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Adherence to HIV Treatment and Care Among Previously Homeless Jail Detainees

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Abstract

HIV-infected persons entering the criminal justice system (CJS) often experience suboptimal healthcare system engagement and social instability, including homelessness. We evaluated surveys from a multisite study of 743 HIV-infected jail detainees prescribed or eligible for antiretroviral therapy (ART) to understand correlates of healthcare engagement prior to incarceration, focusing on differences by housing status. Dependent variables of healthcare engagement were: (1) having an HIV provider, (2) taking ART, and (3) being adherent (≥95% of prescribed doses) to ART during the week before incarceration. Homeless subjects, compared to their housed counterparts, were significantly less likely to be engaged in healthcare using any measure. Despite Ryan White funding availability, insurance coverage remains insufficient among those entering jails, and having health insurance was the most significant factor correlated with having an HIV provider and taking ART. Individuals interfacing with the CJS, especially those unstably housed, need innovative interventions to facilitate healthcare access and retention.

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Acknowledgments

Enhancing Linkages to HIV Primary Care Services Initiative is 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 (K23 DA019381, SAS; K24 DA017072, FLA; R01-DA027204, JD; R01DA028692-02S1, NEC), research grants from the National Institute on Alcohol Abuse and Alcoholism (R01 AA018944, SAS & FLA), and National Institute of Mental Health (R01-MH076068, JD), and an institutional research training grant from the NIMH (T32 MH020031, JPM). The funding sources played no role in study design, data collection, data analysis, data interpretation, writing of the manuscript or the decision to submit the paper for publication.

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Chen, N.E., Meyer, J.P., Avery, A.K. et al. Adherence to HIV Treatment and Care Among Previously Homeless Jail Detainees. AIDS Behav 17, 2654–2666 (2013). https://doi.org/10.1007/s10461-011-0080-2

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