Retention in HIV Care Decreases Over Time Following Release From Incarceration

Retention in HIV care is essential for achieving viral suppression and other positive clinical outcomes, and studying subpopulations can help stakeholders identify vulnerable populations to center their efforts. Looking within criminal justice populations, researchers found that retention in care diminished significantly over time, but it was associated with HIV care during incarceration, health insurance, case management services, and early linkage to care post release.

The study provides a rare look at HIV care behaviors over time among the patient population. While previous studies have highlighted challenges with linkage to care following release from incarceration, the longitudinal impact of incarceration on continuity of care has remained poorly understood.

“The US has the highest incarceration rate globally (910 per 100,000 adults), with one-sixth of the country’s 1.2 million people living with HIV cycling through prisons or jails annually,” according to the researchers. “Yet incarcerated people living with HIV are frequently censored or excluded altogether from retention in care studies.”

The researchers followed 1094 people living with HIV incarcerated in Connecticut between January 1, 2007, to December 31, 2011. Participants were monitored every 3 months during incarceration and were observed post incarceration until December 31, 2014.

More than half (52.3%) of participants were older than 45 years, and most (77%) were male. During the 3-year period, continuous retention in care and viral suppression rates significantly declined. Two-thirds of participants (67.2%) retained care for year 1, 51.3% retained care for years 1 to 2, and 42.5% retained care for years 1 to 3. Excluding deaths, retention in care rates were significantly higher among those who were reincarcerated compared with those who were not (48% vs 34%). However, among those who retained care, reincarcerated people living with HIV were less likely to be virally suppressed (72% vs 81%).

Although those who were reincarcerated had higher rates of continuous retention in care, they too experienced a statistically significant decline in retention in care over time.

Sustained retention in care was associated with being older than 45 years, having health insurance, being reincarcerated for more than 90 days during follow-up, receiving more than 30 case management visits, and being linked to care or reincarcerated within 14 days following initial release. Similarly, viral suppression was associated with these characteristics. Viral suppression prior to release was not associated with retention in care, but not having a viral load measured prior to release was negatively associated with retention in care.

“Re-incarceration likely represented ‘forced’ reengagement in care, but was not necessarily associated with viral suppression itself,” noted the researchers. They added, “These findings speak not only to the potential for incarceration to facilitate reengagement in HIV care within a structured setting that can provide appropriate care and resources, but also the potential for re-incarceration to interrupt HIV care.”

Reference

Loeliger KB, Meyer JP, Desai MM, Ciarleglio MM, Gallagher C, Altice FL. Retention in HIV care during the 3 years following release from incarceration: a cohort study. PLoS Med. 2018;15(10):e1002667. doi: 10.1371/journal.pmed.1002667.