title: Systematic Assessment of Linkage to Care for Persons with HIV Released from Corrections Facilities Using Existing Datasets.
abstract: Populations in corrections continue to have high prevalence of HIV. Expanded testing and treatment programs allow persons to be identified and stabilized on treatment while incarcerated. However, these gains and frequently lost on reentry. Systemic frameworks are needed to monitor linkage to care to guide programs supporting linkage to care. To assess the adequacy of linkage to care on reentry, incarceration data from the National Corrections Reporting Program and data from the Ryan White Services Report from 2010 to 2012 were linked using an encrypted client identification (eUCI). Time from release to the first visit and presence of detectable HIV RNA at linkage were assessed. Multivariate survival analyses were performed to identify associations between patient characteristics and time to linkage. Among those linking, only 43% in Rhode Island and 49% in North Carolina linked within 90 days, and 33% in both states had detectable viremia at the first visit. Those not previously in care and with shorter incarceration experiences longer linkage times. Persons identified as black, had median times greater than 1 year. Using existing datasets, significant gaps in linkage to care for persons with HIV on release from corrections were demonstrated in Rhode Island and North Carolina. Systemically implementing this monitoring to evaluate changes over time would provide important information to support interventions to improve linkage in high-risk populations. Using national datasets for both corrections and clinical data, this framework equally could be used to evaluate experiences of persons with HIV linking to care on release from corrections facilities nationwide.
authors.affiliation: 1 Department of Infectious Diseases, University of Colorado , Aurora, Colorado.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Montague
authors.affiliation: 2 University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
authors.forename: David L
authors.initials: DL
authors.lastname: Rosen
authors.affiliation: 3 School of Public Health, Brown University , Providence, Rhode Island.
authors.forename: Cara
authors.initials: C
authors.lastname: Sammartino
authors.affiliation: 4 Abt Associates , Cambridge, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Costa
authors.affiliation: 3 School of Public Health, Brown University , Providence, Rhode Island.
authors.forename: Roee
authors.initials: R
authors.lastname: Gutman
authors.affiliation: 4 Abt Associates , Cambridge, Massachusetts.
authors.forename: Liza
authors.initials: L
authors.lastname: Solomon
authors.affiliation: 3 School of Public Health, Brown University , Providence, Rhode Island.|5 Warren Alpert School of Medicine, Brown University , Providence, Rhode Island.
authors.forename: Josiah
authors.initials: J
authors.lastname: Rich
mesh_terms: D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003153:Community Health Services / Q000706:statistics & numerical data; D003266:Continuity of Patient Care / Q000458:organization & administration*; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006297:Health Services Accessibility; D006801:Humans; D009657:North Carolina / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D011329:Prisoners / Q000523:psychology / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012237:Rhode Island / Q000453:epidemiology; D012959:Socioeconomic Factors; D013997:Time Factors; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
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