title: A comparison of psychiatric diagnoses among HIV-infected prisoners receiving combination antiretroviral therapy and transitioning to the community.
abstract: BACKGROUND
  The criminal justice system (CJS), specifically prisons and jails, is ideally suited for uniform screening of psychiatric (PD) and substance use disorders (SUDs) among people living with HIV/AIDS (PLWHA), who are concentrated in these settings. By accurately diagnosing PDs and SUDs in these controlled settings, treatment can be initiated and contribute to improved continuity of care upon release. In the context of PLWHA, it may also improve combination antiretroviral treatment (cART) adherence, and reduce HIV transmission risk behaviors.
  
  
  METHODS
  A retrospective data analysis was conducted by creating a cohort of PLWHA transitioning to the community from prison or jail enrolled who were enrolled in a controlled trial of directly administered antiretroviral (DAART). Participants were systematically assessed for PDs and SUDs using the Mini International Neuropsychiatric Interview (MINI), a standardized psychiatric assessment tool, and compared to diagnoses documented within the correctional medical record.
  
  
  RESULTS
  Findings confirm a high prevalence of Axis I PDs (47.4%) and SUDs (67.1%) in PLWHA even after prolonged abstinence from alcohol and drugs. Although prevalence of PDs and SUDs were high in the medical record, there was fair to poor agreement among PDs using the MINI, making evident the potential benefit of more objective and concurrent PD assessments to guide treatment.
  
  
  CONCLUSIONS
  Additional PD diagnoses may be detected in PLWHA in CJS using supplementary and objective screening tools. By identifying and treating PDs and SUDs in the CJS, care may be improved and may ultimately contribute to healthier outcomes after community release if patients are effectively transitioned.
authors.affiliation: Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, Suite 323, New Haven, CT 06519, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Di Paola
authors.affiliation: Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, Suite 323, New Haven, CT 06519, USA ; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, 60 College Street, New Haven, CT 06519, USA.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
authors.affiliation: Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, Suite 323, New Haven, CT 06519, USA.
authors.forename: Mary Lindsay
authors.initials: ML
authors.lastname: Powell
authors.affiliation: University of Connecticut Health Center, Correctional Managed Health Care, 263 Farmington Avenue, Farmington, CT 06030, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Trestman
authors.affiliation: Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, Suite 323, New Haven, CT 06519, USA.
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Springer
keywords: Criminal justice system; HIV; Prisoners; Psychiatric disorders; Substance abuse