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Emergency Department Use among HIV-Infected Released Jail Detainees

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Abstract

Release from short-term jail detention is highly destabilizing, associated with relapse to substance use, recidivism, and disrupted health care continuity. Little is known about emergency department (ED) use, potentially a surrogate for medical, psychiatric, or social instability, by people living with HIV/AIDS (PLWHA) leaving jails. All ED visits were reviewed from medical records for a cohort of 109 PLHWA in the year following release from county jail in Connecticut, between January 1, 2008 and December 31, 2010. Primary outcomes were frequency and timing of ED visits, modeled using multivariate negative binomial regression and Cox proportional hazards regression, respectively. Demographic, substance use, and psychiatric disorder severity factors were evaluated as potential covariates. Overall, 71 (65.1 %) of the 109 participants made 300 unique ED visits (2.75 visits/person-year) in the year following jail-release. Frequency of ED use was positively associated with female sex (incidence rate ratios, IRR 2.40 [1.36–4.35]), homelessness (IRR 2.22 [1.15–4.41]), and recent substance use (IRR 2.47 [1.33–4.64]), and inversely associated with lifetime drug severity (IRR 0.01 [0–0.10]), and being retained in HIV primary care (IRR 0.80 [0.65–0.99]). Those in late or sustained HIV care used the ED sooner than those not retained in HIV primary care (median for late retention 16.3 days, median for sustained retention 24.9 days, median for no retention not reached at 12 months, p value 0.004). Using multivariate modeling, those who used the ED earliest upon release were more likely to be homeless (HR 1.98 [1.02–3.84]), to be retained in HIV care (HR 1.30 [1.04–1.61]), and to have recently used drugs (HR 2.51 [1.30–4.87]), yet had a low lifetime drug severity (HR 0.01 [0.00–0.14]). Among PLWHA released from jail, frequency of ED use is high, often soon after release, and is associated with social and drug-related destabilizing factors. Future interventions for this specific population should focus on addressing these resource gaps, ensuring housing, and establishing immediate linkage to HIV primary care after release from jail.

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Acknowledgments

We would like to thank Ruthanne Marcus for logistical assistance and Maua Herme for data management, as well as Sasha Klein for data collection. We also thank study participants, without whom this work would not be possible. Enhancing Linkages to HIV Primary Care Services Initiative was a HRSA-funded Special Project of National Significance. Funding for this research was also provided through career development grants from the National Institute on Drug Abuse (K24 DA017072, FLA; and K23 DA033858 for JPM). The funding sources played no role in study design, data collection, analysis, or interpretation, writing of the manuscript, or the decision to submit the paper for publication.

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  1. AIDS Program, Yale School of Medicine, New Haven, CT, USA

    Andrew T. Boyd, Dahye L. Song, Jaimie P. Meyer & Frederick L. Altice

  2. Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA

    Jaimie P. Meyer

  3. Epidemiology of Microbial Diseases, Yale School of Public Health, 135 College Street, Suite 323, New Haven, CT, 06510-2283, USA

    Frederick L. Altice

  4. Department of Medicine, Section of Hospital Medicine, Columbia University Medical Center, 8 South Knuckle, Suite 8-004, 177 Fort Washington Ave, New York, NY, 10032, USA

    Andrew T. Boyd

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Boyd, A.T., Song, D.L., Meyer, J.P. et al. Emergency Department Use among HIV-Infected Released Jail Detainees. J Urban Health 92, 108–135 (2015). https://doi.org/10.1007/s11524-014-9905-4

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