HIV and substance use are inextricably intertwined. One-sixth of people living with HIV/AIDS (PLWHA) transition through the correctional system annually. There is paucity of evidence on the impact of substance use disorders on HIV treatment engagement among jail detainees. We examined correlates of HIV treatment in the largest sample of PLWHA transitioning through jail in 10 US sites from 2007 to 2011. Cocaine, alcohol, cannabis, and heroin were the most commonly used substances. Drug use severity was negatively and independently correlated with three outcomes just before incarceration: (1) having an HIV care provider (AOR = 0.28; 95 % CI 0.09–0.89); (2) being prescribed antiretroviral therapy (AOR = 0.12; 95 % CI 0.04–0.35) and (3) high levels (>95 %) of antiretroviral medication adherence (AOR = 0.18; 95 % CI 0.05–0.62). Demographic, medical and psychiatric comorbidity, and social factors also contributed to poor outcomes. Evidence-based drug treatments that include multi-faceted interventions, including medication-assisted therapies, are urgently needed to effectively engage this vulnerable population.
Substance abuse Jail Prisoners Engagement in HIV care Antiretroviral therapy Adherence Criminal justice
This is a preview of subscription content, log in to check access.
Funding from this Grant was provided by the Health Resources and Services Agency for the 10-site demonstration and by the National Institutes on Drug Abuse for career development (K24 DA017072) for Frederick L. Altice.
Springer S, Altice F. Improving the care for HIV-infected prisoners: an integrated prison-release health model. In: Greifinger R, editor. Public health behind bars: from prisons to communities. New York: Springer Science; 2007. pp. 535–555.Google Scholar
Altice FL, Kamarulzaman A, Soriano VV, Schechter M, Friedland GH. Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs. Lancet. 2010;376(9738):367–87.PubMedCrossRefGoogle Scholar
Spaulding AC, Seals RM, Page MJ, Brzozowski AK, Rhodes W, Hammett TM. HIV/AIDS among inmates of and releasees from US correctional facilities, 2006: declining share of epidemic but persistent public health opportunity. PLoS One. 2009;4(11):e7558.PubMedCrossRefGoogle Scholar
Flanigan TP, Zaller N, Beckwith CG, et al. Testing for HIV, sexually transmitted infections, and viral hepatitis in jails: still a missed opportunity for public health and HIV prevention. J Acquir Immune Defic Syndr. 2010;55(Suppl 2):S78–83.PubMedCrossRefGoogle Scholar
Bruce RD, Smith-Rohrberg D, Altice FL. Pharmacological treatment of substance abuse in correctional facilities: prospects and barriers to expanding access to evidence-based therapy public health behind bars. In: Greifinger RB, editor. Public health behind bars: from prisons to communities. New York: Springer; 2007. pp. 385–411.Google Scholar
Nunn A, Zaller N, Dickman S, Trimbur C, Nijhawan A, Rich JD. Methadone and buprenorphine prescribing and referral practices in US prison systems: results from a nationwide survey. Drug Alcohol Depend. 2009;105(1–2):83–8.PubMedCrossRefGoogle Scholar
Springer SA, Chen S, Altice FL. Improved HIV and substance abuse treatment outcomes for released HIV-infected prisoners: the impact of buprenorphine treatment. J Urban Health. 2010;87(4):592–602.PubMedCrossRefGoogle Scholar
Oser CB, Knudsen HK, Staton-Tindall M, Taxman F, Leukefeld C. Organizational-level correlates of the provision of detoxification services and medication-based treatments for substance abuse in correctional institutions. Drug Alcohol Depend. 2009;103(Suppl 1):S73–81.PubMedCrossRefGoogle Scholar
Chandler RK, Fletcher BW, Volkow ND. Treating drug abuse and addiction in the criminal justice system: improving public health and safety. JAMA. 2009;301(2):183–90.PubMedCrossRefGoogle Scholar
Abuse CoAaS. Behind bars II: substance abuse and America’s prison population. New York: Columbia University; 2010.Google Scholar
Wood E, Hogg RS, Harrigan PR, Montaner JS. When to initiate antiretroviral therapy in HIV-1-infected adults: a review for clinicians and patients. Lancet Infect Dis. 2005;5(7):407–14.PubMedCrossRefGoogle Scholar
Porter K, Babiker A, Bhaskaran K, Darbyshire J, Pezzotti P, Walker AS. Determinants of survival following HIV-1 seroconversion after the introduction of HAART. Lancet. 2003;362(9392):1267–74.PubMedCrossRefGoogle Scholar
Lucas GM. Substance abuse, adherence with antiretroviral therapy, and clinical outcomes among HIV-infected individuals. Life Sci. 2011;88(21–22):948–52.PubMedCrossRefGoogle Scholar
Springer SA, Pesanti E, Hodges J, Macura T, Doros G, Altice FL. Effectiveness of antiretroviral therapy among HIV-infected prisoners: reincarceration and the lack of sustained benefit after release to the community. Clin Infect Dis. 2004;38(12):1754–60.PubMedCrossRefGoogle Scholar
Azar MM, Springer SA, Meyer JP, Altice FL. A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization. Drug Alcohol Depend. 2010;112(3):178–93.PubMedCrossRefGoogle Scholar
Springer SA, Azar MM, Altice FL. HIV, alcohol dependence, and the criminal justice system: a review and call for evidence-based treatment for released prisoners. Am J Drug Alcohol Abus. 2011;37(1):12–21.CrossRefGoogle Scholar
Altice FL, Bruce RD, Lucas GM, et al. HIV treatment outcomes among HIV-infected, opioid-dependent patients receiving buprenorphine/naloxone treatment within HIV clinical care settings: results from a multisite study. J Acquir Immune Defic Syndr. 2011;56(Suppl 1):S22–32.PubMedCrossRefGoogle Scholar
Lucas GM, Chaudhry A, Hsu J, et al. Clinic-based treatment of opioid-dependent HIV-infected patients versus referral to an opioid treatment program: a randomized trial. Ann Intern Med. 2010;152(11):704–11.PubMedCrossRefGoogle Scholar
Springer SA, Qiu J, Saber-Tehrani AS, Altice FL. Retention on buprenorphine is associated with high levels of maximal viral suppression among HIV-infected opioid dependent released prisoners. PLoS One. 2012;7(5):e38335.PubMedCrossRefGoogle Scholar
Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793–800.PubMedCrossRefGoogle Scholar
Draine J, Ahuja D, Altice FL, et al. Strategies to enhance linkages between care for HIV/AIDS in jail and community settings. AIDS Care. 2011;23(3):366–77.PubMedCrossRefGoogle Scholar
Krishnan A, Wickersham J, Chitsaz E, et al. Post-release substance abuse outcomes among HIV-infected jail detainees: results from a multisite study. AIDS Behav. 2012;2012(11/01):1–10.Google Scholar
Gelberg L, Andersen RM, Leake BD. The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people. Health Serv Res. 2000;34(6):1273–302.PubMedGoogle Scholar
Chen NE, Meyer JP, Avery AK, et al. Adherence to HIV treatment and care among previously homeless jail detainees. AIDS Behav. 2011. doi:10.1007/s10461-011-0080-2.
McLellan AT, Kushner H, Metzger D, et al. The fifth edition of the addiction severity index. J Subst Abus Treat. 1992;9(3):199–213.CrossRefGoogle Scholar
Stephenson BL, Wohl DA, McKaig R, et al. Sexual behaviours of HIV-seropositive men and women following release from prison. Int J STD AIDS. 2006;17(2):103–8.PubMedCrossRefGoogle Scholar
Springer SA, Spaulding AC, Meyer JP, Altice FL. Public health implications for adequate transitional care for HIV-infected prisoners: five essential components. Clin Infect Dis. 2011;53(5):469–79.PubMedCrossRefGoogle Scholar