The Young and the Care-less?: Youthfulness as a predictor of poor linkage to community-based HIV care among seropositive jail releases in the EnhanceLink cohort Open Access

Abstract

The US currently experiences a dual epidemic of incarceration and HIV/AIDS. Due to highly transitional jail populations and disruption in access to HIV care caused by incarceration, linking HIV-infected inmates to care both poses an important public health challenge. Youthful clients face additional challenges to accessing care. Data from the national, 10-site EnhanceLink demonstration project intending to promote linkage to HIV primary care were analyzed to explore associations between youthfulness and linkage to community-based HIV care after jail release. After excluding individuals not discharged and with missing age data, 1,072 participants were eligible for analysis. The majority of the participants were Black, male, and reported substantial mental health and drug use burdens. In univariate analysis, younger ages were highly predictive of unsuccessful linkage to both HIV medical care and case management services. Multivariate logistic regression identified factors associated with linkage to an HIV care provider or case manager 30 days post-discharge and linkage to CD4 count or viral load laboratory-based testing 6 months post discharge. Youthful age (< 30 years old) was significantly associated with not linking to an HIV care provider (aOR = 0.45, 95 % CI 0.22-0.93). Hispanic identity and prior HIV care were correlated with linkage to HIV provider care while longer length of jail stay was associated with linkage failure. Clients under 30 years old were also less likely to have linked to HIV laboratory measures testing compared to those 50 or older (aOR = 0.41, 95 % CI 0.21-0.77). Results of a sub-analysis indicate that young clients who met with a case manager were more likely to link to laboratory-based care compared to young clients with no interaction with community-based case management (aOR = 10.69, 95% CI 2.53, 45.10). The results of this non-controlled, observational study suggest that younger individuals experience poorer care linkage and may benefit from increased services or tailored assistance in order to achieve successful linkage to HIV care after jail release. The findings advocate for the development and evaluation of linkage programs that aid HIV-positive individuals, particularly those under 30, in the transition from jail to community.

Table of Contents

Background

1

Methods

6

Setting, participants, and data collection

6

Variables used in analysis

7

Statistical analysis

9

Results

11

Discussion

15

Limitations

18

Conclusions

19

References

21

Tables

28

Figures

36

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Sociology, Criminology and Penology Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	HIV EnhanceLink incarceration youthfulness jail linkage to care
Committee Chair / Thesis Advisor	Spaulding, Anne C, Emory University
Partnering Agencies	Community-based non-profit organization (e.g., AID Atlanta) State or local governmental agency (not a health department and not in Georgia) University, college or educational institution (other than Emory)

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