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.

Missed Initial Medical Visits: Predictors, Timing, and Implications for Retention in HIV Care

“…The finding that younger patients take longer to engage in care is consistent with national data, although some studies report that younger individuals have similar timing of linkage to HIV care, but poorer retention in HIV care than their older counterparts. [32][33][34][35] Additional factors associated with delayed linkage to care have been described in other quantitative and qualitative studies, including recent release from incarceration, 36 required HIV testing, 37 latino ethnicity, 38 lack of trust in physicians, 39 fear, psychological distress, and lack of information. 40 Recent domestic and international studies have evaluated rapid linkage to care, including same-day initiation of ART after HIV has been diagnosed, which has been shown to improve ART uptake, result in a more rapid decline in HIV viral load, and increase virologic suppression rates.…”

“…Missing the initial scheduled medical visit was not associated with the care status of the patient (new diagnosis vs. returning to care), mental health diagnoses, or substance use. to complete the initial medical visit Fifty percent of the patients had their first medical visit at 36 days after the CM intake [95% CI[32][33][34][35][36][37][38][39][40][41]. After adjusting for age, gender, race/ethnicity, employment status, and CM visit attendance, a shorter time to completing a medical visit was significantly associated with Dallas study site (HR =…”

“I don’t have to do this all by myself”: Systems Navigation to Ensure Continuity of HIV Care for Persons Leaving Prison

“…Our study adds further nuance to this literature by exploring why, from a client perspective, support services are so valuable for PLWH leaving prison, and illustrating how different types of systems navigations can be perceived as useful for a set of relatively well engaged clients. Most participants met the navigators after they already knew about HIV medical care and, in many cases, had previously received such care outside of prison, which another study found to be associated with shorter linkage times to care in the community compared to individuals who had not previously received care in Ryan White settings [17]. Participants were also coming to the navigator at a time that they were seeking to start anew.…”

Use of viral load surveillance data to assess linkage to care for persons with HIV released from corrections

“…[ 25 ] This method performed comparably to probabilistic matching in validation studies and has been previously used to assess linkage to care using the corrections release data and client level data reporting from Ryan White funded care providers in Rhode Island and North Carolina. [ 14 , 15 ]…”

“…[ 13 ] We developed such a framework based on the linkage of corrections release data from the National Corrections Reporting Program and clinical service data from Ryan White funded care providers in the form of the Ryan White client level data reporting. [ 14 , 15 ] While in many jurisdictions, Ryan White funded service providers are key safety net providers serving people in the post-release period, Medicaid expansion and efforts to enroll patients in Medicaid prerelease may lead to a larger portion of services being provided by non-Ryan White funded care providers. [ 16 – 20 ] The Ryan White reporting files in these jurisdictions may come to include a smaller portion of the services provided to persons with HIV on reentry.…”