HIV Care among Recently Released HIV+ Jail Inmates

Robin Pollini, University of California, San Diego
Social and Behavioral Sciences
Targeted Theme: HIV-Related Disparities in Highly Impacted, Under-researched Populations
Innovative, Developmental, Exploratory Award (IDEA)

One out of every four HIV+ persons in the U.S. spends time in jail or prison each year and in California at least 1,500-2,500 HIV+ inmates are released back into the community annually. For many, the correctional system provides a stable environment in which to engage in HIV care and most incarcerated inmates do well on antiretroviral therapy (ART). After release, however, most experience a disruption in care, with >90% discontinuing use of HIV medications for at least a short period of time. Discontinuing ART can lead to disease progression and antiviral resistance, as well as higher viral loads that increase the likelihood of HIV transmission. This problem is of special concern in communities of color, which bear a disproportionate burden of incarceration, AIDS mortality and HIV infection.

This study will examine barriers and facilitators to continuing HIV care among HIV+ persons recently released from jail in San Diego County. Specifically, we will: 1) determine the proportion of HIV+ inmates who continue HIV medical care after release; 2) describe the contexts in which HIV+ former inmates either continue or discontinue care after release; and 3) characterize how barriers and facilitators to care change during the community reentry period. To fulfill these aims we will employ both quantitative and qualitative research methods. Adult HIV+ inmates who receive HIV care in jail will be informed about the study during their incarceration and invited to voluntarily enroll within 30 days after their release. At the first study visit, and at three monthly visits thereafter, we will assess continuity of care based on participants’ self reports and medical records review. We will also administer a quantitative survey to collect basic information on demographics, HIV diagnosis and treatment history, co-morbid conditions like mental health and substance abuse, and criminal justice history. The first study visit will also include an in-depth qualitative interview to collect detailed information on barriers and facilitators to HIV care encountered by the participant after their release from jail. We will conduct similar qualitative interviews at each subsequent visit to provide a detailed picture of how participants’ experiences with barriers and facilitators to HIV care change over time. Finally, we will conduct in-depth qualitative interviews with key informants including medical care providers, substance abuse treatment providers, and case managers. Data from these interviews will be used to augment our findings from the HIV+ participant interviews to develop a richly detailed understanding of the experiences and challenges faced by HIV+ persons as they transition from jail to community.

Findings from the study will be leveraged to provide preliminary data for larger studies funded by the National Institutes of Health. These future studies will inform policies to improve the health of recently released HIV+ former inmates and reduce the potential for HIV transmission. We anticipate that future grants will include a proposal to fund a California-based multi-site, multi-visit study of barriers to HIV care among former inmates, as well as subsequent proposals to test the effectiveness of new interventions designed to mitigate these barriers.