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The Impact of Incarceration and Release from a Correctional Facility on HIV Treatment Outcomes and All-Cause Mortality Among People Living With HIV.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	The Impact of Incarceration and Release from a Correctional Facility on HIV Treatment Outcomes and All-Cause Mortality Among People Living With HIV./
作者:	Loeliger, Kelsey Burk.
出版者:	Ann Arbor : ProQuest Dissertations & Theses, : 2018,
面頁冊數:	153 p.
附註:	Source: Dissertations Abstracts International, Volume: 80-02, Section: B.
Contained By:	Dissertations Abstracts International80-02B.
標題:	Public health. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=10927833
ISBN:	9780438194038

The Impact of Incarceration and Release from a Correctional Facility on HIV Treatment Outcomes and All-Cause Mortality Among People Living With HIV.
Loeliger, Kelsey Burk.

The Impact of Incarceration and Release from a Correctional Facility on HIV Treatment Outcomes and All-Cause Mortality Among People Living With HIV. - Ann Arbor : ProQuest Dissertations & Theses, 2018 - 153 p.

Source: Dissertations Abstracts International, Volume: 80-02, Section: B.

Thesis (Ph.D.)--Yale University, 2018.

This item must not be added to any third party search indexes.

In order to achieve the UNAIDS 2020 targets for ending the global HIV pandemic by 2030, there has been an urgent need to focus on optimizing HIV care in key vulnerable populations, particularly individuals who interact with the criminal justice system. Due to the criminalization of persons with substance use disorders and the high prevalence of HIV among these same individuals, the HIV prevalence in United States prisons is estimated to be 4-5 times greater than that in the general population. Annually, one in six people living with HIV (PLH) in the United States are estimated to cycle through a correctional facility. Antiretroviral therapy (ART) improves health outcomes for PLH as well as public health outcomes through secondary prevention, and is now recommended for all PLH irrespective of CD4 count. Recent data from the Connecticut Department of Correction show high rates (70%) of viral suppression during incarceration, but low rates (30%) prior to incarceration and after release (at least among PLH who are later re-incarcerated). These findings indicate that viral suppression may be achieved during incarceration but is not sustained after release. However, the exact manner in which incarceration followed by release back into the community impacts HIV care and viral suppression in PLH remains unclear, particularly for those who are never re-incarcerated (non-recidivists). In order to better understand the complex relationship between incarceration and longitudinal HIV treatment outcomes after release, I combined multiple custody and pharmacy databases from the Connecticut Department of Correction with community-based case management, HIV monitoring, and mortality data for all PLH, available through mandatory reporting to the Connecticut Department of Public Health. This innovative, interdisciplinary collaboration produced the largest, most comprehensive, retrospective cohort study of criminal justice-involved PLH of any statewide system in the United States. This new integrated database provides access to eight years of uninterrupted, longitudinal HIV monitoring and mortality data, allowing me to conduct three independent analyses of HIV treatment outcomes and survival in PLH released from prison or jail. In Chapter 1, I assessed the timing of PLH's first viral level drawn in the community after release and their viral suppression status at that time. I found low rates of linkage to care (21.1%-34.0%) within the time frame necessary to avoid a delay in ART and overall HIV care. I then identified predictors of linkage to care, which included duration of incarceration, receipt of transitional case management, receipt of within-prison antiretroviral medications, and higher medical and psychiatric co-morbidity. Re-incarceration and conditional release (e.g., parole, transitional housing, or bond) were negatively associated with linkage to care. In Chapter 2, I followed PLH for three years after release to assess predictors of retention in HIV care and viral suppression over time. Retention in care significantly declined over 3 years of post-release follow-up. Interestingly, compared with non-recidivists, recidivists were more likely to be retained in care but less likely to have viral suppression. In multivariable models, retention in care and viral suppression were independently associated with older age, having health insurance, and receiving case management. Receipt of ART during initial incarceration, immediate linkage to care post-release, and absolute time and proportion of follow-up time spent re-incarcerated were also highly predictive of better treatment outcomes. In Chapter 3, I evaluated time-to-death from any cause after release. I identified predictors of poor survival as well as the main primary causes of death for formerly incarcerated PLH. I found a high crude mortality rate (28.4 per 1,000 person-years). Almost all PLH who died did so in the community as opposed to during a subsequent re-incarceration. Primary causes of death were HIV/AIDS, drug overdose, liver disease and/or viral hepatitis, cardiovascular disease, and accidental injury or suicide. Independent predictors of post-release survival included Black race, health insurance, at least one long (≥365 days) re-incarceration, and receiving ART during one's re-incarcerations. Predictors of shorter survival were older age, more severe HIV disease status, and higher medical co-morbidity. Overall, a history of injection drug use and frequent re-incarceration were detrimental, and case management appeared to be beneficial, but these factors interacted to impact survival in a variety of ways. My work shows that rates of linkage to and retention in HIV care, despite being essential components of the aforementioned UNAIDS targets, are suboptimal in criminal justice-involved PLH. There is also a high risk of death from HIV and other treatable diseases after release. These findings inform the development of criminal justice and community-based healthcare policies by identifying several salient strategies to improve HIV treatment outcomes and reduce mortality in criminal justice-involved PLH.

ISBN: 9780438194038Subjects--Topical Terms:

534748
Public health.

The Impact of Incarceration and Release from a Correctional Facility on HIV Treatment Outcomes and All-Cause Mortality Among People Living With HIV.
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520 $a In order to achieve the UNAIDS 2020 targets for ending the global HIV pandemic by 2030, there has been an urgent need to focus on optimizing HIV care in key vulnerable populations, particularly individuals who interact with the criminal justice system. Due to the criminalization of persons with substance use disorders and the high prevalence of HIV among these same individuals, the HIV prevalence in United States prisons is estimated to be 4-5 times greater than that in the general population. Annually, one in six people living with HIV (PLH) in the United States are estimated to cycle through a correctional facility. Antiretroviral therapy (ART) improves health outcomes for PLH as well as public health outcomes through secondary prevention, and is now recommended for all PLH irrespective of CD4 count. Recent data from the Connecticut Department of Correction show high rates (70%) of viral suppression during incarceration, but low rates (30%) prior to incarceration and after release (at least among PLH who are later re-incarcerated). These findings indicate that viral suppression may be achieved during incarceration but is not sustained after release. However, the exact manner in which incarceration followed by release back into the community impacts HIV care and viral suppression in PLH remains unclear, particularly for those who are never re-incarcerated (non-recidivists). In order to better understand the complex relationship between incarceration and longitudinal HIV treatment outcomes after release, I combined multiple custody and pharmacy databases from the Connecticut Department of Correction with community-based case management, HIV monitoring, and mortality data for all PLH, available through mandatory reporting to the Connecticut Department of Public Health. This innovative, interdisciplinary collaboration produced the largest, most comprehensive, retrospective cohort study of criminal justice-involved PLH of any statewide system in the United States. This new integrated database provides access to eight years of uninterrupted, longitudinal HIV monitoring and mortality data, allowing me to conduct three independent analyses of HIV treatment outcomes and survival in PLH released from prison or jail. In Chapter 1, I assessed the timing of PLH's first viral level drawn in the community after release and their viral suppression status at that time. I found low rates of linkage to care (21.1%-34.0%) within the time frame necessary to avoid a delay in ART and overall HIV care. I then identified predictors of linkage to care, which included duration of incarceration, receipt of transitional case management, receipt of within-prison antiretroviral medications, and higher medical and psychiatric co-morbidity. Re-incarceration and conditional release (e.g., parole, transitional housing, or bond) were negatively associated with linkage to care. In Chapter 2, I followed PLH for three years after release to assess predictors of retention in HIV care and viral suppression over time. Retention in care significantly declined over 3 years of post-release follow-up. Interestingly, compared with non-recidivists, recidivists were more likely to be retained in care but less likely to have viral suppression. In multivariable models, retention in care and viral suppression were independently associated with older age, having health insurance, and receiving case management. Receipt of ART during initial incarceration, immediate linkage to care post-release, and absolute time and proportion of follow-up time spent re-incarcerated were also highly predictive of better treatment outcomes. In Chapter 3, I evaluated time-to-death from any cause after release. I identified predictors of poor survival as well as the main primary causes of death for formerly incarcerated PLH. I found a high crude mortality rate (28.4 per 1,000 person-years). Almost all PLH who died did so in the community as opposed to during a subsequent re-incarceration. Primary causes of death were HIV/AIDS, drug overdose, liver disease and/or viral hepatitis, cardiovascular disease, and accidental injury or suicide. Independent predictors of post-release survival included Black race, health insurance, at least one long (≥365 days) re-incarceration, and receiving ART during one's re-incarcerations. Predictors of shorter survival were older age, more severe HIV disease status, and higher medical co-morbidity. Overall, a history of injection drug use and frequent re-incarceration were detrimental, and case management appeared to be beneficial, but these factors interacted to impact survival in a variety of ways. My work shows that rates of linkage to and retention in HIV care, despite being essential components of the aforementioned UNAIDS targets, are suboptimal in criminal justice-involved PLH. There is also a high risk of death from HIV and other treatable diseases after release. These findings inform the development of criminal justice and community-based healthcare policies by identifying several salient strategies to improve HIV treatment outcomes and reduce mortality in criminal justice-involved PLH.
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