In and Out: Predictors of Recidivism and Locus of Care among Persons Living with HIV released from Jail Pubblico

Abstract

Background: Disproportionate levels of HIV infection among incarcerated persons make correctional facilities (CFs) a critical site for interventions to facilitate transition of care into the community. Stable community care transitions are often challenging due to substantial risk for recidivism in this population. Sustained, Unbroken Connection to Care, Entry Services and Suppression (SUCCESS), is a strengths-based case management (CM) intervention to increase linkage and retention in care upon release. We investigate factors associated with recidivism, examine changes in behavior/attitude, and describe correctional versus community locations of HIV care over 1 year following the intervention.

Methods: In this non-randomized feasibility study, we enrolled 56 intervention group participants and 52 individuals in a comparison group from Fulton County Jail in Atlanta, GA. Recidivism data on 44 intervention and 45 comparison participants were collected over 1 year using database searches from three local area jails. We examined bivariate associations with recidivism using Chi square and Fisher's exact tests, and determined a multivariable logistic regression model. Responses to baseline and 12-month surveys among 28 participants were examined for changes in self-efficacy, social support, HIV stigma, access to care, medication adherence, and housing. We also examined the proportion of participants who received care at community sites versus correctional sites using state electronic HIV/AIDS reporting system (eHARS) data.

Results: Intervention group participants were marginally less likely to return to jail within one year following release versus the comparison group (50% versus 62%, P = 0.24). Among intervention participants, risky drug use, baseline viral load < 200 copies HIV-1 RNA/mL, and younger age were associated with increased odds of recidivism (aOR 8.63, 95% CI [1.55, 48.07]; aOR 11.2, 95% CI [1.09, 114.50]; aOR 2.06, 95% CI [0.44, 9.67]). Those who completed at least four of six CM sessions reported better access to care at follow-up (P = 0.02). Intervention group members connected to community care at a higher rate versus comparators (68% vs. 58%), and 20% fewer obtained HIV care at a Georgia CF.

Conclusion: Substance use treatment and socio-structural support are needed to reduce recidivism concurrently with facilitating community care transitions among persons living with HIV.

Table of Contents

Table of Contents

Chapter I

Incarceration in the U.S.................................................2

HIV in Incarceration Populations.....................................3

Medication Adherence and Self-Efficacy...........................5

Community Re-Entry and Managing HIV..........................7

Recidivism..................................................................9

Chapter II

Abstract...................................................................19

Introduction..............................................................20

Methods...................................................................22

Results.....................................................................26

Discussion................................................................30

Conclusion................................................................33

Tables and Figures.....................................................40

Chapter III

Summary and Public Health Implications.......................45

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	Health Sciences, Public Health Health Sciences, Epidemiology
Parola chiave	HIV Recidivism Incarceration
Committee Chair / Thesis Advisor	Spaulding, Anne C, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Georgia state or local agency (not a health department) Georgia state or local health department

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