Abstract
BackgroundLinkage to and retention in care for US persons living with HIV (PLWH) after release from jail usually declines. We know of no rigorously evaluated behavioral interventions that can improve this. We hypothesized that a strengths-based case management intervention that we developed for PLWH leaving jail would increase linkage/retention in care (indicated by receipt of laboratory draws) and a suppressed HIV viral load (VL) in the year following release.Methods and findingsWe conducted a quasi-experimental feasibility study of our intervention for PLWH jailed in Atlanta. We recruited 113 PLWH in jail starting in 2014. “SUCCESS” (Sustained, Unbroken Connection to Care, Entry Services, and Suppression) began in jail and continued post-release. Subjects who started the intervention but subsequently began long-term incarcerations were excluded from further analysis. Persons who were retained in the intervention group were compared to contemporaneously incarcerated PLWH who did not receive the intervention. Identities were submitted to an enhanced HIV/AIDS reporting system (eHARS) at the state health department to capture all laboratories drawn. Both community engagement and care upon jail return were assessed equally. For 44 intervention participants released to Atlanta, 50% of care occurred on subsequent jail stays, as documented with EventFlow software. Forty-five receiving usual services only were recruited for comparison. By examining records of jail reentries, half of participants and 60% of controls recidivated (range: 1–8 returns). All but 6 participants in the intervention and 9 subjects in the comparison arm had ≥1 laboratory recorded in eHARS post-release. Among the intervention group, 52% were retained in care (i.e., had two laboratory studies, > = 3 months apart), versus 40% among the comparison group (OR = 1.60, 95% CI (0.71, 3.81)). Both arms showed improved viral load suppression.ConclusionsThere was a trend towards increased retention for PLWH released from jail after SUCCESS, compared to usual services. Measuring linkage at all venues, including jail-based clinics, fully captured engagement for this frequently recidivating population.Trial registrationClinicalTrials.gov NCT02185742
Highlights
Staying connected with HIV care is challenging for most infected persons
Identities were submitted to an enhanced HIV/AIDS reporting system at the state health department to capture all laboratories drawn
There was a trend towards increased retention for persons living with HIV (PLWH) released from jail after SUCCESS, compared to usual services
Summary
Staying connected with HIV care is challenging for most infected persons. In the United States, with the world’s highest incarceration rate,[1] 150,000 persons with HIV come in contact with the criminal justice system each year,[2] which further complicates linkage to and retention in care. Of the 150,000 HIV+ persons released annually from U.S correctional facilities, 95% leave jails, which are short-term, high throughput correctional facilities usually run by counties or cities for those who are awaiting trial or serving brief sentences.[2] Results from a study in Baltimore suggest that a short jail stay can disrupt antiretroviral therapy much more than a prison sentence.[7] A jail can release a detained person based on a sudden decision, such as the court system dropping charges. We hypothesized that a strengths-based case management intervention that we developed for PLWH leaving jail would increase linkage/retention in care (indicated by receipt of laboratory draws) and a suppressed HIV viral load (VL) in the year following release
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