Abstract
BackgroundThe criminal justice system (CJS), specifically prisons and jails, is ideally suited for uniform screening of psychiatric (PD) and substance use disorders (SUDs) among people living with HIV/AIDS (PLWHA), who are concentrated in these settings. By accurately diagnosing PDs and SUDs in these controlled settings, treatment can be initiated and contribute to improved continuity of care upon release. In the context of PLWHA, it may also improve combination antiretroviral treatment (cART) adherence, and reduce HIV transmission risk behaviors.MethodsA retrospective data analysis was conducted by creating a cohort of PLWHA transitioning to the community from prison or jail enrolled who were enrolled in a controlled trial of directly administered antiretroviral (DAART). Participants were systematically assessed for PDs and SUDs using the Mini International Neuropsychiatric Interview (MINI), a standardized psychiatric assessment tool, and compared to diagnoses documented within the correctional medical record.ResultsFindings confirm a high prevalence of Axis I PDs (47.4%) and SUDs (67.1%) in PLWHA even after prolonged abstinence from alcohol and drugs. Although prevalence of PDs and SUDs were high in the medical record, there was fair to poor agreement among PDs using the MINI, making evident the potential benefit of more objective and concurrent PD assessments to guide treatment.ConclusionsAdditional PD diagnoses may be detected in PLWHA in CJS using supplementary and objective screening tools. By identifying and treating PDs and SUDs in the CJS, care may be improved and may ultimately contribute to healthier outcomes after community release if patients are effectively transitioned.Electronic supplementary materialThe online version of this article (doi:10.1186/s40352-014-0011-1) contains supplementary material, which is available to authorized users.
Highlights
The criminal justice system (CJS), prisons and jails, is ideally suited for uniform screening of psychiatric (PD) and substance use disorders (SUDs) among people living with HIV/AIDS (PLWHA), who are concentrated in these settings
This is the first English-language study that examines the prevalence of Axis I psychiatric disorder (PD) and SUDs among a group of HIV-infected prisoners who are transitioning to the community, and compares the diagnoses made during incarceration
We formed was that the diagnoses would differ between the two measures and we found a fair level of agreement between the Mini International Neuropsychiatric Interview (MINI) and prison medical record for those with any PD, and fair to poor degrees of concordance between the three major categories explored in this analysis
Summary
The criminal justice system (CJS), prisons and jails, is ideally suited for uniform screening of psychiatric (PD) and substance use disorders (SUDs) among people living with HIV/AIDS (PLWHA), who are concentrated in these settings. Consequences of undiagnosed and under-treated PDs among PLWHA can result in poor treatment outcomes for those transitioning to the community where the highly structured prison setting is discontinued, resulting in poor access and adherence to combination antiretroviral therapy (cART) (Springer et al 2012; Meyer et al 2011), suboptimal viral suppression (Uldall et al 2004; Springer et al 2004; Meyer et al 2011; Meyer et al 2014) and increased HIV risk-taking behaviors (Goforth and Fernandez 2011; Buckingham et al 2013), repeated incarcerations (Baillargeon et al 2009; Baillargeon et al 2010a; Baillargeon et al 2010b), relapse to drug and alcohol use (Krishnan et al 2013), decreased retention in HIV care (Althoff et al 2013), a high frequency of emergency department visits (Meyer et al 2012, 2013), and a higher risk of death (DeLorenze et al 2010). Correctly identifying and treating PDs among HIV-infected prisoners prior to release is crucial for effective transitional care of PLWHA who re-enter the community (Springer et al 2011)
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