Inmates with HIV Often Stop Care After Release

SAN DIEGO – Only slightly more than one–third of HIV-positive inmates linked to care in jail remain on treatment once they are released, a researcher reported.

“We have some room for improvement,” said Frederick Altice, MD, of Yale University School of Medicine.

Jail, he told an oral session at the IDWeek 2012 meeting here, offers the opportunity for “brief” interventions that can help people get access to care, but it’s an open question how well they work.

To help clarify the issue, he and colleagues enrolled 867 prisoners in 10 urban centers, who were on HIV care while they were in jail.

The researchers followed them for 6 months after their release to see how many would be retained in care – defined as one clinic visit in each quarter that included either a viral load or a CD4 count – and what factors played a role in the outcome.

Overall, he reported, 34% were immediately lost to care – they had no clinic visits in the first 6 months after release. Another 19% made it to their first quarter visit, while 8% missed the first quarter visit but had a clinic visit in the second quarter.

Only 38% had “sustained retention in care,” he said – they had clinic visits in both quarters.

A multivariate analysis, Altice said, found, among other things, that:

• Men were twice as likely as women to be retained in care.
• Those who had been seeing an HIV provider before they went to jail were 67% more likely to stay in care than those who had not.
• HIV education, in a post-release session, doubled the chance of staying in care, as did disease management education while in jail.
• Oddly, those who had been heroin users before jail were 49% more likely to stay in care than others.

The latter finding, Altice said, is “provocative” and needs more analysis. It could be, he said, that heroin is in some way a “less chaotic” illicit drug, or it could be an unmeasured effect of the opioid substitution programs offered by some of the jails.

The rate of loss to follow-up is “unacceptably high for any HIV-positive population,” commented Barry Zingman, MD, of Montefiore Medical Center in New York City, who was not involved in the study.

“Better efforts need to be made to effectively re-engage people in care after release from prison,” Zingman told MedPage Today. “The prisons can do better, and important contributions could be made by community-based organizations and HIV providers and their support staff.”

He also called for specially designed prison release programs to address the problem and more research on “risk factors for lack of follow-up after prison release and on programs to mitigate this significant problem.”