Study Exposes Major Gaps in Post-Incarceration Care for Patients with HIV

Jaimie Meyer, MD, MS, FACP, of Yale University School of Medicine

Jaimie Meyer, MD, MS, FACP

HIV-positive patients who are incarcerated have a legal right to medical treatment while they are in jail or prison, but a new study finds that most of the time those patients face a delay in connecting with care once they are released back into the community.

The study is based on data from all of the HIV-positive individuals in Connecticut jails and prisons between 2007—2014. Those data were cross-referenced with mandatory HIV/AIDS surveillance monitoring, case management records, administrative custody and pharmacy databases.

All told, the study looked at 3,302 instances of incarceration, spread across 1,350 HIV-positive individuals (including many who spent multiple stints in jail or prison). Of those more than 3,000 incarceration periods, the newly released HIV-positive individual had linkage to care (LTC) within 2 weeks in only 1 in 5 cases (21%). In just 34% of incarceration periods did the patient connect to care within 30 days of release.

Of those connecting to care within a month, 29% already had detectable viral loads at the time of LTC.

Study author Jaimie Meyer, MD, MS, FACP, of Yale University School of Medicine, told MD Magazine that other studies previously looked at prescription records and showed that a relatively low percentage of incarcerated patients were filling prescriptions for antiretroviral therapy soon after release. This new study took a bigger, more comprehensive look at the issue.

“No study before, however, had really used ‘big data’ from both prisons and communities to examine this issue,” she said. “...This is important because people need to obtain care and refill their antiretroviral medications within this window to prevent a lapse in treatment.”

The study identified a number of factors that seemed to affect likelihood of linking with care in a timely fashion. Those incarcerated between 1 month and 1 year were more likely to get HIV care within 2 weeks, as were those receiving ART while incarcerated, those receiving transitional case management, and those with 2 or more comorbidities.

Meyer said the latter category of people are more likely to benefit from closer monitoring of their healthcare while incarcerated.

“People receiving treatment for, and thus having more severe, medical and psychiatric comorbidities while imprisoned are likely flagged for extra help linking to community services,” she said. “They also likely experience greater social stability when released since their psychiatric disorders are actually treated, and are thus more likely to engage in care.”

On the other end of the spectrum, reincarceration and conditional release seemed to decrease the likelihood that a patient was linked to care within 2 weeks of release.

The study sheds light on a significant gap in care for people living with HIV. It also falls squarely in the middle of a number of hot-button political issues: healthcare, mass incarceration, and government spending on the social safety net.

Meyer noted that, in the case of offenders with less severe crimes or substance abuse-related crimes, it would be far less expensive to use alternatives to incarceration and doing so would allow offenders to receive services in the community, which has also been shown to increase continuity of HIV care.

While state departments of corrections usually end up bearing most of the cost of medical care for incarcerated individuals, the cost of care coordination and case management is usually spread more broadly, Meyer added.

“In Connecticut, where this study took place, transitional case management programs are supported by the Department of Public Health and utilizes resources of community-based AIDS service organizations,” she said. “This promotes sustainability of the programs.”

Meyer’s study, titled, “Predictors of linkage to HIV care and viral suppression after release from jails and prisons: a retrospective cohort study,” was published Nov. 27 in The Lancet HIV.