A new monitoring approach developed by researchers from The Miriam Hospital could close a major gap by providing the ability to track whether HIV-positive prisoners are getting the community-based HIV care they need once they are released.
Reporting in the journal Virulence, researchers say this new tool could play a major role in preventing the spread of the disease and could guide future strategies to improve the quality of care for prisoners, a population disproportionately affected by HIV.
"Jails and prisons are an opportunity to diagnose and treat inmates with HIV, but when they are released, their care is suddenly interrupted, and many former prisoners may have limited or no access to treatment for many months, or they may stop taking their HIV medications altogether," says lead study author Brian Montague, D.O., of The Miriam Hospital. "This is a huge public health problem, because during this treatment gap, ex-offenders are not only putting their own health in jeopardy, but they are also more likely to infect others."
Although there is a strong national push for continuity of care for HIV-positive inmates transitioning to their communities, Montague says there is no systematic framework to evaluate how successfully these individuals are being connected to and actually receiving care once they are released.
"We need to understand the various factors that influence access to post-release HIV care as well as the quality of care being provided if we want to move the needle on the HIV epidemic," he says. "The method we've developed can be done systematically with existing data and, when validated, could guide future strategies to improve the quality of care for this vulnerable population."
Currently, an estimated 1.1 million people in the United States are infected with HIV. HIV/AIDS rates in jails or prisons are three times greater than that of the general population: each year, an estimated one in seven individuals infected with HIV passes through a correctional facility, suggesting that there is a disproportionate number of HIV-positive individuals in the criminal justice system. For many individuals, incarceration is the only time they will access HIV testing, education, counseling and treatment services.
During the transition back to the community, recently released prisoners face a number of challenges, including finding employment, securing housing and, in many cases, coping with substance use and mental health problems. All of these obstacles represent a possible barrier to HIV care.
In their report, Montague and colleagues from the University of North Caroline at Chapel Hill, Abt Associates, Inc. and the University of Texas Medical Branch studied clinical data from the Ryan White HIV/AIDS Program to track if HIV-positive ex-offenders are receiving community follow-up care. Ryan White is the only federal program designed to support services for people with HIV/AIDS and is a major source of care for inmates who have been recently released. Starting in 2009, all Ryan White funded HIV/AIDS care programs were required to submit encrypted, client-level data to the federal government to provide a clear picture of all individuals receiving care who receive care from Ryan White providers throughout the nation.