Antiretroviral Treatment in Correctional Facilities

Pontali, Emanuele

doi:10.1310/gtqm-qrm1-fdw8-y2ft

Cited by 31 publications

(13 citation statements)

References 36 publications

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“…Participants in this study reported many of the same institutional barriers to adherence reported in similar studies (Pontali, 2005) including delayed prescribing, medications out-of-stock, and intermittent dosing during lockdowns. Fewer than half of participants estimated their adherence to be >90 percent during their most recent incarceration.…”

Section: Discussionsupporting

confidence: 53%

“…We know less, however, about why some HIV-infected men refuse HIV testing or how prisoners cope with an HIV diagnosis in jail/prison. There is also a lack of clear evidence about the best way to provide antiretroviral therapy (ART) to inmates (Springer and Altice, 2005; Roberson et al , 2009; Pontali, 2005), and adherence to ART frequently remains suboptimal despite tightly regulated administration of ART in custodial settings (Altice et al , 2001; Wohl et al , 2003). Most importantly, despite improving standards for correctional healthcare (Rold, 2008), prisoners too often view the provision of correctional health services as unjust, degrading, and dangerous (de Viggiani, 2007; Condon et al , 2007).…”

mentioning

confidence: 99%

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Violence and the perceived risks of taking antiretroviral therapy in US jails and prisons

Culbert

2014

International Journal of Prisoner Health

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Purpose About one in five men living with HIV in the USA passes through a correctional center annually. Jails and prisons are seen therefore as key intervention sites to promote HIV treatment as prevention. Almost no research, however, has examined inmates' perspectives on HIV treatment or their strategies for retaining access to antiretroviral therapy (ART) during incarceration. The purpose of this paper is to describe the results of an exploratory study examining men's perceptions of and experiences with HIV care and ART during incarceration. Design/methodology/approach Semi-structured, in-depth interviews were conducted with 42 HIV positive male and male-to-female transgendered persons recently released from male correctional centers in Illinois, USA. Findings Interpersonal violence, a lack of safety, and perceived threats to privacy were frequently cited barriers to one's willingness and ability to access and adhere to treatment. Over 60 percent of study participants reported missed doses or sustained treatment interruption (greater than two weeks) because of failure to disclose their HIV status, delayed prescribing, intermittent dosing and out-of-stock medications, confiscation of medications, and medication strikes. Research limitations/implications Substantial improvements in ART access and adherence are likely to follow organizational changes that make incarcerated men feel safer, facilitate HIV status disclosure, and better protect the confidentiality of inmates receiving ART. Originality/value This study identified novel causes of ART non-adherence among prisoners and provides first-hand information about how violence, stigma, and the pursuit of social support influence prisoner's decisions to disclose their HIV status or accept ART during incarceration.

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Section: Discussionsupporting

confidence: 53%

mentioning

confidence: 99%

Violence and the perceived risks of taking antiretroviral therapy in US jails and prisons

Culbert

2014

International Journal of Prisoner Health

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“…Directly Observed Therapy (DOTS) for ART has previously been evaluated, with conflicting results [34]–[36]. The success of a non-DOTS or patient-retained approach [33] in this cohort suggests DOTS would yield limited, if any, benefit and may even, as seen elsewhere [37], impact acceptability and uptake of ART services.…”

Section: Discussionmentioning

confidence: 89%

Antiretroviral Outcomes in South African Prisoners: A Retrospective Cohort Analysis

Davies

Karstaedt

2012

PLoS ONE

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Background and MethodsLittle is known about antiretroviral therapy (ART) outcomes in prisoners in Africa. We conducted a retrospective review of outcomes of a large cohort of prisoners referred to a public sector, urban HIV clinic. The review included baseline characteristics, sequential CD4 cell counts and viral load results, complications and co-morbidities, mortality and loss to follow-up up to 96 weeks on ART.Findings148 inmates (133 male) initiated on ART were included in the study. By week 96 on ART, 73% of all inmates enrolled in the study and 92% of those still accessing care had an undetectable viral load (<400copies/ml). The median CD4 cell count increased from 122 cells/mm3 at baseline to 356 cells/mm3 by 96 weeks. By study end, 96 (65%) inmates had ever received tuberculosis (TB) therapy with 63 (43%) receiving therapy during the study: 28% had a history of TB prior to ART initiation, 33% were on TB therapy at ART initiation and 22% developed TB whilst on ART. Nine (6%) inmates died, 7 in the second year on ART. Loss to follow-up (LTF) was common: 14 (9%) patients were LTF whilst still incarcerated, 11 (7%) were LTF post-release and 9 (6%) whose movements could not be traced. 16 (11%) inmates had inter-correctional facility transfers and 34 (23%) were released of whom only 23 (68%) returned to the ART clinic for ongoing follow-up.ConclusionsInmates responded well to ART, despite a high frequency of TB/HIV co-infection. Attention should be directed towards ensuring eligible prisoners access ART programs promptly and that inter-facility transfers and release procedures facilitate continuity of care. Institutional TB control measures should remain a priority.

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“…Over 2 million individuals are incarcerated and a quarter of HIV-infected individuals are believed to pass through correctional facilities annually [2]. Due to the high proportion of HIV-infected individuals passing through correctional facilities, jails and prisons serve as entry points and are often the most consistent site of HIV care for marginalized populations [3]. However, HIV care in jails, which are usually local, county run facilities for persons charged, but not convicted or serving short sentences, is often minimal because stays are assumed to be short and a single person may be in and out of jail many times in a single year.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Antiretroviral Therapy in a Cohort of HIV Infected Patients Going in and out of the San Francisco County Jail

et al. 2009

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BackgroundJails are an important venue of HIV care and a place for identification, treatment and referral for care. HIV infected inmates in the San Francisco County jail are offered antiretroviral treatment (ART), which many take only while in jail. We evaluated the effect of ART administration in a cohort of jail inmates going in and out of jail over a nine year period.Methodology/Principal FindingsIn this retrospective study, we examined inmates with HIV going in and out of jail. Inmates were categorized by patterns of ART use: continuous ART - ART both in and out of jail, intermittent ART - ART only in jail; never on ART - eligible by national guidelines, but refused ART. CD4 and HIV viral load (VL) were compared over time in these groups. Over a 9 year period, 512 inmates were studied: 388 (76%) on intermittent ART, 79 (15%) on continuous ART and 45(9%) never-on ART. In a linear mixed model analysis, inmates on intermittent ART were 1.43; 95%CI (1.03, 1.99) times and those never on ART were 2.89; 95%CI (1.71, 4.87) times more likely to have higher VL than inmates on continuous ART. Furthermore, Inmates on intermittent ART and never-on ART lost 1.60; 95%CI (1.06, 2.13) and 1.97; 95%CI (0.96, 3.00) more CD4 cells per month, respectively, compared to continuously treated inmates. The continuous ART inmates gained 0.67CD4 cells/month.Conclusions/SignificanceContinuous ART therapy in jail inmate's benefits CD4 cell counts and control of VL especially compared to those who never took ART. Although jail inmates on intermittent ART were more likely to lose CD4 cells and experience higher VL over time than those on continuous ART, CD4 cell loss was slower in these inmates as compared to inmates never on ART. Further studies are needed to evaluate whether or not intermittent ART provides some benefit in outcome if continuous ART is not possible or likely.

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Antiretroviral Treatment in Correctional Facilities

Cited by 31 publications

References 36 publications

Violence and the perceived risks of taking antiretroviral therapy in US jails and prisons

Violence and the perceived risks of taking antiretroviral therapy in US jails and prisons

Antiretroviral Outcomes in South African Prisoners: A Retrospective Cohort Analysis

The Impact of Antiretroviral Therapy in a Cohort of HIV Infected Patients Going in and out of the San Francisco County Jail

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