% CI [2.03, 3.43] and VS: AOR = 1.79; 95% CI [1.45, 2.21]).
Although prior studies suggest that prison provides a temporary window of opportunity to reconnect people to care, supporting community-based retention in HIV care efforts is critical for improving long-term treatment outcomes.