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Abstract
BackgroundIncarceration is disruptive to HIV care, often resulting in poor retention in care for people living with HIV (PLWH) after jail release. This gap in HIV care might result in potentially preventable emergency department (ED) utilization. We analyzed demographic, incarceration, socioeconomic and clinical data for PLWH released from the Dallas County Jail to the community (1450 incarcerations, 1155 unique individuals) between January 2011 and November 2013.ResultsThe study population consisted of predominantly men (77%), with a mean age of 39 years, 67% were black and 14% were Hispanic; half of the releasees visited the ED at least once during the first-year post-jail. In adjusted analyses, female gender, family awareness of HIV status, serious mental illness, and late engagement to HIV care were significantly associated with higher ED utilization. Compared to the general Dallas population, PLWH released from jail had a 5-fold higher proportion of ED visits classified as related to substance use or mental health.ConclusionsFurther efforts are needed to improve the transition from incarceration to community-based HIV care, substance use disorder treatment and mental health services, and to directly address re-engagement in HIV care for out-of-care PLWH who visit the ED.
Highlights
6.9 million adults in the United States (US) were under correctional supervision in 2013 (Glaze & Herberman, 2013)
43% of the cohort did not present to an Human immunodeficiency virus (HIV) clinic during the year after release to the community with 34% linked to HIV care within 90 days of jail release, and an additional 23% linked to HIV care after 90 days from release to the community
In this study using a comprehensive database of hospitals, jail health data and data from community-based HIV clinics in North Texas, we demonstrated that high emergency department (ED) utilization by people living with HIV (PLWH) occurs shortly and frequently after jail release
Summary
6.9 million adults in the US were under correctional supervision in 2013 (Glaze & Herberman, 2013). In 2015, the HIV seroprevalence in state and federal prisons was 1.3% (Bronson, 2017), whereas in large urban jails, it was estimated to be between 1 to 6% (Beckwith et al, 2012; Spaulding et al, 2015). It is estimated that only 36% of HIV-positive released detainees will present to an HIV provider within 6 months after release from jail or prison (Iroh et al, 2015). Incarceration is disruptive to HIV care, often resulting in poor retention in care for people living with HIV (PLWH) after jail release. This gap in HIV care might result in potentially preventable emergency department (ED) utilization. Incarceration, socioeconomic and clinical data for PLWH released from the Dallas County Jail to the community (1450 incarcerations, 1155 unique individuals) between January 2011 and November 2013
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