Accessing antiretroviral therapy following release from prison.
BACKGROUND
Interruption of antiretroviral therapy (ART) during the first weeks after release from prison may increase risk for adverse clinical outcomes, transmission of human immunodeficiency virus (HIV), and drug-resistant HIV reservoirs in the community. The extent to which HIV-infected inmates experience ART interruption following release from prison is unknown.


OBJECTIVE
To determine the proportion of inmates who filled an ART prescription within 60 days after release from prison and to examine predictors of this outcome.


METHODS
Retrospective cohort study of all 2115 HIV-infected inmates released from the Texas Department of Criminal Justice prison system between January 2004 and December 2007 and who were receiving ART before release.


METHODS
Proportion of inmates who filled an ART prescription within 10, 30, and 60 days of release from prison.


RESULTS
Among the entire study cohort (N = 2115), an initial prescription for ART was filled by 115 (5.4%) inmates within 10 days of release (95% confidence interval [CI], 4.5%-6.5%), by 375 (17.7%) within 30 days (95% CI, 16.2%-19.4%), and by 634 (30.0%) within 60 days (95% CI, 28.1%-32.0%). In a multivariate analysis of predictors (including sex, age, race/ethnicity, viral load, duration of ART, year of discharge, duration of incarceration, parole, and AIDS Drug Assistance Program application assistance), Hispanic and African American inmates were less likely to fill a prescription within 10 days (adjusted estimated risk ratio [RR], 0.4 [95% CI, 0.2-0.8] and 0.4 [95% CI, 0.3-0.7], respectively) and 30 days (adjusted estimated RR, 0.7 [95% CI, 0.5-0.9] and 0.7 [95% CI, 0.5-0.9]). Inmates with an undetectable viral load were more likely to fill a prescription within 10 days (adjusted estimated RR, 1.8 [95% CI, 1.2-2.7]), 30 days (1.5 [95% CI, 1.2-1.8]), and 60 days (1.3 [95% CI, 1.1-1.5]). Inmates released on parole were more likely to fill a prescription within 30 days (adjusted estimated RR, 1.3 [95% CI, 1.1-1.6]) and 60 days (1.5 [95% CI, 1.4-1.7]). Inmates who received assistance completing a Texas AIDS Drug Assistance Program application were more likely to fill a prescription within 10 days (adjusted estimated RR, 3.1 [95% CI, 2.0-4.9]), 30 days (1.8 [95% CI, 1.4-2.2]), and 60 days (1.3 [95% CI, 1.1-1.4]).


CONCLUSIONS
Only a small percentage of Texas prison inmates receiving ART while incarcerated filled an initial ART prescription within 60 days of their release.
Baillargeon
Jacques
J
Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Mail Route 1007, Galveston, TX 77555, USA. jbaillar@utmb.edu
Giordano
Thomas P
TP
Rich
Josiah D
JD
Wu
Z Helen
ZH
Wells
Katherine
K
Pollock
Brad H
BH
Paar
David P
DP
D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D015658:HIV Infections / Q000188:drug therapy*; D006285:Health Planning; D006801:Humans; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010352:Patient Dropouts; D011330:Prisons; D012189:Retrospective Studies; D013781:Texas; D019562:Viral Load; D055815:Young Adult