Correlates of retention in HIV care after release from jail: results from a multi-site study

Abstract

Retention in care is key to effective HIV treatment, but half of PLWHA in the US are continuously engaged in care. Incarcerated individuals are an especially challenging population to retain, and empiric data specific to jail detainees is lacking. We prospectively evaluated correlates of retention in care for 867 HIV-infected jail detainees enrolled in a 10-site demonstration project. Sustained retention in care was defined as having a clinic visit during each quarter in the 6 month post-release period. The following were independently associated with retention: being male (AOR = 2.10, p ≤ 0.01), heroin use (AOR 1.49, p = 0.04), having an HIV provider (AOR 1.67, p = 0.02), and receipt of services: discharge planning (AOR 1.50, p = 0.02) and disease management session (AOR 2.25, p ≤ 0.01) during incarceration; needs assessment (AOR 1.59, p = 0.02), HIV education (AOR 2.03, p ≤ 0.01), and transportation assistance (AOR 1.54, p = 0.02) after release. Provision of education and case management services improve retention in HIV care after release from jail.

Figure 1

Subject Disposition

Figure 2

Behavioral Model Adapted from Chen et al. (6) and Gelberg et al. (16)

Figure 3. Proportion of all subjects retained in care (N=867)

Legend: Retention in care is defined as having an HIV provider visit during a specified time period following release from jail: Early = clinic visit in first quarter only; Late = clinic visit in second quarter only; Sustained = clinic visits in both first and second quarters.

Figure 4. Proportion of newly diagnosed subjects linked to care (N= 36)

Legend: Linkage or retention in care is defined as having an HIV provider visit during a specified time period following release from jail. Early Linkage = clinic visit in first quarter only; Late Linkage = clinic visit in second quarter only; Retention = clinic visits in both first and second quarters.