Within 30 days of their release from prison, around 80 percent of HIV-infected inmates in Texas did not fill a first prescription for antiretroviral treatment. According to a study in the February 25 issue of JAMA, the pause in the treatment could have dangerous health consequences.
The authors write: “The U.S. prison system has become an important front in the effort to treat and control the spread of human immunodeficiency virus (HIV) infection, serving as the principal screening and treatment venue for thousands of individuals with or at high risk for HIV infection who have limited access to community-based health care. Many inmates are offered HIV testing for the first time while incarcerated, and three-quarters of inmates with HIV infection initiate treatment during incarceration.”
Suitable medical help to antiretroviral therapy (ART) is a challenge, since most former inmates do not have private or public health insurance in the early months after their liberation. The authors say, “Those who discontinue ART at this time are at increased risk of developing a higher viral burden, resulting in greater infectiousness and higher levels of drug resistance, potentially creating reservoirs of drug-resistant HIV in the general community.” There is no information on the degree to which HIV-infected inmates experience a break in ART following release.
A study in the nation’s major state penitentiary system was conducted by Jacques Baillargeon, Ph.D., University Of Texas Medical Branch, Galveston, and team. The research evaluated the percentage of HIV-infected inmates who filled a prescription for ART medication in the two months after their release from detention. Between January 2004 and December 2007, all of the 2,115 HIV-infected inmates released from the Texas Department of Criminal Justice prison System who were receiving ART prior to their release, were included in the study.
A first ART prescription was filled by 5.4 percent (115) of the former inmates within ten days of release, by 17.7 percent (375) within one month, and by 30 percent (634) within two months, in the entire study group. One of the findings was that non-Hispanic whites were more likely to fill a prescription within ten and thirty days compared to Hispanic and African American inmates. Ex-prisoners with an undetectable viral load had a higher probability of filling a prescription than those with a detectable viral load at release. Within the first two months, inmates released on parole were more likely to fill a prescription than inmates with a regular, unsupervised release. Ex-prisoners receiving formal aid in completing an AIDS Drug Assistance Program application had a higher probability of filling a prescription than inmates with no assistance.
The authors write, “In this 4-year study of HIV-infected inmates released from the nation’s largest state prison system, we found that only 5 percent of released inmates filled a prescription for ART medications soon enough (i.e., within 10 days after release) to avoid treatment interruption.” A pause in treatment was experienced in a least 90 percent of the inmates, in all the subgroups examined. The treatment interruption lasted at least a month for more than 70 percent, and at least two months for more than 60 percent.
“These exceedingly high rates of treatment interruption suggest that most inmates face significant administrative, socioeconomic, or personal barriers to accessing ART when they return to their communities. Future prospective and in-depth qualitative studies are needed to more rigorously examine these barriers. Adequately addressing a public health crisis of this scale and complexity will require carefully coordinated efforts between academic institutions, the criminal justice system, and public health agencies,” the authors write. “In particular, greater coordination between state and local agencies, health care institutions, and community-based organizations is needed to reduce this high rate of treatment interruption among newly released inmates.”
JAMA. 301[8]:848-857
Written by Stephanie Brunner (B.A.)