title: Predictors of reincarceration and disease progression among released HIV-infected inmates.
abstract: We conducted a retrospective cohort study to determine the 3-year reincarceration rate of all HIV-infected inmates (n = 1917) released from the Texas prison system between January 2004 and March 2006. We also analyzed postrelease changes in HIV clinical status in the subgroup of inmates who were subsequently reincarcerated and had either CD4 lymphocyte counts (n = 119) or plasma HIV RNA levels (n = 122) recorded in their electronic medical record at both release and reincarceration. Multivariable analyses were performed to assess predictors of reincarceration and clinical changes in HIV status. Only 20% of all HIV-infected inmates were reincarcerated within 3 years of release. Female inmates (hazard ratio [HR] 0.63; 95% confidence interval [CI], 0.47, 0.84) and inmates taking antiretroviral therapy at the time of release (HR 0.31; 95% CI, 0.25, 0.39) were at decreased risk of reincarceration. African Americans (HR 1.58; 95% CI, 1.22, 2.05), inmates with a major psychiatric disorder (HR 1.82; 95% CI, 1.41, 2.34), and inmates released on parole (HR 2.86; 95% CI, 2.31, 3.55) were at increased risk of reincarceration. A subgroup of reincarcerated inmates had a mean decrease in CD4 cell count of 79.4 lymphocytes per microliter (p < 0.0003) and a mean increase in viral load of 1.5 log(10) copies per milliliter (p < 0.0001) in the period between release and reincarceration. Our findings, although substantially limited by selection bias, highlight the importance of developing discharge planning programs to improve linkage to community-based HIV care and reduce recidivism among released HIV-infected inmates.
authors.affiliation: Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas 77555, USA. jbaillar@utmb.edu
authors.forename: Jacques
authors.initials: J
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: Anne C
authors.initials: AC
authors.lastname: Spaulding
authors.forename: Z Helen
authors.initials: ZH
authors.lastname: Wu
authors.forename: James J
authors.initials: JJ
authors.lastname: Grady
authors.forename: Gwen
authors.initials: G
authors.lastname: Baillargeon
authors.forename: David P
authors.initials: DP
authors.lastname: Paar
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D057286:Electronic Health Records; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000503:physiopathology* / Q000821:virology; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011329:Prisoners; D011330:Prisons / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013781:Texas; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents