title: Influence of Jail Incarceration and Homelessness Patterns on Engagement in HIV Care and HIV Viral Suppression among New York City Adults Living with HIV/AIDS.
abstract: OBJECTIVE
  Both homelessness and incarceration are associated with housing instability, which in turn can disrupt continuity of HIV medical care. Yet, their impacts have not been systematically assessed among people living with HIV/AIDS (PLWHA).
  
  
  METHODS
  We studied a retrospective cohort of 1,698 New York City PLWHA with both jail incarceration and homelessness during 2001-05 to evaluate whether frequent transitions between jail incarceration and homelessness were associated with a lower likelihood of continuity of HIV care during a subsequent one-year follow-up period. Using matched jail, single-adult homeless shelter, and HIV registry data, we performed sequence analysis to identify trajectories of these events and assessed their influence on engagement in HIV care and HIV viral suppression via marginal structural modeling.
  
  
  RESULTS
  Sequence analysis identified four trajectories; 72% of the cohort had sporadic experiences of both brief incarceration and homelessness, whereas others experienced more consistent incarceration or homelessness during early or late months. Trajectories were not associated with differential engagement in HIV care during follow-up. However, compared with PLWHA experiencing early bouts of homelessness and later minimal incarceration/homelessness events, we observed a lower prevalence of viral suppression among PLWHA with two other trajectories: those with sporadic, brief occurrences of incarceration/homelessness (0.67, 95% CI = 0.50,0.90) and those with extensive incarceration experiences (0.62, 95% CI = 0.43,0.88).
  
  
  CONCLUSIONS
  Housing instability due to frequent jail incarceration and homelessness or extensive incarceration may exert negative influences on viral suppression. Policies and services that support housing stability should be strengthened among incarcerated and sheltered PLWHA to reduce risk of adverse health conditions.
authors.affiliation: Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, Queens, New York, United States of America.
authors.forename: Sungwoo
authors.initials: S
authors.lastname: Lim
authors.affiliation: CUNY School of Public Health, City University of New York, New York, New York, United States of America.
authors.forename: Denis
authors.initials: D
authors.lastname: Nash
authors.affiliation: Monitoring and Evaluation, Corporate Contributions, Johnson & Johnson, New Brunswick, New Jersey, United States of America.
authors.forename: Laura
authors.initials: L
authors.lastname: Hollod
authors.affiliation: ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America.|Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, Queens, New York, United States of America.
authors.forename: Tiffany G
authors.initials: TG
authors.lastname: Harris
authors.affiliation: CUNY School of Public Health, City University of New York, New York, New York, United States of America.|The PhD program in Sociology, Graduate Center, City University of New York, New York, New York, United States of America.
authors.forename: Mary Clare
authors.initials: MC
authors.lastname: Lennon
authors.affiliation: CUNY School of Public Health, City University of New York, New York, New York, United States of America.
authors.forename: Lorna E
authors.initials: LE
authors.lastname: Thorpe
mesh_terms: D000328:Adult; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology*; D015497:HIV-1 / Q000502:physiology*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D011320:Primary Health Care; D011329:Prisoners / Q000706:statistics & numerical data*; D011330:Prisons / Q000706:statistics & numerical data*