(PS2-7) Examining the Impact of Recent Incarceration on Engagement in HIV Care: a Survival Analysis Approach

Abstract Text:

Introduction: Although incarceration may provide a chance for people living with HIV (PLWH) to receive HIV treatment, there is a notable drop-off in care that happens after release. The current study sought to examine how recent incarceration is associated with structural barriers and the HIV care cascade in a sample of recently incarcerated and never incarcerated PLWH in Miami.

Methods: A sample of 725 participants (97 recently incarcerated, 628 never incarcerated) receiving HIV care at a large public HIV clinic in Miami completed an interviewer-administered survey. HIV viral load and dates of HIV care visits over time since completing the survey were extracted from medical charts. Linear regressions were used to examine the relationship between recent incarceration and experiencing structural barriers (unstable housing, lower education level, and lower health literacy). Then, survival analyses were used to determine whether the time to falling off the HIV care cascade differed based on incarceration history. Lastly, structural barriers and substance use were added to the survival analysis model.

Results: Recent incarceration was associated with a higher likelihood of experiencing unstable housing and having a lower education level, but was not associated with health literacy. Using survival analysis, participants who were recently incarcerated fell out of HIV care over one year (398.05 days) sooner than those without a history of incarceration. Lastly, after the structural barriers and substance use were added to the model, the model remained significant. The structural barrier variables did not significantly contribute to the model; however, substance use was significantly related.

Conclusions: The findings highlight the unique contribution that past-year incarceration contributes to likelihood of falling out of HIV care. The specific reasons for this relationship need further exploration to inform and develop interventions specific for PLWH being released from incarceration. Clinicians addressing psychosocial concerns, like substance use or depression, in the context of recent release from incarceration may need to consider incorporating interventions specific to improving and maintaining engagement in HIV care.