title: Emergency department use by released prisoners with HIV: an observational longitudinal study.
abstract: BACKGROUND
  Many people living with HIV access healthcare systems through the emergency department (ED), and increased ED use may be indicative of disenfranchisement with primary HIV care, under-managed comorbid disease, or coincide with use of other healthcare resources. The goal of this study was to investigate ED use by HIV-infected prisoners transitioning to communities.
  
  
  METHODS
  We evaluated ED use by 151 HIV-infected released prisoners who were enrolled in a randomized controlled trial of directly administered versus self-administered antiretroviral therapy in Connecticut. Primary outcomes were quantity and type of ED visits and correlates of ED use were evaluated with multivariate models by Poisson regression.
  
  
  RESULTS
  In the 12 months post-release, there were 227 unique ED contacts made by 85/151 (56%) subjects. ED visits were primarily for acute febrile syndromes (32.6%) or pain (20.3%), followed by substance use issues (19.4%), trauma (18%), mental illness (11%), and social access issues (4.4%). Compared to those not utilizing the ED, users were more likely to be white, older, and unmarried, with less trust in their physician and poorer perceived physical health but greater social support. In multivariate models, ED use was correlated with moderate to severe depression (IRR = 1.80), being temporarily housed (IRR = 0.54), and alcohol addiction severity (IRR = 0.21) but not any surrogates of HIV severity.
  
  
  CONCLUSIONS
  EDs are frequent sources of care after prison-release with visits often reflective of social and psychiatric instability. Future interventions should attempt to fill resource gaps, engage released prisoners in continuous HIV care, and address these substantial needs.
authors.affiliation: Department of Medicine, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, United States of America. jaimie.meyer@yale.edu
authors.forename: Jaimie P
authors.initials: JP
authors.lastname: Meyer
authors.forename: Jingjun
authors.initials: J
authors.lastname: Qiu
authors.forename: Nadine E
authors.initials: NE
authors.lastname: Chen
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Larkin
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D003237:Connecticut / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D011329:Prisoners / Q000706:statistics & numerical data*