title: Gender Differences in HIV Care among Criminal Justice-Involved Persons: Baseline Data from the CARE+ Corrections Study.
abstract: BACKGROUND
  HIV-infected individuals recently released from incarceration have suboptimal linkage and engagement in community HIV care. We conducted a study to evaluate an information and communication technology intervention to increase linkage to community care among HIV-infected persons recently involved in the criminal justice (CJ) system. Baseline characteristics including risk behaviors and HIV care indicators are reported and stratified by gender.
  
  
  METHODS
  We recruited HIV-infected individuals in the District of Columbia jail and persons with a recent history of incarceration through community and street outreach. Participants completed a baseline computer-assisted personal interview regarding HIV care and antiretroviral treatment (ART) adherence, substance use, and sexual behaviors. CD4 and HIV plasma viral load testing were performed at baseline or obtained through medical records. Data were analyzed for the sample overall and stratified by gender.
  
  
  RESULTS
  Of 110 individuals, 70% were community-enrolled, mean age was 40 (SD = 10.5), 85% were Black, and 58% were male, 24% female, and 18% transgender women. Nearly half (47%) had condomless sex in the three months prior to incarceration. Although drug dependence and hazardous alcohol use were highly prevalent overall, transgender women were more likely to have participated in drug treatment than men and women (90%, 61%, and 50% respectively; p = 0.01). Prior to their most recent incarceration, 80% had an HIV provider and 91% had ever taken ART. Among those, only 51% reported ≥90% ART adherence. Fewer women (67%) had received HIV medications during their last incarceration compared to men (96%) and transgender women (95%; p = 0.001). Although neither was statistically significant, transgender women and men had higher proportions of baseline HIV viral suppression compared to women (80%, 69%, and 48.0% respectively, p>0.05); a higher proportion of women had a CD4 count ≤200 compared to men and transgender women (17%, 8% and 5% respectively; p>0.05).
  
  
  CONCLUSIONS
  In this study, HIV-infected persons with recent incarceration in Washington, DC reported important risk factors and co-morbidities, yet the majority had access to HIV care and ART prior to, during, and after incarceration. Self-reported ART adherence was sub-optimal, and while there were not statistically significant differences, CJ-involved women appeared to be at greatest risk of poor HIV outcomes.
  
  
  BACKGROUND
  Registered on ClinicalTrials.gov on 10/16/2012. Reference number: NCT01721226.
authors.affiliation: The Miriam Hospital, Providence, RI, United States of America.|Brown University Alpert School of Medicine, Providence, RI, United States of America.
authors.forename: Curt
authors.initials: C
authors.lastname: Beckwith
authors.affiliation: George Washington University Milken Institute School of Public Health, Washington, DC, United States of America.
authors.forename: Breana Uhrig
authors.initials: BU
authors.lastname: Castonguay
authors.affiliation: George Washington University Milken Institute School of Public Health, Washington, DC, United States of America.
authors.forename: Claudia
authors.initials: C
authors.lastname: Trezza
authors.affiliation: The Miriam Hospital, Providence, RI, United States of America.
authors.forename: Lauri
authors.initials: L
authors.lastname: Bazerman
authors.affiliation: George Washington University Milken Institute School of Public Health, Washington, DC, United States of America.
authors.forename: Rudy
authors.initials: R
authors.lastname: Patrick
authors.affiliation: George Washington University Milken Institute School of Public Health, Washington, DC, United States of America.
authors.forename: Alice
authors.initials: A
authors.lastname: Cates
authors.affiliation: George Washington University Milken Institute School of Public Health, Washington, DC, United States of America.
authors.forename: Halli
authors.initials: H
authors.lastname: Olsen
authors.affiliation: Yale University School of Nursing, New Haven, CT, United States of America.
authors.forename: Ann
authors.initials: A
authors.lastname: Kurth
authors.affiliation: Brown University School of Public Health, Providence, RI, United States of America.
authors.forename: Tao
authors.initials: T
authors.lastname: Liu
authors.affiliation: George Washington University Milken Institute School of Public Health, Washington, DC, United States of America.
authors.forename: James
authors.initials: J
authors.lastname: Peterson
authors.affiliation: George Washington University Milken Institute School of Public Health, Washington, DC, United States of America.
authors.forename: Irene
authors.initials: I
authors.lastname: Kuo
mesh_terms: D000328:Adult; D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D057237:Criminals; D003695:Delivery of Health Care; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015995:Prevalence; D012727:Sex Characteristics; D012737:Sex Factors; D063106:Transgender Persons; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents