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Randomized Controlled Trial
. 2017 May 1;75(1):81-90.
doi: 10.1097/QAI.0000000000001337.

Randomized Controlled Trial of an Intervention to Maintain Suppression of HIV Viremia After Prison Release: The imPACT Trial

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Free PMC article
Randomized Controlled Trial

Randomized Controlled Trial of an Intervention to Maintain Suppression of HIV Viremia After Prison Release: The imPACT Trial

David A Wohl et al. J Acquir Immune Defic Syndr. .
Free PMC article

Abstract

Background: HIV-infected individuals transitioning from incarceration to the community are at risk for loss of viral suppression. We compared the effects of imPACT, a multidimensional intervention to promote care engagement after release, to standard care on sustaining viral suppression after community re-entry.

Methods: This trial randomized 405 HIV-infected inmates being released from prisons in Texas and North Carolina with HIV-1 RNA levels <400 copies/mL to imPACT versus standard care. The imPACT arm received motivational interviewing prerelease and postrelease, referral to care within 5 days of release, and a cellphone for medication text reminders. The standard care arm received routine discharge planning and a cellphone for study staff contact. The primary outcome was the difference between arms in week 24 postrelease viral suppression (HIV-1 RNA <50 copies/mL) using intention-to-treat analysis with multiple imputation of missing data.

Results: The proportion with 24-week HIV-1 RNA <50 copies/mL was 60% and 61% in the imPACT and standard care arms, respectively [odds ratio for suppression 0.95 (95% confidence interval: 0.59 to 1.53)]. By week 6 postrelease, 86% in the imPACT arm versus 75% in the standard care arm attended at least 1 nonemergency clinic visit (P = 0.02). At week 24, 62% in both arms reported not missing any antiretroviral doses in the past 30 days (P > 0.99).

Conclusions: Higher rates of HIV suppression and medical care engagement than expected based on previous literature were observed among HIV-infected patients with suppressed viremia released from prison. Randomization to a comprehensive intervention to motivate and facilitate HIV care access after prison release did not prevent loss of viral suppression. A better understanding of the factors influencing prison releasees' linkage to community care, medication adherence, and maintenance of viral suppression is needed to inform policy and other strategic approaches to HIV prevention and treatment.

Conflict of interest statement

Conflicts: None

Figures

Figure 1
Figure 1
Screening, Enrollment and Follow-up. *Includes 3 participants who completed week 24 but for whom plasma HIV RNA was unable to be performed.
Figure 2
Figure 2
HIV RNA During Follow-up Between Groups, According to (A) Complete Case and (B) Multiple Imputation for Missing Data.
Figure 3
Figure 3
Timeline of events for intervention and control study arms.

Comment in

  • Reply.
    Wohl DA, Golin CE, Napravnik S, Knight K, Flynn PM. Wohl DA, et al. J Acquir Immune Defic Syndr. 2017 Sep 1;76(1):e21-e22. doi: 10.1097/QAI.0000000000001457. J Acquir Immune Defic Syndr. 2017. PMID: 28796096 Free PMC article. No abstract available.
  • Censoring of HIV Viremia Data of Reincarcerated Individuals: A Response to Wohl et al.
    Drobeniuc AM, Spaulding A. Drobeniuc AM, et al. J Acquir Immune Defic Syndr. 2017 Sep 1;76(1):e22-e23. doi: 10.1097/QAI.0000000000001465. J Acquir Immune Defic Syndr. 2017. PMID: 28797025 Free PMC article. No abstract available.

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