Adherence to HIV treatment and care among previously homeless jail detainees

AIDS Behav. 2013 Oct;17(8):2654-66. doi: 10.1007/s10461-011-0080-2.

Abstract

HIV-infected persons entering the criminal justice system (CJS) often experience suboptimal healthcare system engagement and social instability, including homelessness. We evaluated surveys from a multisite study of 743 HIV-infected jail detainees prescribed or eligible for antiretroviral therapy (ART) to understand correlates of healthcare engagement prior to incarceration, focusing on differences by housing status. Dependent variables of healthcare engagement were: (1) having an HIV provider, (2) taking ART, and (3) being adherent (≥95% of prescribed doses) to ART during the week before incarceration. Homeless subjects, compared to their housed counterparts, were significantly less likely to be engaged in healthcare using any measure. Despite Ryan White funding availability, insurance coverage remains insufficient among those entering jails, and having health insurance was the most significant factor correlated with having an HIV provider and taking ART. Individuals interfacing with the CJS, especially those unstably housed, need innovative interventions to facilitate healthcare access and retention.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Analysis of Variance
  • Anti-HIV Agents / therapeutic use*
  • Cross-Sectional Studies
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology*
  • HIV Infections / psychology
  • Health Services Accessibility / statistics & numerical data
  • Health Services Needs and Demand
  • Healthcare Disparities / statistics & numerical data
  • Humans
  • Ill-Housed Persons* / psychology
  • Ill-Housed Persons* / statistics & numerical data
  • Insurance Coverage
  • Insurance, Health
  • Male
  • Medication Adherence / psychology
  • Medication Adherence / statistics & numerical data*
  • Mental Disorders / epidemiology*
  • Needs Assessment
  • Prisoners / psychology
  • Prisoners / statistics & numerical data*
  • Substance Abuse, Intravenous / epidemiology*
  • Substance Abuse, Intravenous / psychology
  • United States / epidemiology
  • Vulnerable Populations / statistics & numerical data

Substances

  • Anti-HIV Agents