title: Enrollment in outpatient care among newly released prison inmates with HIV infection.
abstract: 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.
authors.affiliation: Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA. jbaillar@utmb.edu
authors.forename: Jacques G
authors.initials: JG
authors.lastname: Baillargeon
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Giordano
authors.forename: Amy Jo
authors.initials: AJ
authors.lastname: Harzke
authors.forename: Gwen
authors.initials: G
authors.lastname: Baillargeon
authors.forename: Josiah D
authors.initials: JD
authors.lastname: Rich
authors.forename: David P
authors.initials: DP
authors.lastname: Paar
mesh_terms: 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
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