title: Post-release substance abuse outcomes among HIV-infected jail detainees: results from a multisite study.
abstract: HIV-infected individuals with substance use disorders have a high prevalence of medical and psychiatric morbidities that complicate treatment. Incarceration further disrupts healthcare access and utilization. Without appropriate diagnosis and treatment, drug relapse upon release exceeds 85 %, which contributes to poor health outcomes. A prospective cohort of 1,032 HIV-infected jail detainees were surveyed in a ten-site demonstration project during incarceration and six-months post-release, in order to examine the effect of predisposing factors, enabling resources and need factors on their subsequent drug use. Homelessness, pre-incarceration cocaine and opioid use, and high drug and alcohol severity were significantly associated with cocaine and opioid relapse. Substance abuse treatment, though poorly defined, did not influence post-release cocaine and opioid use. An approach that integrates multiple services, simultaneously using evidence-based substance abuse, psychiatric care, and social services is needed to improve healthcare outcomes for HIV-infected persons transitioning from jails to the community.
authors.affiliation: Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, 135 College St., Suite 323, New Haven, CT, 06510-2283, USA, archana.krishnan@yale.edu.
authors.forename: Archana
authors.initials: A
authors.lastname: Krishnan
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Wickersham
authors.forename: Ehsan
authors.initials: E
authors.lastname: Chitsaz
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Springer
authors.forename: Alison O
authors.initials: AO
authors.lastname: Jordan
authors.forename: Nick
authors.initials: N
authors.lastname: Zaller
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D000328:Adult; D016739:Behavior, Addictive / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006703:Ill-Housed Persons; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D015995:Prevalence; D011330:Prisons; D011446:Prospective Studies; D012720:Severity of Illness Index; D012947:Social Work; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology* / Q000534:rehabilitation; D016896:Treatment Outcome; D055815:Young Adult