Enrollment in outpatient care among newly released prison inmates with HIV infection.
OBJECTIVE
Although many prisoners infected with human immunodeficiency virus (HIV) initiate and adhere to treatment regimens while incarcerated, the benefits of in-prison therapy are frequently lost after community reentry. Little information is available on the percentage of released inmates who establish community-based HIV outpatient treatment in a timely fashion. We sought to determine the proportion of HIV-infected Texas prison inmates who enrolled in an HIV clinic within 90 days after release and to identify variables associated with timely linkage to clinical care.


METHODS
This was a retrospective cohort study of 1,750 HIV-infected inmates who were released from the Texas Department of Criminal Justice (TDCJ) and returned to Harris County between January 2004 and December 2007. We obtained demographic and clinical data from centralized databases maintained by TDCJ and the Harris County Health District, and used logistic regression analysis to identify factors associated with linkage to post-release outpatient


RESULTS
Only 20% of released inmates enrolled in an HIV clinic within 30 days of release, and only 28% did so within 90 days. Released inmates > or = 30 years of age were more likely than their younger counterparts to have enrolled in care at the 30- and 90-day time points. Inmates diagnosed with schizophrenia were more likely to have initiated care within 30 days. Inmates who received antiretroviral therapy while incarcerated and those who received enhanced discharge planning were more likely to begin care at both time points.


CONCLUSIONS
A large proportion of HIV-infected inmates fail to establish outpatient care after their release from the Texas prison system. Implementation of intensive discharge planning programs may be necessary to ensure continuity of HIV care among newly released inmates.
Baillargeon
Jacques G
JG
Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA. jbaillar@utmb.edu
Giordano
Thomas P
TP
Harzke
Amy Jo
AJ
Baillargeon
Gwen
G
Rich
Josiah D
JD
Paar
David P
DP
D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011329:Prisoners; D012189:Retrospective Studies; D013781:Texas; D055815:Young Adult
Clin Infect Dis. 2004 Jun 15;38(12):1754-60
15227623
Health Psychol. 2007 Jan;26(1):40-9
17209696
Am J Med. 1993 Dec;95(6):629-35
8259780
AIDS Care. 2005 Aug;17(6):773-83
16036264
J Urban Health. 2001 Jun;78(2):290-303
11419582
J Urban Health. 2001 Jun;78(2):279-89
11419581
South Med J. 2006 May;99(5):472-81
16711309
J Acquir Immune Defic Syndr. 2001 Sep 1;28(1):47-58
11579277
Clin Infect Dis. 2004 Jun 15;38(12):1761-3
15227624
J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Aug 1;18(4):341-8
9704939
N Engl J Med. 2006 Nov 30;355(22):2283-96
17135583
Antivir Ther. 2004 Oct;9(5):713-9
15535408
Am J Public Health. 1998 Aug;88(8):1249-50
9702163
AIDS Care. 2006 May;18(4):290-301
16809106
Clin Infect Dis. 2007 Jun 1;44(11):1493-9
17479948
AIDS. 2005 Mar 4;19(4):423-31
15750396
Public Health Rep. 2005 Jan-Feb;120(1):84-8
15736336
JAMA. 2009 Feb 25;301(8):848-57
19244192