Predictors of Emergency Department Use Among Jail Releasees Living With HIV/AIDS Public

Abstract

The socioeconomic and public health relevance of HIV/AIDS remains a global health issue in the 21^st century. People incarcerated constitute a significant proportion of individuals living with HIV/AIDS. Incarceration disrupts optimal access to and utilization of health care services. This observational study aims to evaluate the predictors of emergency department use among jail releases living with HIV/AIDS. To understand this relationship, a prospective cohort of 1,078 individuals living with HIV was evaluated in a ten-site demonstration using data from the EnhanceLink project. The study cohort was tracked from time of incarceration to six months post-incarceration. The effect of potential predictors of emergency department use among this population was analyzed. Linkage to care upon release, age at index incarceration, homelessness, pre-incarceration use of the emergency department, lack of medical insurance and mental instability were significantly associated with emergency department use. A holistic perspective involving primary health care provision, mental and socioeconomic rehabilitation is needed to ensure a sustained improvement on the health outcomes of released individuals living with HIV/AIDS. This would lead to a reduction in the transmission of HIV/AIDS and less use of the emergency department.

Table of Contents

TABLE OF CONTENTS

INTRODUCTION1

LITERATURE REVIEW 5

Introduction 5

Health care Utilization and Emergency Department Use 5

Linkage to HIV Care 8

Substance Abuse 10

Housing/Homelessness 12

Medical Insurance 14

Mental Status 15

Conclusion 16

INTRODUCTION TO MANUSCRIPT 18

Hypothesis 18

METHODS19

Sample and Study Design 19

Study Variables 21

Dependent Variable of Interest 21

Independent Variables of Interest 21

Statistical Analysis 23

RESULTS 25

DISCUSSION 28

Study Strengths and Limitations 30

Conclusion 31

Future Directions 32

REFERENCES33

ILLUSTRATIONS

Figure 1: Participants in the EnhanceLink initiative used for the analysis of predictors

of emergency department use six-month post-incarceration 36

Table 1: Descriptive characteristics for study population among those with complete

and incomplete information (N = 1078) 37

Table 2: Univariate analysis: factors associated with emergency department visit

at the end of the six-month post-incarceration (N = 583) 38

Table 3: Multivariate analysis: factors associated with emergency department visit

at the end of the six-month post-incarceration (N = 583) 39

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	Emergency department Jail Releasees HIV/AIDS
Committee Chair / Thesis Advisor	Spaulding, Anne C, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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