Antiretroviral Adherence Following Prison Release in a Randomized Trial of the imPACT Intervention to Maintain Suppression of HIV Viremia

  • Bethany L. DiPreteEmail author
  • Brian W. Pence
  • Carol E. Golin
  • Kevin Knight
  • Patrick M. Flynn
  • Jessica Carda-Auten
  • Jennifer S. Groves
  • Kimberly A. Powers
  • Becky L. White
  • Sonia Napravnik
  • David A. Wohl
Original Paper


Many people living with HIV (PLWH) pass through correctional facilities each year, a large proportion of whom do not maintain viral suppression following release. We examined the effects of imPACT, an intervention designed to promote post-release viral suppression, on antiretroviral therapy (ART) adherence. PLWH awaiting release from prisons in two southern states were randomized to imPACT (consisting of motivational interviewing, care linkage coordination, and text message medication reminders) versus standard care (SC). ART adherence, measured by unannounced monthly telephone pill counts, was compared between study arms over 6 months post-release. Of 381 participants eligible for post-release follow-up, 302 (79%) completed ≥ 1 of 6 possible pill counts (median: 4; IQR 1–6). Average adherence over follow-up was 80.3% (95% CI 77.5, 83.1) and 81.0% (78.3, 83.6) of expected doses taken in the imPACT and SC arms, respectively. There was no difference between arms when accounting for missing data using multiple imputation (mean difference = − 0.2 percentage points [− 3.7, 3.3]), controlling for study site and week of follow-up. Of the 936 (40.9%) pill counts that were missed, 212 (22.7%) were due to re-incarceration. Those who missed pill counts for any reason were more likely to be unsuppressed, suggesting that they had lower adherence. However, missingness was balanced between arms. Among PLWH released from prison, ART adherence averaged > 80% in both study arms over 6 months—a level higher than seen with most other chronic diseases. However, missing data may have led to an overestimate of adherence. Factors independent of the intervention influence ART adherence in this population and should be identified to inform future targeted interventions.


HIV infection ART adherence Prisons Medication adherence Telephone pill counts 



All authors take responsibility for and approve the final version of the manuscript. We thank the National Institute of Drug Abuse (NIDA) at the National Institutes of Health (NIH) (R01-DA030793), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K24-DA037101; K24-HD06920), the University of North Carolina Center for AIDS Research (CFAR) (P30 AI-50410), and the National Institute of Allergy and Infectious Diseases (NIAID) at the NIH (T32-AI007001) for their support of this work. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health.

Authors Contribution

CEG, KK, PMF, and DAW contributed to acquisition of the data. JSG assisted with data management. BWP, CEG, SN and DAW conceived of the analysis. BLD and BWP designed and completed the analysis. BLD drafted the manuscript. BWP, CEG, KK, PMF, JCA, JSG, KAP, BLW, SN, and DAW assisted with the interpretation of the data and critically revised the manuscript for important intellectual content. The authors thank the TDCJ (including Allyson Glass, Scott Edmiston, Valla Kirby-Brossman; Frances Gattis; April Scott; Courtney Ross; Mandy Vance) and the NCDPS (including Paula Smith, Pamela Gibbs), particularly the discharge planning and clinic staff, as well as the participants for their generous contribution. We also thank the trial research staff including: UNC - Lisa McKeithan, Steve Bradley-Bull, Kemi Amola, Lynn Tillery, Makisha Ruffin, Angela Edwards, Katesha Peele, Neeve Neevel, Madeline McCrary, Elizabeth Roberts, Erika Hallback, and Sayaka Hino; TCU - Roxanne Muiruri, Molly McFatrich, Julie Gray, Scott Edmiston, Allyson Glass, Courtney Ross, Mandy Vance, Valla Kirby-Brossman, Elizabeth Larios, Laurence Misedah, and Bethany Evans.


This research was supported by funding from the National Institute of Drug Abuse (NIDA) at the National Institutes of Health (NIH) (R01-DA030793) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K24-DA037101; K24-HD06920). Additional support was provided by the University of North Carolina Center for AIDS Research (CFAR) (P30 AI-50410) and the National Institute of Allergy and Infectious Diseases (NIAID) at the NIH (T32-AI007001). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health.

Compliance with Ethical Standards

Conflicts of interest

The authors have no conflicts of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10461_2019_2488_MOESM1_ESM.docx (14 kb)
Electronic supplementary material 1 (DOCX 14 kb)
10461_2019_2488_MOESM2_ESM.docx (14 kb)
Electronic supplementary material 2 (DOCX 14 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Bethany L. DiPrete
    • 1
    Email author
  • Brian W. Pence
    • 1
  • Carol E. Golin
    • 2
  • Kevin Knight
    • 3
  • Patrick M. Flynn
    • 3
  • Jessica Carda-Auten
    • 4
  • Jennifer S. Groves
    • 5
  • Kimberly A. Powers
    • 1
  • Becky L. White
    • 4
  • Sonia Napravnik
    • 1
    • 4
  • David A. Wohl
    • 4
  1. 1.Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of Health BehaviorUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.The Institute of Behavioral ResearchTexas Christian UniversityFort WorthUSA
  4. 4.The Institute for Global Health and Infectious DiseasesThe University of North Carolina at Chapel HillChapel HillUSA
  5. 5.The Cecil G. Sheps Center for Health Services ResearchThe University of North Carolina at Chapel HillChapel HillUSA

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