title: HIV outcomes at a Canadian remand centre.
abstract: Purpose The purpose of this paper is to assess the impact of short-term incarceration on antiretroviral therapy (ART) adherence, virologic suppression, and engagement and retention in community care post-release. Design/methodology/approach A retrospective chart review of patients who attended the human immunodeficiency virus (HIV) Outreach Clinic at a Canadian remand center between September 2007 and December 2011 was carried out. Data extraction included CD4 lymphocyte count, HIV viral load, ART prescription refills, and community engagement and retention during and one-year pre- and post-incarceration. Findings Outpatient engagement increased by 23 percent ( p=0.01), as did ART adherence (55.2-70.7 percent, p=0.01), following incarceration. Retention into community care did not significantly improve following incarceration (22.4 percent pre-incarceration to 25.9 percent post-release, p=0.8). There was a trend toward improved virologic suppression (less than 40 copies/ml; 50-77.8 percent ( p=0.08)) during incarceration and 70. 4 percent sustained this one-year post-incarceration ( p=0.70). Originality/value The impact of short-term incarceration in a Canadian context of universal health coverage has not been previously reported and could have significant implications in optimizing HIV patient outcomes given the large number of HIV-positive patients cycling through short-term remand centers.
authors.affiliation: Department of Family Medicine, University of Alberta , Edmonton, Canada .
authors.forename: Yazhini
authors.initials: Y
authors.lastname: Subramanian
authors.affiliation: Communicable Disease Control, Alberta Health Services, Edmonton, Canada .
authors.forename: Muhammad Naeem
authors.initials: MN
authors.lastname: Khan
authors.affiliation: HIV Northern Alberta Program, Alberta Health Services, Edmonton, Canada .
authors.forename: Sara
authors.initials: S
authors.lastname: Berger
authors.affiliation: HIV Northern Alberta Program, Alberta Health Services, Edmonton, Canada .
authors.forename: Michelle
authors.initials: M
authors.lastname: Foisy
authors.affiliation: Department of Medicine, Infectious Diseases, University of Alberta , Edmonton, Canada .
authors.forename: Ameeta
authors.initials: A
authors.lastname: Singh
authors.affiliation: Corrections Health, Alberta Health Services, Edmonton, Canada .
authors.forename: Dan
authors.initials: D
authors.lastname: Woods
authors.affiliation: Corrections Health, Alberta Health Services, Edmonton, Canada .
authors.forename: Diane
authors.initials: D
authors.lastname: Pyne
authors.affiliation: Department of Medicine, Infectious Diseases, University of Alberta , Edmonton, Canada .
authors.forename: Rabia
authors.initials: R
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D000359:Aftercare / Q000706:statistics & numerical data; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D002170:Canada / Q000453:epidemiology; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data; D011330:Prisons / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D019562:Viral Load / Q000187:drug effects / Q000706:statistics & numerical data; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral; Correctional health care; Engagement; HIV; Incarceration; Medication adherence