Limited spending: an analysis of correctional expenditures on antiretrovirals for HIV-infected prisoners.
OBJECTIVE
Correctional facilities provide a critical opportunity to treat and manage human immunodeficiency virus (HIV) and HIV-related complications among inmates. Inmates bear a higher HIV burden than the general population, and many have never received HIV care prior to incarceration. The standard of care in the community and in corrections for the treatment of HIV is highly active antiretroviral therapy (HAART). This study evaluated U.S. correctional expenditures for antiretrovirals (ARVs) and compared them to the estimated need for ARVs among HIV-infected prisoners in the U.S. to treat this population successfully.


METHODS
The total number of HIV-infected prisoners in the United States was estimated using Bureau of Justice Statistics data. The National Sales Perspectives Audit, Combined Retail and Nonretail, July 1999 to December 2004 was used to estimate correctional ARV expenditures in 2004. Both measures were used to calculate treatment costs for ARV therapy.


RESULTS
The analysis demonstrates that, in 2004, total ARV sales represented only 29% of the total necessary to treat all HAART eligible inmates with known HIV infection.


CONCLUSIONS
There is a substantial unmet need for ARVs in correctional health care. Although many barriers exist to treating all eligible HIV-infected prisoners, treatment reduces costs associated with HIV-related complications and may encourage linkage to HIV care in the community. Treatment of all eligible HIV-infected inmates should be a public health priority.
Zaller
Nick
N
Department of Medicine, Division of Infectious Diseases, Miriam Hospital/Brown Medical School, Brown University, Center for Prisoner Health and Human Rights, Providence, RI 02906, USA. nzaller@lifespan.org
Thurmond
Portia
P
Rich
Josiah D
JD
D019380:Anti-HIV Agents / Q000191:economics*; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics; D015658:HIV Infections / Q000188:drug therapy*; D005102:Health Expenditures; D006296:Health Services / Q000191:economics*; D006801:Humans; D011329:Prisoners; D011330:Prisons / Q000191:economics* / Q000458:organization & administration
D019380:Anti-HIV Agents