title: Incarceration and health outcomes in HIV-infected patients: the impact of substance use, primary care engagement, and antiretroviral adherence.
abstract: OBJECTIVE
  One in seven HIV-infected individuals is incarcerated each year. We used data from the Veterans Aging Cohort Study (VACS) to explore the relationship between incarceration and HIV disease outcomes and evaluate potential mediators of this relationship.
  
  
  METHODS
  HIV disease outcomes included: low CD4 counts (<200 cells/mL), detectable viral RNA loads (>500 copies/mL), and the VACS Index score. We performed a mediation analysis among 1,591 HIV-infected patients to examine whether unhealthy alcohol use, drug use, primary care engagement, or antiretroviral adherence mediated observed associations.
  
  
  RESULTS
  Among 1,591 HIV-infected patients, 47% reported having a history of incarceration. In multivariate analyses, a history of incarceration was associated with a higher VACS Index score (β 2.47, 95% CI 0.52-4.43). Mediation analysis revealed that recent drug use attenuated the association by 22% (β 1.93, 95% CI -0.06, 3.91) while other proposed mediators did not.
  
  
  CONCLUSIONS
  Improving access to drug treatment when incarcerated and upon release may be an important target to improving the health of HIV-infected individuals with a history of incarceration. (Am J Addict 2015;24:178-184).
authors: Yale University School of Medicine, New Haven, Connecticut.|Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut.
authors: Emily A
authors: EA
authors: Wang
authors: VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
authors: Kathleen A
authors: KA
authors: McGinnis
authors: Yale University School of Medicine, New Haven, Connecticut.
authors: Jessica B
authors: JB
authors: Long
authors: Yale University School of Medicine, New Haven, Connecticut.|VA Connecticut Healthcare System, West Haven, Connecticut.
authors: Kathleen M
authors: KM
authors: Akgün
authors: Yale University School of Medicine, New Haven, Connecticut.|Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut.
authors: E Jennifer
authors: EJ
authors: Edelman
authors: Atlanta VA Medical Center and Emory University School of Medicine, Atlanta, Georgia.
authors: David
authors: D
authors: Rimland
authors: Yale University School of Medicine, New Haven, Connecticut.|VA Connecticut Healthcare System, West Haven, Connecticut.
authors: Karen H
authors: KH
authors: Wang
authors: Yale University School of Medicine, New Haven, Connecticut.|Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut.|VA Connecticut Healthcare System, West Haven, Connecticut.
authors: Amy C
authors: AC
authors: Justice
authors: Yale University School of Medicine, New Haven, Connecticut.|Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut.
authors: David A
authors: DA
authors: Fiellin
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D057237:Criminals / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011329:Prisoners / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents