Post-Release Substance Abuse Outcomes Among HIV-Infected Jail Detainees: Results from a Multisite Study

Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, 135 College St., Suite 323, New Haven, CT, 06510-2283, USA, .
AIDS and Behavior (Impact Factor: 3.49). 11/2012; 17(S2). DOI: 10.1007/s10461-012-0362-3
Source: PubMed


HIV-infected individuals with substance use disorders have a high prevalence of medical and psychiatric morbidities that complicate treatment. Incarceration further disrupts healthcare access and utilization. Without appropriate diagnosis and treatment, drug relapse upon release exceeds 85 %, which contributes to poor health outcomes. A prospective cohort of 1,032 HIV-infected jail detainees were surveyed in a ten-site demonstration project during incarceration and six-months post-release, in order to examine the effect of predisposing factors, enabling resources and need factors on their subsequent drug use. Homelessness, pre-incarceration cocaine and opioid use, and high drug and alcohol severity were significantly associated with cocaine and opioid relapse. Substance abuse treatment, though poorly defined, did not influence post-release cocaine and opioid use. An approach that integrates multiple services, simultaneously using evidence-based substance abuse, psychiatric care, and social services is needed to improve healthcare outcomes for HIV-infected persons transitioning from jails to the community.

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Available from: Frederick Altice, Jan 09, 2014
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    • "Despite effective treatment response during incarceration (Meyer, Cepeda, Springer, et al., 2014), the transitional period after release from incarceration is especially problematic for PLWH. Documented lapses in ART (Baillargeon et al., 2009), the inability to maintain viral suppression (Meyer, Cepeda, Wu, et al., 2014; Springer et al., 2004) and relapse to drug and/or alcohol use have been described (Krishnan et al., 2013; Springer, Spaulding, Meyer, & Altice, 2011). The intertwining epidemics of incarceration, the explosion of HIV among MSM, including Black and younger MSM, as well as persistent healthcare access disparities and retention in care challenges among HIV-infected Black MSM indicate a need for targeted interventions that consider these factors. "
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    ABSTRACT: The US HIV/AIDS epidemic is concentrated among men who have sex with men (MSM). Black men are disproportionately affected by incarceration and Black MSM experience higher infection rates and worse HIV-related health outcomes compared to non-Black MSM. We compared HIV treatment outcomes for Black MSM to other HIV-infected men from one of the largest cohorts of HIV-infected jail detainees (N = 1270) transitioning to the community. Of the 574 HIV-infected men released, 113 (19.7%) self-identified as being MSM. Compared to other male subgroups, young Black MSM (<30 years old, N = 18) were significantly less likely: (1) before incarceration, to have insurance, access to an HIV healthcare provider, and use cocaine; (2) during incarceration, to receive a disease management intervention; and (3) in the 6 months post-release, to link to HIV care. Interventions that effectively link and retain young HIV-infected Black MSM in care in communities before incarceration and post-release from jail are urgently needed.
    Full-text · Article · Aug 2015 · AIDS Care
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    • "Additionally, in the presence of active substance use, inadequate diagnosis and treatment of PDs in community settings unwittingly contribute to the overburdened CJS (Draine et al. 2002), which struggles with insufficient resources, yet these structured settings makes them suitable for standardized screening and treatment algorithms (Finkelstein et al. 2005; Maruschak and Beavers 2009; Kamath et al. 2013). Consequences of undiagnosed and under-treated PDs among PLWHA can result in poor treatment outcomes for those transitioning to the community where the highly structured prison setting is discontinued, resulting in poor access and adherence to combination antiretroviral therapy (cART) (Springer et al. 2012; Meyer et al. 2011), suboptimal viral suppression (Uldall et al. 2004; Springer et al. 2004; Meyer et al. 2011; Meyer et al. 2014) and increased HIV risk-taking behaviors (Goforth and Fernandez 2011; Buckingham et al. 2013), repeated incarcerations (Baillargeon et al. 2009; Baillargeon et al. 2010a; Baillargeon et al. 2010b), relapse to drug and alcohol use (Krishnan et al. 2013), decreased retention in HIV care (Althoff et al. 2013), a high frequency of emergency department visits (Meyer et al. 2012, 2013), and a higher risk of death (DeLorenze et al. 2010). Thus, correctly identifying and treating PDs among HIV-infected prisoners prior to release is crucial for effective transitional care of PLWHA who re-enter the community (Springer et al. 2011). "
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    ABSTRACT: The criminal justice system (CJS), specifically prisons and jails, is ideally suited for uniform screening of psychiatric (PD) and substance use disorders (SUDs) among people living with HIV/AIDS (PLWHA), who are concentrated in these settings. By accurately diagnosing PDs and SUDs in these controlled settings, treatment can be initiated and contribute to improved continuity of care upon release. In the context of PLWHA, it may also improve combination antiretroviral treatment (cART) adherence, and reduce HIV transmission risk behaviors. A retrospective data analysis was conducted by creating a cohort of PLWHA transitioning to the community from prison or jail enrolled who were enrolled in a controlled trial of directly administered antiretroviral (DAART). Participants were systematically assessed for PDs and SUDs using the Mini International Neuropsychiatric Interview (MINI), a standardized psychiatric assessment tool, and compared to diagnoses documented within the correctional medical record. Findings confirm a high prevalence of Axis I PDs (47.4%) and SUDs (67.1%) in PLWHA even after prolonged abstinence from alcohol and drugs. Although prevalence of PDs and SUDs were high in the medical record, there was fair to poor agreement among PDs using the MINI, making evident the potential benefit of more objective and concurrent PD assessments to guide treatment. Additional PD diagnoses may be detected in PLWHA in CJS using supplementary and objective screening tools. By identifying and treating PDs and SUDs in the CJS, care may be improved and may ultimately contribute to healthier outcomes after community release if patients are effectively transitioned.
    Full-text · Article · Oct 2014
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    • "b For categorical variables, chi-squared was used. An independent samples t-test was used for continuous level variables (Draine et al., 2011; Chen et al., 2011; Chitsaz et al., 2013; Krishnan et al., 2012). Women in this sample were significantly more likely than men to report being homo/bisexual (30.4 vs 5.1 percent) or having diagnosed bipolar disorder (26.1 vs 6.8 percent) but were similar to men in terms of all other demographic, HIV health outcomes, mental disorders, and substance use indicators (data not shown). "
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    ABSTRACT: Little is known about the association of intimate partner violence (IPV) with specific HIV treatment outcomes, especially among criminal justice (CJ) populations who are disproportionately affected by IPV, HIV, mental and substance use disorders (SUDs) and are at high risk of poor post-release continuity of care. Mixed methods were used to describe the prevalence, severity, and correlates of lifetime IPV exposure among HIV-infected jail detainees enrolled in a novel jail-release demonstration project in Connecticut. Additionally, the effect of IPV on HIV treatment outcomes and longitudinal healthcare utilization was examined. Structured baseline surveys defined 49% of 84 participants as having significant IPV-exposure, which was associated with female gender, longer duration since HIV diagnosis, suicidal ideation, having higher alcohol use severity, having experienced other forms of childhood and adulthood abuse, and homo/bisexual orientation. IPV was not directly correlated with HIV healthcare utilization or treatment outcomes. In-depth qualitative interviews with 20 surveyed participants, however, confirmed that IPV was associated with disengagement from HIV care especially in the context of overlapping vulnerabilities, including transitioning from CJ to community settings, having untreated mental disorders, and actively using drugs or alcohol at the time of incarceration. Post-release interventions for HIV-infected CJ populations should minimally integrate HIV secondary prevention with violence reduction and treatment for SUDs.
    Full-text · Article · Sep 2013 · International Journal of Prisoner Health
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