The association of addressing unmet needs and structural barriers with linkage to care among HIV-positive inmates released from jail Open Access

Abstract

Background: HIV/AIDS is overrepresented in the correctional settings, and in recent
years more attention has been given to public health consequences of HIV-positive
inmates released to the community. EnhanceLink is a multi-site demonstration project
designed to develop models of effective community linkage for HIV+ jail releases in jail
settings. Programs emphasize linkage to HIV clinical services as well as ancillary
services such as substance abuse treatment, mental health care, housing, and
employment. This study investigates the association of these non-HIV services with
linkage and retention in care.
Methods: Longitudinal client-level data consisting of interviews and chart reviews have
been collected on all clients. Clients eligible for this study were those who had been
released for at least 5 months and did not prematurely discontinue the program (n=459).
The main outcomes were linkage to care, defined as obtaining at least one CD4 count
post-release, and retention in care, defined as obtaining 2 CD4 counts post-release.
Multivariate logistic regression models were constructed for each outcome using
demographic variables, HIV-related baseline characteristics, and services delivered in
jail and post-release. Services included substance abuse treatment, mental health care,
housing, social services, and assistance with arranging HIV care.
Results: Half of the clients (n=230) were linked to care, and 84% of those linked were
also retained. Delivery of non-HIV medical services in the jail and the community were
associated with lower odds of linkage, while addressing substance abuse treatment at
follow-up increased the odds of linkage. In contrast, services addressing HIV care post-
release were associated with retention. In general, community-based services appeared
to be more influential than jail-based services. Age, gender, and level of education were
also
Conclusions: This exploratory study shows that it is feasible to link and keep inmates in
HIV primary care. Addressing their non-HIV needs appears to be an important factor in
facilitating their engagement in care. Of note, it may be particularly important to
continue intensive case management services post-release when working in the jail
setting, where turnover is high and timing of jail-based interventions may be difficult.

Table of Contents

TABLE OF CONTENTS

Background/Literature Review - Page 1
Methods - Page 14
Results - Page 18
Discussion,limitations,and conclusion - Page 21
Tables - Page 27

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	HIV jail linkage
Committee Chair / Thesis Advisor	Spaulding, Anne C, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Community-based non-profit organization (e.g., AID Atlanta) University, college or educational institution (other than Emory)

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