Situation Improving For HIV-Positive Individuals Detained at the United States Border

Individuals with HIV who have been detained by United States Immigration and Customs Enforcement are far more likely to be released having had some consultation about their health and steps to improve their outlook compared with those who were detained several years ago, according to new research presented the 2018 ID Week Annual Meeting in San Francisco, CA.

“The key finding of the study was the data concerning the frequency of discussion of HIV and HIV care with detainees just prior to their release. In 2015, only about 29% of detainees were spoken to by a clinician or someone qualified in HIV care. In 2017 the rate had increased to about 62%,” lead investigator Alexandra Mishreki, MPH, ‎Safe Harbor International Relief, San Diego, CA, explained to MD Magazine® in an interview.

The provision of care during the transition from detention back into society—termed continuity of care (COC) by the Immigration and Customs Enforcement Health Service Corps (IHSC)—is important. Detainees can fall through the health care cracks, with consequent detriment to their health. For those infected with HIV, the lack of contact with health care systems can be especially bad.

Several years ago, the IHSC recognized the need to do better in the provision of health care to detainees and took steps to do so. The study presented at IDWeek 2018 assessed whether the efforts have paid off in improvements.

The investigators retrospectively compared the situation in 2015 with 2017 by reviewing electronic health records of detainees with confirmed HIV infection who had been detained at any of the 21 IHSC facilities in the continental United States between the whole calendar year 2015 and from January to August of 2017.

The search identified 642 detainees with HIV. Most were male (87.5%), 36.5% were born in Mexico followed by Honduras (14.5%) and El Salvador (8.7%). Most (86.2%) had CD4 counts >200 and 94.1% had been diagnosed with HIV before being detained.

Multiple regression analysis revealed significant associations of time and whether detainees had been consulted about their infection prior to release. In 2015, 29.1% received health care advice prior to discharge. In 2017, this had more than doubled to 61.7% (adjusted odds ratio 1.002, 95% confidence interval [CI] 1.001-1.002; P < .001).

Among the HIV-positive detainees who had not received antiretroviral therapy prior to being detained, 87% were receiving the therapy at the time of their release in 2017, compared with 58% in 2015. “At their release, detainees receive a 30-day supply of some medications, but this does not include antiretrovirals. It is up to them to seek that care after their release,” said Mishreki.

“With increased coordination between the ICE Health Service Corps and medical authorities prior to detainee release, and with the availability of resources like handouts and webinars, we hope that the continuity of care rate will have increased when the next survey s done in several years,” principal investigator Edith Lederman, MD, MPH, shared with MD Magazine®.

DISCLOSURES

Alexandra Mishrecki, MPH: none; Edith Lederman MD, MPH; none

PRESENTATIONS

Poster Session: HIV Management and Clinical Outcomes

Alexandra Mishrecki, MPH

School of Public Health, San Diego State University

Poster 593. A Nationwide Assessment of Predictive Factors for Provision of Continuity of Care Resources for HIV-Positive Detainees in ICE Health Service Corps-staffed Facilities, 2015 and 2017

Brian Hoyle, PhD, is a medical and science writer and editor from Halifax, Nova Scotia, Canada. He has been a full-time freelance writer/editor for over 15 years. Prior to that, he was a research microbiologist and lab manager of a provincial government water testing lab. He can be reached at hoyle@square-rainbow.com.