The HIV Care Cascade Before, During, and After Incarceration: A Systematic Review and Data Synthesis

Abstract

We conducted a systematic literature review of the data on HIV testing, engagement in care, and treatment in incarcerated persons, and estimated the care cascade in this group. We identified 2706 titles in MEDLINE, EBSCO, and Cochrane Library databases for studies indexed to January 13, 2015, and included 92 for analysis. We summarized HIV testing results by type (blinded, opt-out, voluntary); reviewed studies on HIV care engagement, treatment, and virological suppression; and synthesized these results into an HIV care cascade before, during, and after incarceration. The HIV care cascade following diagnosis increased during incarceration and declined substantially after release, often to levels lower than before incarceration. Incarceration provides an opportunity to address HIV care in hard-to-reach individuals, though new interventions are needed to improve postrelease care continuity.

FIGURE 1—

Flow diagram of study selection in a systematic review and data synthesis indexed up to January 13, 2015, of the HIV care cascade before, during, and after incarceration: United States and Canada.

FIGURE 2—

HIV care cascade—before, during, and after release from incarceration: systematic review and data synthesis indexed up to January 13, 2015, United States and Canada. Note. ART = antiretroviral therapy; VL = viral load. ^aReferences 4, 14, 69–71, and 76. ^bReferences 4, 67, 75, 77–79, 82, 83, 86, 89, and 90. ^cReferences 4 and 77. ^dReferences 4, 65, 67, 72, 75, 77, 78, 80–86, 88, 90–96, and 98. ^eReferences 4, 17, 28–30, 38, 40, 67, 72, 75, 77, 78, 80, 83, 87, 90, 99, and 100.