Two Paths, One Transition: A Comparative Analysis of Linkage to ART vs. PrEP Among Justice-Involved Individuals with Substance Use Disorders in Metro Atlanta Restricted; Files Only
Rahman, Kashfia (Spring 2026)
Abstract
Justice-involved populations experience a disproportionate burden of HIV risk and face persistent barriers to engaging in both prevention and care, particularly during the transition from incarceration to the community. While status-neutral approaches aim to integrate HIV prevention and treatment within a unified framework, less is known about how individuals at different points along the HIV continuum differ in their capacity to engage with these services. In particular, differences in adherence self-efficacy between people living with HIV (PLWH) and people at high risk of HIV seroconversion (PHRS) may shape engagement with care and prevention in distinct ways, yet remain underexplored within reentry settings.
This study utilized cross-sectional baseline data from the SHARE (Substance use and HIV Action for Reentry and Engagement) study, a status-neutral intervention conducted among individuals transitioning from incarceration in metro Atlanta. The analytic sample included 92 participants with complete data on HIV status, self-efficacy, and key covariates. adherence self-efficacy was measured using a validated scale, and sociodemographic, behavioral, and psychosocial factors were assessed through structured survey instruments. Multivariable linear regression models were used to identify factors associated with self-efficacy, adjusting for housing instability, depressive symptoms (PHQ-9), and polysubstance use.
PLWH demonstrated substantially higher adherence self-efficacy compared to PHRS (β=3.38, 95% CI: 2.05, 4.71). Other factors, including housing instability (β=0.34, 95% CI: -1.01, 1.69), depressive symptoms (β=0.06, 95% CI: -0.03, 0.14), and polysubstance use (β=0.00, p=0.96), were not significantly associated with self-efficacy after adjustment. Descriptively, the sample was characterized by high levels of structural vulnerability, including housing instability (62.8%) and material hardship (71.1%), as well as substantial prevalence of recent substance use. Despite these shared challenges, differences in self-efficacy remained strongly patterned by HIV status.
These findings highlight important gaps in HIV prevention engagement among persons at risk of HIV seroconversion within reentry settings. While PLWH may develop self-efficacy through sustained interaction with care systems, PHRS may lack comparable exposure to prevention resources and support. Interventions that strengthen prevention-specific self-efficacy, particularly through integrated peer navigation and expanded access to long-acting prevention modalities, may help address these disparities. This thesis underscores the importance of tailoring status-neutral approaches to account for differences in readiness, experience, and structural context across the HIV continuum.
Table of Contents
Table of Contents
Chapter 1. Literature Review
1.1 Introduction
1.2 HIV and Mass Incarceration in the United States
1.3 HIV Risk and Care Disruption During Reentry
1.4 Substance Use Disorder and HIV Vulnerability
1.5 HIV Prevention and the Status-Neutral Framework
1.6 Reentry Interventions and Peer Navigation
1.7 Stigma, Structural Vulnerability, and Risk Environments
1.8 An Exploratory Investigation of Self-Efficacy Measurement
1.9 Gaps in the Literature
Chapter 2. Methods
2.1 Study Aims
2.2 Methods
2.3 Statistical Analysis
Chapter 3. Results
3.1 Baseline Characteristics
3.2 Multivariable Linear Regression Models
Chapter 4. Discussion
4.1 Main Findings
4.2 Strengths and Limitations
4.3 Public Health Implications
4.4 Conclusion
References
About this Master's Thesis
| School | |
|---|---|
| Department | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| Keyword | |
| Committee Chair / Thesis Advisor |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
File download under embargo until 21 May 2028 | 2026-04-22 22:12:31 -0400 | File download under embargo until 21 May 2028 |
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|